Clinical Characteristics Of Patients With Asthma COPD Overlap (ACO) In Australian Primary Care

Abstract

Gabriel Izbicki,1,2 Valerie Teo,1,3 Jenifer Liang,4 Grant M Russell,5 Anne E Holland,6 Nicholas A Zwar,7 Billie Bonevski,8 Ajay Mahal,9 Paula Eustace,10 Eldho Paul,1 Kirsten Phillips,11 Sally Wilson,4,12 Johnson George,1,4 Michael J Abramson1 1School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; 2Shaare Zedek Medical Center and The Hebrew University Hadassah Medical School, Jerusalem, Israel; 3National Healthcare Group Polyclinics, Singapore; 4Centre For Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia; 5Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Notting Hill, Australia; 6Discipline of Physiotherapy, La Trobe University and Alfred Health, Melbourne, Australia; 7Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia; 8School of Medicine and Public Health, University of Newcastle, Callaghan, Australia; 9The Nossal Institute For Global Health, University of Melbourne, Melbourne, Australia; 10Eastern Melbourne PHN (EMPHN), Box Hill, Australia; 11Lung Foundation Australia (LFA), Milton, Australia; 12Department of Infrastructure Engineering, The University of Melbourne, Melbourne, AustraliaCorrespondence: Michael J AbramsonSchool of Public Health & Preventive Medicine, 553 St Kilda Road, Melbourne, VIC 3004, AustraliaTel [phone]Fax [phone]Email [email protected]: Many older adults with a history of smoking and asthma develop clinical features of both asthma and COPD, an entity sometimes called asthma-COPD overlap (ACO). Patients with ACO may be at higher risk of poor health outcomes than those with asthma or COPD alone. However, understanding of ACO is limited in the primary care setting and more information is needed to better inform patient management. We aimed to compare the characteristics of patients with ACO or COPD in Australian general practices.Patients and methods: Data were from the RADICALS (Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers) trial, an intervention study of an interdisciplinary community-based model of care. Baseline demographic and clinical characteristics, pre- and post-bronchodilator spirometry, dyspnoea and St. George’s Respiratory Questionnaire scores were compared between 60 ACO patients and 212 with COPD alone.Results: Pre-bronchodilator Forced Expiratory Volume in 1 second (mean±SD 58.4±14.3 vs 67.5±20.1% predicted) and Forced Vital Capacity (mean 82.1±16.9 v 91.9±17.2% predicted) were significantly lower in the ACO group (p<0.001), but no difference was found in post-bronchodilator spirometry. Demographic and clinical characteristics, dyspnoea, quality of life, comorbidities and treatment prescribed did not differ significantly between groups.Conclusion: This is the first study describing the clinical characteristics of ACO patients in Australian general practices. Our finding of lower pre-bronchodilator lung function in the ACO group compared to those with COPD reinforces the importance of spirometry in primary care to inform management.Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.Keywords: asthma, chronic obstructive pulmonary disease, primary care, spirometry

Keywords

• asthma
• chronic obstructive pulmonary disease
• primary care
• spirometry