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

Int J Chron Obstruct Pulmon Dis. 2019 Dec 3;14:2745-2752. doi: 10.2147/COPD.S220346. eCollection 2019.


Purpose: 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.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome / diagnosis*
  • Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome / epidemiology
  • Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome / physiopathology
  • Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome / therapy
  • Australia / epidemiology
  • Clinical Trials as Topic
  • Comorbidity
  • Dyspnea / diagnosis*
  • Dyspnea / epidemiology
  • Dyspnea / physiopathology
  • Dyspnea / therapy
  • Female
  • Forced Expiratory Volume
  • Humans
  • Lung / physiopathology*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Primary Health Care*
  • Prognosis
  • Pulmonary Disease, Chronic Obstructive / diagnosis*
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / therapy
  • Quality of Life
  • Spirometry
  • Surveys and Questionnaires
  • Vital Capacity