Treatment trends in patients with asthma–COPD overlap syndrome in a COPD cohort: findings from a real-world survey

Abstract

Background

Asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is an increasingly recognized phenotype. Few randomized clinical trials have been conducted in patients with ACOS; therefore, scientific evidence concerning ACOS is scarce and a therapeutic approach remains unclear. The aim of this study was to evaluate current treatment trends for patients with ACOS, identified as those with a dual definition of asthma and COPD, in a real-world COPD cohort.

Methods

Data were analyzed from patients with asthma and COPD in the USA, France, Germany, Italy, Spain, and the UK who participated in the 2012 and 2013 Adelphi Respiratory Disease Specific Programmes (DSPs). Patients with ACOS were identified in the COPD population; these patients had a physician-confirmed, concomitant asthma diagnosis. Physicians completed a patient record form providing information on patient and disease characteristics including prescribed respiratory treatment. Pairwise comparisons were made between the ACOS, asthma, and COPD populations using χ² tests.

Results

In total, 9,042 patients with asthma-only, 7,119 patients with COPD-only, and 523 patients with ACOS (a dual diagnosis of asthma and COPD) participated in the study. The most commonly prescribed regimens were inhaled corticosteroid/long-acting β₂-agonist (ICS/LABA) + long-acting muscarinic antagonist (LAMA); (ACOS 30%, asthma 1.4%, and COPD 32%), ICS/LABA (19%, 41.5%, and 17%, respectively), and LAMA (6%, 0.4%, and 19%, respectively); 18% of patients with ACOS were not prescribed an ICS. Patients with ACOS had a significantly higher incidence of gastroesophageal reflux disease, diabetes, and obesity and experienced more exacerbations in the past year than those with COPD or asthma.

Conclusions

The majority of patients with ACOS, as defined in this research, were prescribed similar treatment to those with COPD. There is a need, however, for better treatment for patients with ACOS, as indicated by symptoms and exacerbation levels. A clearer therapeutic approach for patients with ACOS is required.

Keywords:

• asthma–COPD overlap syndrome
• asthma
• chronic obstructive pulmonary disease
• ACO
• pharmacotherapy

Supplementary material

Table S1 Patient baseline characteristics according to region

Acknowledgments

This study was supported by AstraZeneca. Medical writing support was provided by Deirdre Carman of Alispera Communications Ltd, funded by AstraZeneca. The authors wish to thank Nicola Johns, a former employee of Adelphi Real World, who provided analytical support and prepared the study report.

Disclosure

BD is an employee of AstraZeneca. MS is an employee of Adelphi Real World. The authors report no other conflicts of interest in this work.