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Original Research: Asthma |

Increased Risk of Exacerbation and Hospitalization in Subjects With an Overlap PhenotypeOverlap COPD-Asthma: COPD-Asthma

Ana Maria B. Menezes, MD; Maria Montes de Oca, MD; Rogelio Pérez-Padilla, MD; Gilbert Nadeau, BSc; Fernando César Wehrmeister, PhD; Maria Victorina Lopez-Varela, MD; Adriana Muiño, MD; José Roberto B. Jardim, MD; Gonzalo Valdivia, MD; Carlos Tálamo, MD, FCCP; for the PLATINO Team*
Author and Funding Information

From the Postgraduate Program in Epidemiology (Drs Menezes and Wehrmeister), Federal University of Pelotas, Pelotas, Brazil; the Facultad de Medicina (Drs Montes de Oca and Tálamo), Universidad Central de Venezuela, Caracas, Venezuela; the Sleep Clinic and Pulmonary Physiology (Dr Pérez-Padilla), National Institute of Respiratory Diseases, Mexico City, Mexico; GlaxoSmithKline (Mr Nadeau), London, England; the Facultad de Medicina (Dr Lopez-Varela), Universidad de la Republica, Montevideo, Uruguay; the Centro Hospitalario Pereira Rossell (Dr Muiño), Montevideo, Uruguay; the Federal University of São Paulo (Dr Jardim), São Paulo, Brazil; and the Pontificia Universidad Católica de Chile (Dr Valdivia), Santiago de Chile, Chile.

Correspondence to: Ana Maria B. Menezes, MD, Federal University of Pelotas, Rua Mal. Deodoro, 1160, 3° piso, 96020-220, Brazil; e-mail: anamene@terra.com.br

*

A complete list of PLATINO team participants is located in e-Appendix 1.


Funding/Support: The PLATINO study was funded by Boehringer Ingelheim GmbH; GlaxoSmithKline supported the analysis presented in this paper.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(2):297-304. doi:10.1378/chest.13-0622
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Background:  Several COPD phenotypes have been described; the COPD-asthma overlap is one of the most recognized. The aim of this study was to evaluate the prevalence of three subgroups (asthma, COPD, and COPD-asthma overlap) in the Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) study population, to describe their main characteristics, and to determine the association of the COPD-asthma overlap group with exacerbations, hospitalizations, limitations due to physical health, and perception of general health status (GHS).

Methods:  The PLATINO study is a multicenter population-based survey carried out in five Latin American cities. Outcomes were self-reported exacerbations (defined by deterioration of breathing symptoms that affected usual daily activities or caused missed work), hospitalizations due to exacerbations, physical health limitations, and patients’ perception of their GHS obtained by questionnaire. Subjects were classified in three specific groups: COPD—a postbronchodilator (post-BD) FEV1/FVC ratio of < 0.70; asthma—presence of wheezing in the last year and a minimum post-BD increase in FEV1 or FVC of 12% and 200 mL; and overlap COPD-asthma—the combination of the two.

Results:  Out of 5,044 subjects, 767 were classified as having COPD (12%), asthma (1.7%), and COPD-asthma overlap (1.8%). Subjects with COPD-asthma overlap had more respiratory symptoms, had worse lung function, used more respiratory medication, had more hospitalization and exacerbations, and had worse GHS. After adjusting for confounders, the COPD-asthma overlap was associated with higher risks for exacerbations (prevalence ratio [PR], 2.11; 95% CI, 1.08-4.12), hospitalizations (PR, 4.11; 95% CI, 1.45-11.67), and worse GHS (PR, 1.47; 95% CI, 1.18-1.85) compared with those with COPD.

Conclusions:  The coexisting COPD-asthma phenotype is possibly associated with increased disease severity.

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