Clinical characteristics of patients with asthma COPD overlap (ACO) in australian primary care

Gabriel Izbicki, Valerie Teo, Jenifer Liang, Grant M. Russell, Anne E. Holland, Nicholas A. Zwar, Billie Bonevski, Ajay Mahal, Paula Eustace, Eldho Paul, Kirsten Phillips, Sally Wilson, Johnson George, Michael J. Abramson*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Purpose: Many older adults with a history of smoking and asthma develop clinical features of both asthma and COPD, an entity sometimes called asthma-COPD overlap (ACO). Patients with ACO may be at higher risk of poor health outcomes than those with asthma or COPD alone. However, understanding of ACO is limited in the primary care setting and more information is needed to better inform patient management. We aimed to compare the characteristics of patients with ACO or COPD in Australian general practices. Patients and methods: Data were from the RADICALS (Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers) trial, an intervention study of an interdisciplinary community-based model of care. Baseline demographic and clinical characteristics, pre-and post-bronchodilator spirometry, dyspnoea and St. George’s Respiratory Questionnaire scores were compared between 60 ACO patients and 212 with COPD alone. Results: Pre-bronchodilator Forced Expiratory Volume in 1 second (mean±SD 58.4±14.3 vs 67.5±20.1% predicted) and Forced Vital Capacity (mean 82.1±16.9 v 91.9±17.2% predicted) were significantly lower in the ACO group (p<0.001), but no difference was found in post-bronchodilator spirometry. Demographic and clinical characteristics, dyspnoea, quality of life, comorbidities and treatment prescribed did not differ significantly between groups. Conclusion: This is the first study describing the clinical characteristics of ACO patients in Australian general practices. Our finding of lower pre-bronchodilator lung function in the ACO group compared to those with COPD reinforces the importance of spirometry in primary care to inform management. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.

Original languageEnglish
Pages (from-to)2745-2752
Number of pages8
JournalInternational Journal of COPD
Volume14
DOIs
Publication statusPublished - 3 Dec 2019
Externally publishedYes

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Chronic Obstructive Pulmonary Disease
Primary Health Care
Asthma
Bronchodilator Agents
Spirometry
General Practice
Dyspnea
Interdisciplinary Studies
Demography
Vital Capacity
Forced Expiratory Volume
Long-Term Care
New Zealand
Registries
Comorbidity
Smoking
Quality of Life
Clinical Trials
Lung

Cite this

Izbicki, Gabriel ; Teo, Valerie ; Liang, Jenifer ; Russell, Grant M. ; Holland, Anne E. ; Zwar, Nicholas A. ; Bonevski, Billie ; Mahal, Ajay ; Eustace, Paula ; Paul, Eldho ; Phillips, Kirsten ; Wilson, Sally ; George, Johnson ; Abramson, Michael J. / Clinical characteristics of patients with asthma COPD overlap (ACO) in australian primary care. In: International Journal of COPD. 2019 ; Vol. 14. pp. 2745-2752.
@article{3d47d486e17a4673bc768ed993303bc4,
title = "Clinical characteristics of patients with asthma COPD overlap (ACO) in australian primary care",
abstract = "Purpose: Many older adults with a history of smoking and asthma develop clinical features of both asthma and COPD, an entity sometimes called asthma-COPD overlap (ACO). Patients with ACO may be at higher risk of poor health outcomes than those with asthma or COPD alone. However, understanding of ACO is limited in the primary care setting and more information is needed to better inform patient management. We aimed to compare the characteristics of patients with ACO or COPD in Australian general practices. Patients and methods: Data were from the RADICALS (Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers) trial, an intervention study of an interdisciplinary community-based model of care. Baseline demographic and clinical characteristics, pre-and post-bronchodilator spirometry, dyspnoea and St. George’s Respiratory Questionnaire scores were compared between 60 ACO patients and 212 with COPD alone. Results: Pre-bronchodilator Forced Expiratory Volume in 1 second (mean±SD 58.4±14.3 vs 67.5±20.1{\%} predicted) and Forced Vital Capacity (mean 82.1±16.9 v 91.9±17.2{\%} predicted) were significantly lower in the ACO group (p<0.001), but no difference was found in post-bronchodilator spirometry. Demographic and clinical characteristics, dyspnoea, quality of life, comorbidities and treatment prescribed did not differ significantly between groups. Conclusion: This is the first study describing the clinical characteristics of ACO patients in Australian general practices. Our finding of lower pre-bronchodilator lung function in the ACO group compared to those with COPD reinforces the importance of spirometry in primary care to inform management. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.",
author = "Gabriel Izbicki and Valerie Teo and Jenifer Liang and Russell, {Grant M.} and Holland, {Anne E.} and Zwar, {Nicholas A.} and Billie Bonevski and Ajay Mahal and Paula Eustace and Eldho Paul and Kirsten Phillips and Sally Wilson and Johnson George and Abramson, {Michael J.}",
year = "2019",
month = "12",
day = "3",
doi = "10.2147/COPD.S220346",
language = "English",
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Izbicki, G, Teo, V, Liang, J, Russell, GM, Holland, AE, Zwar, NA, Bonevski, B, Mahal, A, Eustace, P, Paul, E, Phillips, K, Wilson, S, George, J & Abramson, MJ 2019, 'Clinical characteristics of patients with asthma COPD overlap (ACO) in australian primary care', International Journal of COPD, vol. 14, pp. 2745-2752. https://doi.org/10.2147/COPD.S220346

