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)12890_2017_571_MOESM1_ESM.pdf
Global Initiative for Asthma. Global strategy for asthma management and prevention, updated 2014. http://ginasthma.org/. Accessed 6 Oct 2014.
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease, updated 2014. www.goldcopd.org. Accessed 6 Oct 2014.
Global Initiative for Asthma. Global strategy for asthma management and prevention, updated 2017. http://ginasthma.org/. Accessed 15 May 2017.
de Marco R, Pesce G, Marcon A, Accordini S, Antonicelli L, Bugiani M, et al. The coexistence of asthma and chronic obstructive pulmonary disease (COPD): prevalence and risk factors in young, middle-aged and elderly people from the general population. PLoS One. 2013;8:e62985. CrossRefPubMedPubMedCentral
Pleasants RA, Ohar JA, Croft JB, Liu Y, Kraft M, Mannino DM, et al. Chronic obstructive pulmonary disease and asthma-patient characteristics and health impairment. COPD. 2014;11:256–66. PubMed
Blanchette CM, Gutierrez B, Ory C, Chang E, Akazawa M. Economic burden in direct costs of concomitant chronic obstructive pulmonary disease and asthma in a Medicare advantage population. J Manag Care Pharm. 2008;14:176–85. PubMed
Kitaguchi Y, Komatsu Y, Fujimoto K, Hanaoka M, Kubo K. Sputum eosinophilia can predict responsiveness to inhaled corticosteroid treatment in patients with overlap syndrome of COPD and asthma. Int J COPD. 2012;7:283–9.
Ding B, DiBonaventura M, Karlsson N, Ling X. Asthma-chronic obstructive pulmonary disease overlap syndrome in the urban Chinese population: prevalence and disease burden using the 2010, 2012, and 2013 China National Health and wellness surveys. Int J Chron Obstruct Pulmon Dis. 2016;11:1139–50. PubMedPubMedCentral
Chung WS, Lin CL, Kao CH. Comparison of acute respiratory events between asthma-COPD overlap syndrome and COPD patients: a population-based cohort study. Medicine (Baltimore). 2015;94:e755. CrossRef
Bureau of National Health Insurance of Taiwan. Universal Health Coverage in Taiwan. http://www.nhi.gov.tw/English/index.aspx. Accessed 22 Aug 2016.
ExchangeRates.org.uk. US Dollar to New Taiwan Dollar conversion at 31 December 2012 (1 New Taiwan Dollar = 0.0345 USD). http://www.exchangerates.org.uk/USD-TWD-31_12_2012-exchange-rate-history.html. Accessed 11 Oct 2016.
Barnes CB, Andersen ZJ, Overvad K, Tjonneland A, Ulrik CS. Prevalence and mortality of the asthma-COPD overlap syndrome (ACOS) in Denmark: a long-term follow-up study of a large random population sample. Am J Respir Crit Care Med. 2016;193:A6161. CrossRef
Kendzerska T, Sadatsafavi M, Aaron SD, To T, Lougheed M, FitzGerald JM, et al. Trends in asthma-COPD overlap syndrome prevalence, incidence and mortality in Ontario, Canada: a population study. Am J Respir Crit Care Med. 2015;191:A6165.
Global Initiative for Asthma. Global strategy for asthma management and prevention, updated 2008. http://ginasthma.org/. Accessed 26 Aug 2008.
Global Initiative for Asthma. Global strategy for asthma management and prevention, updated 2011. http://ginasthma.org/. Accessed 26 Oct 2011.
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease, updated 2006. http://goldcopd.org/. Accessed 28 Aug 2006.
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease, updated 2011. http://goldcopd.org/. Accessed 27 Oct 2011.
Ram FS, Jones P, Jardim JR, Castro AA, Alatallah AN, Lacasse Y, et al. Oral theophylline for chronic obstructive pulmonary disease (review). Cochrane Database Syst Rev. 2002:(4)CD003902.
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease, updated 2017. www.goldcopd.org. Accessed 28 Nov 2016.
Tan WC. Chapter 5: Chronic Obstructive Pulmonary Disease: Pharmacological Treatment. In Respiratory Medicine: an Asian Perspective. Edited by Ip M, Chan-Yeung M, Lam W, Zhong N. Hong Kong: Hong Kong University Press; 2005.
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease, updated 2016. www.goldcopd.org. Accessed 15 Nov 2016.
Sadatsafavi M, Tavakoli H, Kendzerska T, Gershon A, To T, Aaron SD, et al. History of asthma in patients with chronic obstructive pulmonary disease. A comparative study of economic burden. Ann Am Thorac Soc. 2016;13:188–96. PubMed
Lenz PH, Panos RJ. Chapter 2: Asthma and COPD - overlapping disorders or distinct processes? In COPD Clinical Perspectives. Croatia: Edited by Panos RJ. InTech; 2014.
Bai JW, Mao B, Yang WL, Liang S, HW L, Xu JF. Asthma-COPD overlap syndrome showed more exacerbations however lower mortality than COPD. QJM. 2017;110:431–6. PubMed
Miravitlles M. Diagnosis of asthma-COPD overlap: the five commandments. Eur Respir J. 2017;49:1700506. https://doi.org/10.1183/13993003.00506-2017
- Burden of asthma and COPD overlap (ACO) in Taiwan: a nationwide population-based study
K. Arnold Chan
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