International Journal of COPD (Jan 2023)

Real-World Evidence on the Diagnostic and Clinical Characteristics of Asthma in Japanese Patients with COPD: The ACO Japan Cohort Study

  • Hashimoto S,
  • Yoshida Y,
  • Makita N,
  • Sorimachi R,
  • Sugaya S,
  • Arita Y,
  • Hayashi N,
  • Tashiro N,
  • Ichinose M

Journal volume & issue
Vol. Volume 18
pp. 37 – 46

Abstract

Read online

Shu Hashimoto1,2 ,† Yuri Yoshida,3 Naoyuki Makita,3 Ryoko Sorimachi,3 Satoko Sugaya,4 Yoshifumi Arita,3 Nobuya Hayashi,4 Naoki Tashiro,3 Masakazu Ichinose5,6 1Nihon University, Tokyo, Japan; 2Hibiya Kokusai Clinic, Tokyo, Japan; 3Medical Department, AstraZeneca K.K., Osaka, Japan; 4R&D, AstraZeneca K.K., Osaka, Japan; 5Academic Center of Osaki Citizen Hospital, Miyagi, Japan; 6Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan†Dr Shu Hashimoto passed away on July 03, 2022Correspondence: Masakazu Ichinose, Academic Center of Osaki Citizen Hospital, 3-8-1 Honami, Furukawa, Osaki, 989-6183, Japan, Tel +81-229-23-3311, Fax +81-229-23-5380, Email [email protected]: The ACO Japan Cohort Study, a multicenter observational study, investigated the proportion of patients with chronic obstructive pulmonary disease (COPD) who met the Japanese Respiratory Society (JRS) asthma–COPD overlap (ACO) diagnostic criteria, characteristics of ACO and non-ACO patients, and the patient transitions between ACO/non-ACO diagnosis over 2 years.Patients and Methods: Patients with COPD were consecutively enrolled between June and December 2018 and followed up continuously for 2 years. All participating study sites were medical institutions where respiratory specialists routinely conducted medical examinations/tests required for ACO diagnosis.Results: Among 708 patients with COPD, 101 (14.3%), 118 (16.7%), and 125 (17.7%) were diagnosed with ACO at registration, 1 year, and 2 years, respectively. In total, 22.6% of patients lacked the data necessary for ACO diagnosis throughout the 2 years. Among patients who had the necessary data for ACO diagnosis, 24.7% were diagnosed with ACO at 2 years. More ACO patients had moderate or severe exacerbations in the past year than non-ACO patients at registration (15.8% vs 6.3%, p = 0.049) and 1 year (19.4% vs 7.6%, p = 0.025). ACO patients had a greater decrease in mean forced expiratory volume in one second over 2 years than non-ACO patients (− 92.0 vs 43.4 mL). Among patients diagnosed with ACO at registration, 21.4% transitioned to non-ACO after 1 year. Conversely, almost all non-ACO patients at registration remained non-ACO after 1 year.Conclusion: COPD patients with ACO determined by the JRS criteria had a high risk of exacerbations and a rapid decline in respiratory function, indicating that the JRS criteria for ACO are useful for identifying high-risk COPD patients. Testing necessary for ACO diagnosis is insufficiently performed even in real-world clinical practice of COPD specialists.Keywords: asthma, chronic obstructive pulmonary disease, exacerbation, FEV1 decline, inhaled corticosteroid

Keywords