Heterogeneity within and between physician-diagnosed asthma and/or COPD: NOVELTY cohort. Issue 3 (23rd September 2021)

• Record Type: Journal Article
• Authors: Reddel, Helen K.; Vestbo, Jørgen; Agustí, Alvar; Anderson, Gary P.; Bansal, Aruna T.; Beasley, Richard; Bel, Elisabeth H.; Janson, Christer; Make, Barry; Pavord, Ian D.; Price, David; Rapsomaniki, Eleni; Karlsson, Niklas; Finch, Donna K.; Nuevo, Javier; de Giorgio-Miller, Alex; Alacqua, Marianna; Hughes, Rod; Müllerová, Hana; Gerhardsson de Verdier, Maria
• Is Part Of: European respiratory journal. Volume 58:Issue 3(2021)
• Publication Date: 2021-09-23
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.03927-2020
• Languages: English
• ISSNs: 0903-1936

Abstract

Background: Studies of asthma and chronic obstructive pulmonary disease (COPD) typically focus on these diagnoses separately, limiting understanding of disease mechanisms and treatment options. NOVELTY is a global, 3-year, prospective observational study of patients with asthma and/or COPD from real-world clinical practice. We investigated heterogeneity and overlap by diagnosis and severity in this cohort. Methods: Patients with physician-assigned asthma, COPD or both (asthma+COPD) were enrolled, and stratified by diagnosis and severity. Baseline characteristics were reported descriptively by physician-assigned diagnosis and/or severity. Factors associated with physician-assessed severity were evaluated using ordinal logistic regression analysis. Results: Of 11 243 patients, 5940 (52.8%) had physician-assigned asthma, 1396 (12.4%) had asthma+COPD and 3907 (34.8%) had COPD; almost half were from primary care. Symptoms, health-related quality of life and spirometry showed substantial heterogeneity and overlap between asthma, asthma+COPD and COPD, with 23%, 62% and 64% of patients, respectively, having a ratio of post-bronchodilator forced expiratory volume in 1 s to forced vital capacity below the lower limit of normal. Symptoms and exacerbations increased with greater physician-assessed severity and were higher in asthma+COPD. However, 24.3% with mild asthma and 20.4% with mild COPD had experienced ≥1 exacerbation in the past 12 months. Medication records suggested both under-treatment and over-treatment relative to severity. Blood eosinophil counts varied little across diagnosis and severity groups, but blood neutrophil counts increased with severity across all diagnoses. Conclusion: This analysis demonstrates marked heterogeneity within, and overlap between, physician-assigned diagnosis and severity groups in patients with asthma and/or COPD. Current diagnostic and severity classifications in clinical practice poorly differentiate between clinical phenotypes that may have specific risks and treatment implications. Heterogeneity within and between physician-diagnosed asthma and/or COPD in the NOVELTY cohort at baseline suggests that current diagnostic and severity classifications poorly differentiate between clinically important phenotypes https://bit.ly/3qc4kNC