Clinical characteristics of patients with asthma COPD overlap (ACO) in australian primary care. / Izbicki, Gabriel; Teo, Valerie; Liang, Jenifer; Russell, Grant M.; Holland, Anne E.; Zwar, Nicholas A.; Bonevski, Billie; Mahal, Ajay; Eustace, Paula; Paul, Eldho; Phillips, Kirsten; Wilson, Sally; George, Johnson; Abramson, Michael J.

In: International Journal of COPD, Vol. 14, 03.12.2019, p. 2745-2752.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Clinical characteristics of patients with asthma COPD overlap (ACO) in australian primary care

AU - Izbicki, Gabriel

AU - Teo, Valerie

AU - Liang, Jenifer

AU - Russell, Grant M.

AU - Holland, Anne E.

AU - Zwar, Nicholas A.

AU - Bonevski, Billie

AU - Mahal, Ajay

AU - Eustace, Paula

AU - Paul, Eldho

AU - Phillips, Kirsten

AU - Wilson, Sally

AU - George, Johnson

AU - Abramson, Michael J.

PY - 2019/12/3

Y1 - 2019/12/3

N2 - Purpose: Many older adults with a history of smoking and asthma develop clinical features of both asthma and COPD, an entity sometimes called asthma-COPD overlap (ACO). Patients with ACO may be at higher risk of poor health outcomes than those with asthma or COPD alone. However, understanding of ACO is limited in the primary care setting and more information is needed to better inform patient management. We aimed to compare the characteristics of patients with ACO or COPD in Australian general practices. Patients and methods: Data were from the RADICALS (Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers) trial, an intervention study of an interdisciplinary community-based model of care. Baseline demographic and clinical characteristics, pre-and post-bronchodilator spirometry, dyspnoea and St. George’s Respiratory Questionnaire scores were compared between 60 ACO patients and 212 with COPD alone. Results: Pre-bronchodilator Forced Expiratory Volume in 1 second (mean±SD 58.4±14.3 vs 67.5±20.1% predicted) and Forced Vital Capacity (mean 82.1±16.9 v 91.9±17.2% predicted) were significantly lower in the ACO group (p<0.001), but no difference was found in post-bronchodilator spirometry. Demographic and clinical characteristics, dyspnoea, quality of life, comorbidities and treatment prescribed did not differ significantly between groups. Conclusion: This is the first study describing the clinical characteristics of ACO patients in Australian general practices. Our finding of lower pre-bronchodilator lung function in the ACO group compared to those with COPD reinforces the importance of spirometry in primary care to inform management. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.

AB - Purpose: Many older adults with a history of smoking and asthma develop clinical features of both asthma and COPD, an entity sometimes called asthma-COPD overlap (ACO). Patients with ACO may be at higher risk of poor health outcomes than those with asthma or COPD alone. However, understanding of ACO is limited in the primary care setting and more information is needed to better inform patient management. We aimed to compare the characteristics of patients with ACO or COPD in Australian general practices. Patients and methods: Data were from the RADICALS (Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers) trial, an intervention study of an interdisciplinary community-based model of care. Baseline demographic and clinical characteristics, pre-and post-bronchodilator spirometry, dyspnoea and St. George’s Respiratory Questionnaire scores were compared between 60 ACO patients and 212 with COPD alone. Results: Pre-bronchodilator Forced Expiratory Volume in 1 second (mean±SD 58.4±14.3 vs 67.5±20.1% predicted) and Forced Vital Capacity (mean 82.1±16.9 v 91.9±17.2% predicted) were significantly lower in the ACO group (p<0.001), but no difference was found in post-bronchodilator spirometry. Demographic and clinical characteristics, dyspnoea, quality of life, comorbidities and treatment prescribed did not differ significantly between groups. Conclusion: This is the first study describing the clinical characteristics of ACO patients in Australian general practices. Our finding of lower pre-bronchodilator lung function in the ACO group compared to those with COPD reinforces the importance of spirometry in primary care to inform management. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.

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U2 - 10.2147/COPD.S220346

DO - 10.2147/COPD.S220346

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VL - 14

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EP - 2752

JO - International Journal of COPD

JF - International Journal of COPD

SN - 1176-9106

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