Heterogeneity within and between physician-diagnosed asthma and/or COPD: NOVELTY cohort. Reddel, H. K, Vestbo, J., Agustí, A., Anderson, G. P, Bansal, A. T, Beasley, R., Bel, E. H, Janson, C., Make, B., Pavord, I. D, Price, D., Rapsomaniki, E., Karlsson, N., Finch, D. K, Nuevo, J., de Giorgio-Miller, A., Alacqua, M., Hughes, R., Müllerová, H., & Gerhardsson de Verdier, M. European Respiratory Journal, February, 2021.
Heterogeneity within and between physician-diagnosed asthma and/or COPD: NOVELTY cohort [link]Paper  doi  abstract   bibtex   
Background Studies of asthma and chronic obstructive pulmonary disease (COPD) typically focus on these diagnoses separately, limiting understanding of disease mechanisms and treatment options. NOVELTY is a global, 3-year, prospective observational study of patients with asthma and/or COPD from real-world clinical practice. We investigated heterogeneity and overlap by diagnosis and severity in this cohort. Methods Patients with physician-assigned asthma, COPD or both (asthma+COPD) were enrolled, stratified by diagnosis and severity. Baseline characteristics were reported descriptively by physician-assigned diagnosis and/or severity. Factors associated with physician-assessed severity were evaluated using ordinal logistic regression analysis. Results Of 11 243 patients, 5940 (52.8%) had physician-assigned asthma, 1396 (12.4%) had asthma+COPD and 3907 (34.8%) had COPD; almost half were from primary care. Symptoms, health-related quality of life and spirometry showed substantial heterogeneity and overlap between asthma, asthma+COPD and COPD, with 23%, 62% and 64% of patients, respectively, having post-bronchodilator FEV 1 /FVC \textlesslower limit of normal. Symptoms and exacerbations increased with greater physician-assessed severity, and were higher in asthma+COPD, but 24.3% with mild asthma and 20.4% with mild COPD had experienced ≥1 exacerbation in the past 12 months. Medication records suggested both under-treatment and over-treatment relative to severity. Blood eosinophil counts varied little across diagnosis/severity groups, but blood neutrophil counts increased with severity across all diagnoses. Conclusion This analysis demonstrates marked heterogeneity within, and overlap between, physician-assigned diagnosis and severity groups in patients with asthma and/or COPD. Current diagnostic and severity classifications in clinical practice poorly differentiate between clinical phenotypes that may have specific risks and treatment implications.
@article{reddel_heterogeneity_2021,
	title = {Heterogeneity within and between physician-diagnosed asthma and/or {COPD}: {NOVELTY} cohort},
	issn = {0903-1936, 1399-3003},
	shorttitle = {Heterogeneity within and between physician-diagnosed asthma and/or {COPD}},
	url = {http://erj.ersjournals.com/lookup/doi/10.1183/13993003.03927-2020},
	doi = {10.1183/13993003.03927-2020},
	abstract = {Background
              Studies of asthma and chronic obstructive pulmonary disease (COPD) typically focus on these diagnoses separately, limiting understanding of disease mechanisms and treatment options. NOVELTY is a global, 3-year, prospective observational study of patients with asthma and/or COPD from real-world clinical practice. We investigated heterogeneity and overlap by diagnosis and severity in this cohort.
            
            
              Methods
              Patients with physician-assigned asthma, COPD or both (asthma+COPD) were enrolled, stratified by diagnosis and severity. Baseline characteristics were reported descriptively by physician-assigned diagnosis and/or severity. Factors associated with physician-assessed severity were evaluated using ordinal logistic regression analysis.
            
            
              Results
              
                Of 11 243 patients, 5940 (52.8\%) had physician-assigned asthma, 1396 (12.4\%) had asthma+COPD and 3907 (34.8\%) had COPD; almost half were from primary care. Symptoms, health-related quality of life and spirometry showed substantial heterogeneity and overlap between asthma, asthma+COPD and COPD, with 23\%, 62\% and 64\% of patients, respectively, having post-bronchodilator FEV
                1
                /FVC {\textless}lower limit of normal.
              
              Symptoms and exacerbations increased with greater physician-assessed severity, and were higher in asthma+COPD, but 24.3\% with mild asthma and 20.4\% with mild COPD had experienced ≥1 exacerbation in the past 12 months. Medication records suggested both under-treatment and over-treatment relative to severity. Blood eosinophil counts varied little across diagnosis/severity groups, but blood neutrophil counts increased with severity across all diagnoses.
            
            
              Conclusion
              This analysis demonstrates marked heterogeneity within, and overlap between, physician-assigned diagnosis and severity groups in patients with asthma and/or COPD. Current diagnostic and severity classifications in clinical practice poorly differentiate between clinical phenotypes that may have specific risks and treatment implications.},
	language = {en},
	urldate = {2021-04-28},
	journal = {European Respiratory Journal},
	author = {Reddel, Helen K and Vestbo, Jørgen and Agustí, Alvar and Anderson, Gary P and Bansal, Aruna T and Beasley, Richard and Bel, Elisabeth H and Janson, Christer and Make, Barry and Pavord, Ian D and Price, David and Rapsomaniki, Eleni and Karlsson, Niklas and Finch, Donna K and Nuevo, Javier and de Giorgio-Miller, Alex and Alacqua, Marianna and Hughes, Rod and Müllerová, Hana and Gerhardsson de Verdier, Maria},
	month = feb,
	year = {2021},
	pages = {2003927},
}
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