PT  - JOURNAL ARTICLE
AU  - Helen K. Reddel
AU  - Jørgen Vestbo
AU  - Alvar Agustí
AU  - Gary P. Anderson
AU  - Aruna T. Bansal
AU  - Richard Beasley
AU  - Elisabeth H. Bel
AU  - Christer Janson
AU  - Barry Make
AU  - Ian D. Pavord
AU  - David Price
AU  - Eleni Rapsomaniki
AU  - Niklas Karlsson
AU  - Donna K. Finch
AU  - Javier Nuevo
AU  - Alex de Giorgio-Miller
AU  - Marianna Alacqua
AU  - Rod Hughes
AU  - Hana Müllerová
AU  - Maria Gerhardsson de Verdier
AU  - for the NOVELTY study investigators
TI  - Heterogeneity within and between physician-diagnosed asthma and/or COPD: NOVELTY cohort
AID  - 10.1183/13993003.03927-2020
DP  - 2021 Sep 01
TA  - European Respiratory Journal
PG  - 2003927
VI  - 58
IP  - 3
4099  - http://erj.ersjournals.com/content/58/3/2003927.short
4100  - http://erj.ersjournals.com/content/58/3/2003927.full
SO  - Eur Respir J2021 Sep 01; 58
AB  - 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, and 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 a ratio of post-bronchodilator forced expiratory volume in 1 s to forced vital capacity below the lower limit of normal. Symptoms and exacerbations increased with greater physician-assessed severity and were higher in asthma+COPD. However, 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 and 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.Heterogeneity within and between physician-diagnosed asthma and/or COPD in the NOVELTY cohort at baseline suggests that current diagnostic and severity classifications poorly differentiate between clinically important phenotypes https://bit.ly/3qc4kNC