title: Comorbidome, Pattern, and Impact of Asthma-COPD Overlap Syndrome in Real Life.
abstract: BACKGROUND
  Asthma-COPD overlap syndrome (ACOS) has been described and acknowledged as a distinct clinical entity; however, its characteristics in daily clinical practice are largely unknown. The aim of this study was to identify the prevalence of ACOS in the real-life population, its pattern of comorbidities, and its impact on hospitalization risk.
  
  
  METHODS
  Data for this retrospective cohort study were extracted from the Majorca Real-Life Investigation in COPD and Asthma cohort, including primary care, hospitalization, and pharmacy data from the Balearic Islands, Spain. Patients who had received a physician-confirmed diagnosis of both asthma and COPD were identified as having ACOS and compared with a COPD-only population. In subanalyses, more stringent diagnostic criteria (Global Initiative for Asthma-Global Initiative for Chronic Obstructive Lung Disease) were applied. The pattern and impact of comorbidities on all-cause hospitalization were compared by multivariate logistic regression.
  
  
  RESULTS
  In total, 5,093 patients with ACOS (prevalence, 5.55 per 1,000 inhabitants) were compared with 22,778 patients with COPD (30.40 per 1,000 inhabitants). Patients with ACOS were more frequently female (53.4%) than were patients with COPD (30.8%), younger (ACOS, 64.0 years; COPD, 65.8 years), and differed by nonsmoking status (ACOS, 41.4%; COPD, 22.1%) (all, P < .001). In adjusted analyses, allergic rhinitis (OR, 1.81; 95% CI, 1.63-2.00), anxiety (OR, 1.18; 95% CI, 1.10-1.27), gastroesophageal reflux disease (OR, 1.18; 95% CI, 1.04-1.33), and osteoporosis (OR, 1.14; 95% CI, 1.04-1.26) were more frequent in ACOS than COPD. In contrast, chronic kidney disease (OR, 0.79; 95% CI, 0.66-0.95) and ischemic heart disease (OR, 0.88; 95% CI, 0.79-0.98) were less frequent. In patients with ACOS, cardiovascular diseases showed the strongest association with hospitalization.
  
  
  CONCLUSIONS
  ACOS is prevalent in the general population, and it affects to a large extent females with less smoking exposure compared with patients with COPD only. Cardiovascular comorbidities in particular contribute most to overall hospitalization risk of patients with ACOS.
authors.affiliation: Instituto de Investigacíón Sanitaria de Palma, Hospital Universitario Son Espases, Palma de Mallorca, Spain; Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Primary Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: j.f.m.van.boven@rug.nl.
authors.forename: Job F M
authors.initials: JF
authors.lastname: van Boven
authors.affiliation: Instituto de Investigacíón Sanitaria de Palma, Hospital Universitario Son Espases, Palma de Mallorca, Spain; Primary Care Health Service, Servei de Salut de les Illes Balears, Palma de Mallorca, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Román-Rodríguez
authors.affiliation: Instituto de Investigacíón Sanitaria de Palma, Hospital Universitario Son Espases, Palma de Mallorca, Spain; Primary Care Health Service, Servei de Salut de les Illes Balears, Palma de Mallorca, Spain.
authors.forename: Josep F
authors.initials: JF
authors.lastname: Palmer
authors.affiliation: Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Toledo-Pons
authors.affiliation: Instituto de Investigacíón Sanitaria de Palma, Hospital Universitario Son Espases, Palma de Mallorca, Spain; Department of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Borja G
authors.initials: BG
authors.lastname: Cosío
authors.affiliation: Instituto de Investigación Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Cátedra Universidad Autónoma de Madrid-Linde, Madrid, Spain.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
mesh_terms: D017677:Age Distribution; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D001249:Asthma / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005541:Forced Expiratory Volume; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000453:epidemiology; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D065631:Rhinitis, Allergic / Q000453:epidemiology; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D014797:Vital Capacity
keywords: COPD; asthma; asthma-COPD overlap; epidemiology (pulmonary)