Nonatopic asthma is associated with adverse outcomes and exacerbation risk in chronic obstructive pulmonary disease (COPD), while patients having atopy alone and atopic asthma had less risk, according to study results published in CHEST.

Although it is known that individuals with asthma-COPD overlap (ACO) have a high risk for exacerbations, symptoms, and adverse outcomes, a major limitation of the current research is the lack of a clear definition for ACO or understanding of what this phenotype represents.

Thus, investigators sought to evaluate subtypes of COPD defined by atopy and asthma overlap, and to determine the association of these subtypes with exacerbation risk, symptom scores, and clinical and radiologic phenotypes in 403 individuals with COPD from the SPIROMICS study (ClinicalTrials.gov Identifier: NCT01969344) and 696 individuals from the COPDGene study (ClinicalTrials.gov Identifier: NCT00608764). The prevalence of atopy was 35% and 36% in patients with COPD from SPIROMICS and COPDGene, respectively, and there was <50% overlap between atopic status with asthma in both cohorts.

According to the meta-analysis, individuals with nonatopic asthma had the most impaired symptom scores and the highest risk for exacerbations compared with the group without atopy or asthma. In addition, individuals with atopy and atopic asthma were not at an increased risk for adverse outcomes.


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“In this study, individuals with COPD and non-atopic asthma had increased adverse respiratory outcomes and COPD exacerbations compared to those with atopic asthma or those without asthma regardless of atopic status,” the researchers concluded.  They added, “Ascertaining the atopic status of patients with asthma-COPD overlap may be necessary to fully identify risk of adverse outcomes and guide therapeutic management.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Putcha N, Fawzy A, Matsui EC, et al. Clinical phenotypes of atopy and asthma in COPD: a meta-analysis of SPIROMICS and COPDGene [published online May 22, 2020]. CHEST. doi:10.1016/j.chest.2020.04.069