Allergy Asthma Immunol Res.  2018 May;10(3):225-235. 10.4168/aair.2018.10.3.225.

Perceptions of Severe Asthma and Asthma-COPD Overlap Syndrome Among Specialists: A Questionnaire Survey

• Kim SH
• Moon JY
• Lee JH
• Ban GY
• Kim S
• Kim MA
• Kim JH
• Kim MH
• Park CS
• Park SY
• Kwon HS
• Kwon JW
• Jung JW
• Kang HR
• Park JS
• Kim TB
• Park HW
• Cho YS
• Yoo KH
• Oh YM
• Lee BJ
• Jang AS
• Cho SH
• Park HS
• Park CS
• Yoon HJ
• on behalf of the Severe Asthma Work Group, the Korean Academy of Asthma, Allergy and Clinical Immunology

• KMID: 2409057
• DOI: http://doi.org/10.4168/aair.2018.10.3.225

Abstract

PURPOSE
Severe asthma and asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) are difficult to control and are often associated with poor clinical outcomes. However, much is not understood regarding the diagnosis and treatment of severe asthma and ACOS. To evaluate the current perceptions of severe asthma and COPD among asthma and COPD specialists, we designed an e-mail and internet-based questionnaire survey.
METHODS
Subjects were selected based on clinical specialty from among the members of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Academy of Tuberculosis and Respiratory Diseases. Of 432 subjects who received an e-mail invitation to the survey, 95 subjects, including 58 allergists and 37 pulmonologists, responded and submitted their answers online.
RESULTS
The specialists estimated that the percentage of severe cases among total asthma patients in their practice was 13.9%±11.0%. Asthma aggravation by stepping down treatment was the most common subtype, followed by frequent exacerbation, uncontrolled asthma despite higher treatment steps, and serious exacerbation. ACOS was estimated to account for 20.7% of asthma, 38.0% of severe asthma, and 30.1% of COPD cases. A history of smoking, persistently low forced expiratory volume in 1 second (FEV1), and low FEV1 variation were most frequently classified as the major criteria for the diagnosis of ACOS among asthma patients. Among COPD patients, the highly selected major criteria for ACOS were high FEV1 variation, positive bronchodilator response, a personal history of allergies and positive airway hyperresponsiveness. Allergists and pulmonologists showed different assessments and opinions on asthma phenotyping, percentage, and diagnostic criteria for ACOS.
CONCLUSIONS
Specialists had diverse perceptions and clinical practices regarding severe asthma and ACOS patients. This heterogeneity must be considered in future studies and strategy development for severe asthma and ACOS.

Keyword

Severe asthma; asthma-chronic obstructive pulmonary disease overlap syndrome; perception

MeSH Terms

Allergy and Immunology
Asthma*
Diagnosis
Electronic Mail
Forced Expiratory Volume
Humans
Hypersensitivity
Lung Diseases, Obstructive
Population Characteristics
Pulmonary Disease, Chronic Obstructive
Smoke
Smoking
Specialization*
Tuberculosis
Smoke

Figure

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  Fig. 1 Estimated percentage of asthma patients who had severe asthma.

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  Fig. 2 Estimated percentage of asthma patients who had specific features of the disease.

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  Fig. 3 Estimated percentage of patients with severe asthma who were prescribed add-on asthma controllers.

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  Fig. 4 Estimated proportion of patients with asthma, severe asthma, and COPD who had ACOS. COPD, chronic obstructive pulmonary disease; ACOS, asthma-chronic obstructive pulmonary disease overlap syndrome.

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