Chronic Obstructive Pulmonary Disease With Asthma-Like Features in the General Population in China

Kewu Huang; Kian Fan Chung; Ting Yang; Jianying Xu; Lan Yang; Jianping Zhao; Xiangyan Zhang; Chunxue Bai; Jian Kang; Pixin Ran; Huahao Shen; Fuqiang Wen; Yahong Chen; Tieying Sun; Guangliang Shan; Yingxiang Lin; Guodong Xu; Sinan Wu; Ying Wang; Xiaoying Gu; Ruiying Wang; Zhihong Shi; Yongjian Xu; Xianwei Ye; Yuanlin Song; Qiuyue Wang; Yumin Zhou; Wen Li; Liren Ding; Chun Wan; Wanzhen Yao; Yanfei Guo; Fei Xiao; Yong Lu; Xiaoxia Peng; Dan Xiao; Xiaoning Bu; Hong Zhang; Xiaolei Zhang; Li An; Shu Zhang; Zhixin Cao; Qingyuan Zhan; Yuanhua Yang; Lirong Liang; Wenjun Wang; Huaping Dai; Bin Cao; Jiang He; Chen Wang

doi:10.3389/fmed.2022.876240

Chronic Obstructive Pulmonary Disease With Asthma-Like Features in the General Population in China

Front Med (Lausanne). 2022 May 6:9:876240. doi: 10.3389/fmed.2022.876240. eCollection 2022.

Authors

Kewu Huang^{1

2}, Kian Fan Chung³, Ting Yang^{4

5

6

7}, Jianying Xu⁸, Lan Yang⁹, Jianping Zhao¹⁰, Xiangyan Zhang¹¹, Chunxue Bai¹², Jian Kang¹³, Pixin Ran¹⁴, Huahao Shen¹⁵, Fuqiang Wen¹⁶, Yahong Chen¹⁷, Tieying Sun^{18

19}, Guangliang Shan²⁰, Yingxiang Lin^{1

2}, Guodong Xu²¹, Sinan Wu^{4

6

21}, Ying Wang^{1

2}, Xiaoying Gu^{4

5

7

21}, Ruiying Wang⁸, Zhihong Shi⁹, Yongjian Xu¹⁰, Xianwei Ye¹¹, Yuanlin Song¹², Qiuyue Wang¹³, Yumin Zhou¹⁴, Wen Li¹⁵, Liren Ding¹⁵, Chun Wan¹⁶, Wanzhen Yao¹⁷, Yanfei Guo^{18

19}, Fei Xiao¹⁹, Yong Lu^{1

2}, Xiaoxia Peng²², Dan Xiao^{4

5

7

23

24}, Xiaoning Bu^{1

2}, Hong Zhang^{1

2}, Xiaolei Zhang^{4

5

6

7}, Li An^{1

2}, Shu Zhang^{1

2}, Zhixin Cao^{1

2}, Qingyuan Zhan^{4

5

6

7}, Yuanhua Yang^{1

2}, Lirong Liang^{2

25}, Wenjun Wang^{1

2}, Huaping Dai^{4

5

6}, Bin Cao^{4

5

6}, Jiang He²⁶, Chen Wang^{4

5

6

7

23

24

27

28}

Affiliations

¹ Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing, China.
² Beijing Institute of Respiratory Medicine, Beijing, China.
³ National Heart & Lung Institute, Imperial College London & Royal Brompton & Harefield NHS Trust, London, United Kingdom.
⁴ National Center for Respiratory Medicine, Beijing, China.
⁵ National Clinical Research Center for Respiratory Diseases, Beijing, China.
⁶ Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
⁷ Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.
⁸ Department of Pulmonary and Critical Care Medicine, Shanxi Bethune Hospital, Taiyuan, China.
⁹ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
¹⁰ Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹¹ Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China.
¹² Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
¹³ Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China.
¹⁴ State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
¹⁵ Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
¹⁶ State Key Laboratory of Biotherapy of China and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.
¹⁷ Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China.
¹⁸ Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, China.
¹⁹ National Center of Gerontology, Beijing Hospital, Beijing, China.
²⁰ Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing, China.
²¹ Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
²² Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
²³ Tobacco Medicine and Tobacco Cessation Center, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
²⁴ WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China.
²⁵ Department of Epidemiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
²⁶ Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States.
²⁷ Department of Respiratory Medicine, Capital Medical University, Beijing, China.
²⁸ Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Background: Patients with features of both asthma and chronic obstructive pulmonary disease (COPD) are seen commonly in the clinic but less is known in the general population. We investigated the prevalence and the heterogeneity of COPD with concomitant features of asthma in Chinese adult population.

Methods: COPD was defined as post-bronchodilator ratio of forced expiratory volume in 1s (FEV₁) to forced vital capacity of less than the lower limits of normal. COPD with concomitant features of asthma was defined as either COPD with asthma diagnosed by self-reported physician-diagnosis or by presence of current wheeze, or as COPD with high bronchodilator response (HBR) defined as an increase in FEV₁ >15% and >400 ml after bronchodilator.

Results: COPD with concomitant features of asthma was found in 1.62% (95% CI 1.31-2.00) of adults (≥20 years) or in 15.2% (95% CI 13.0-17.7) of COPD patients. Compared with COPD with HBR, COPD with asthma diagnosis or wheeze were older (61.8 ± 1.1 years vs. 47.4 ± 2.8 years, P < 0.001), and with a lower post-bronchodilator FEV₁%pred (68.2 ± 2.3 vs. 96.6 ± 3.4, P < 0.001). Age, smoking status, biomass use and allergic rhinitis were associated with increasing prevalence of COPD with asthma diagnosis or wheeze, and had greater impaired health status, more comorbidities and more acute exacerbations in the preceding 12 months.

Conclusions: COPD with concomitant features of asthma is common in people with COPD and those with COPD with asthma diagnosis or wheeze experience worse clinical severity than COPD with HBR. These findings will help toward the definition of the asthma-COPD overlap condition.

Keywords: asthma; bronchodilator response; chronic obstructive pulmonary disease; general population; wheeze.

Copyright © 2022 Huang, Chung, Yang, Xu, Yang, Zhao, Zhang, Bai, Kang, Ran, Shen, Wen, Chen, Sun, Shan, Lin, Xu, Wu, Wang, Gu, Wang, Shi, Xu, Ye, Song, Wang, Zhou, Li, Ding, Wan, Yao, Guo, Xiao, Lu, Peng, Xiao, Bu, Zhang, Zhang, An, Zhang, Cao, Zhan, Yang, Liang, Wang, Dai, Cao, He and Wang.