Characteristics of Specialist-Diagnosed Asthma-COPD Overlap in Severe Asthma: Observations from the Korean Severe Asthma Registry (KoSAR)

Background: While the clinical characteristics and outcomes of asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) have been frequently compared with those of COPD or asthma, the prevalence and features of ACO in patients with severe asthma are unclear. Objectives: Evaluation of the prevalence and clinical features of ACO using the Korean severe asthma registry. Methods: At the time of registration, ACO was determined in patients with severe asthma by attending specialists. Patients were classified into ACO and non-ACO groups, and the demographic and clinical characteristics of these two groups were compared. Results: Of 482 patients with severe asthma, 23.7% had ACO. Patients in the ACO group were more likely to be male (P <.001), older (P <.001), and ex- or current smokers (P <.001) compared with those in the non-ACO group. Patients in the ACO group had lower mean forced expiratory volume in 1 second (P <.001) and blood eosinophil percentage (P =.006), but higher blood neutrophil percentage (P =.027) than those in the non-ACO group. The ACO group used more inhaled long-acting muscarinic antagonist (P <.001), methylxanthine (P =.001), or sustained systemic corticosteroid (P =.002). In addition, unscheduled emergency department visits due to exacerbation were more frequent in the ACO group (P =.006). Conclusion: Among patients with severe asthma, those with ACO were older, predominantly male, and were more likely to have a smoking history than those with asthma only. Patients with ACO used more systemic corticosteroid and had more frequent exacerbations related to emergency department visits than those with severe asthma only.