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Early, late onset asthma–COPD overlap lowers overall prognosis

Patients in this study who had early-onset and late-onset asthma overlapped with chronic obstructive pulmonary disease showed decreased clinical function and worse overall prognosis compared with healthy patients who never smoked, according to recent research.

“Findings from this study highlight differences in the long-term prognosis of different phenotypes of chronic airway disease in the general population,” Peter Lange, DMSc, from the Institute of Public Health and Section of Social Medicine at Copenhagen University in Copenhagen, Denmark, and colleagues wrote in their study. “In particular, we present novel findings regarding long-term prognosis of individuals with asthma–chronic obstructive pulmonary disease overlap and identify a susceptible subgroup with late-onset asthma with an extraordinarily poor prognosis according to FEV₁ decline, exacerbations, pneumonias, and survival.”

Lange and colleagues evaluated patients from the Copenhagen City Heart Study divided into six subgroups based on smoking status, age, asthma and chronic obstructive pulmonary disease (COPD) status, according to the abstract. Of the 8,382 participants in the study, 2,199 patients never smoked, 5,435 patients had smoked previously but did not have asthma or COPD, 158 patients had asthma, 320 patients had COPD, 68 patients had early-onset asthma and COPD and 202 patients had late-onset asthma and COPD. The researchers analyzed decline in FEV₁ over a period of 18 years, as well as the risk of all-cause mortality and admission to hospital for exacerbations over a period of 22 years.

They found no significant difference in FEV₁ decline among patients with early-onset asthma and COPD and healthy patients who never smoked (27.3 mL vs. 20.9 mL; P = 0.19). However, there was a significant difference when comparing patients with early-onset asthma and late-onset asthma with COPD (49.6 mL; P = 0.001). A significant difference also appeared when comparing patients with COPD (39.5 mL; P = 0.003) and healthy patients who never smoked (P < 0.0001), according to the abstract.

The hazard ratios for the various groups were 39.48 for patients with early-onset asthma and COPD (95% CI, 25.93-60.11; P < 0.0001), 83.47 for patients with late-onset asthma and COPD (95% CI, 61.67-112.98; P < 0.0001), 23.80 in patients with COPD (95% CI, 17.43-33.50; P < 0.0001) and 14.74 among patients with asthma (95% CI, 10.06-21.59; P < 0.0001) compared with healthy patients who never smoked. Compared with healthy patients who never smoked, life expectancy decreased by 9.3 years (95% CI, 5.4-13.1) in patients with early-onset asthma and COPD, 12.8 years (95% CI, 11.1-14.6) in patients with late-onset asthma and COPD, 10.1 years (95% CI, 8.6-11.5) in patients with COPD and 3.3 years (95% CI, 1.0-5.5) in patients with asthma, according to the abstract.

“Our findings underline an urgent need for intervention studies in order to establish evidence-based treatment options for individuals with features of both asthma and COPD,” Lange and colleagues wrote. – by Jeff Craven

Disclosure: Lange received grants from AstraZeneca and personal fees from AstraZeneca, Norpharma, Takeda, Pfizer, and Teva. The other researchers received various financial disclosures. Please see the full study for a complete list of disclosures.