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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Pulmonary Medicine 1/2018

Burden of asthma and COPD overlap (ACO) in Taiwan: a nationwide population-based study

BMC Pulmonary Medicine > Ausgabe 1/2018
Sumitra Shantakumar, Raoh-Fang Pwu, Liesel D’Silva, Keele Wurst, Yao-Wen Kuo, Yen-Yun Yang, Yi-Chen Juan, K. Arnold Chan
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12890-017-0571-7) contains supplementary material, which is available to authorized users.



Patients with symptoms of both asthma and chronic obstructive pulmonary disease (COPD) may be classified with the term asthma-COPD overlap (ACO). ACO is of considerable interest as it is currently poorly characterised and has been associated with worse health outcomes and higher healthcare costs compared with COPD or asthma alone. Patients with ACO in Asia remain poorly described, and there is limited information regarding their resource utilisation compared with patients with asthma or COPD only. This study investigated the characteristics, disease burden and medical resource utilisation of patients with ACO in Taiwan.


This was a retrospective cohort study of patients identified from National Health Insurance (NHI) claims data in Taiwan in 2009–2011. Patients were classified into incident ACO, COPD or asthma cohorts according to International Classification of Disease, ninth revision, clinical modification codes in claims. Eligible patients were ≥40 years of age with 12 months’ continuous enrolment in the NHI programme pre- and post-index date (date of the first relevant medical claim).


Patients with ACO (N = 22,328) and COPD (N = 69,648) were older and more likely to be male than those with asthma (N = 50,293). Patients with ACO had more comorbidities and exacerbations, with higher medication use: short-acting β2-agonist prescriptions ranged from 30.4% of patients (asthma cohort) to 43.6% (ACO cohort), and inhaled corticosteroid/long-acting β2-agonist combination prescriptions ranged from 11.1% (COPD cohort) to 35.0% (ACO cohort) in the 12 months following index. Patients with ACO generally had the highest medication costs of any cohort (long-acting muscarinic antagonist costs ranged from $227/patient [asthma cohort] to $349/patient [ACO cohort]); they also experienced more respiratory-related hospital visits than patients with asthma or COPD (mean outpatient/inpatient visits per patient post-index: 9.1/1.9 [ACO cohort] vs 5.7/1.4 [asthma cohort] and 6.4/1.7 [COPD cohort]).


Patients with ACO in Taiwan experience a greater disease burden with greater healthcare resource utilisation, and higher costs, than patients with asthma or COPD alone.
Additional file 1: Figure S1. Patient flow diagram for the COPD cohort. Figure S2. Patient flow diagram for the asthma cohort. Figure S3. Patient flow diagram for the ACO cohort and groups with different ACO definitions. Table S1. Characteristics of the ACO cohort and groups with different ACO definitions at index date. Table S2. Respiratory-related medication use in the 12 months post-index date for the ACO cohort and groups with different ACO definitions. Table S3. All-cause medical utilisation in the asthma, COPD and ACO cohorts in the 12 months post-index date. Table S4. Respiratory-related medical utilisation in the 12 months post-index date for the ACO cohort and groups with different ACO definitions. (PDF 2324 kb)
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