Clinical, instrumental and pharmacological comparisons of patients with chronic obstructive pulmonary disease (COPD) and asthma in real clinical practice

The objective of this study was to compare demographic, clinical, functional, laboratory data, and therapy in patients with chronic obstructive pulmonary disease (COPD) and asthma who seek for medical aid at medical institutions of Kazan’. Methods. The study involved 153 patients with COPD aged 33 to 89 years and 229 patients with asthma aged 18 to 87 years. Clinical status, rate of exacerbations, spirometric data, treatment and compliance during the previous year were analyzed. Statistical analysis was performed using the SPSS-18 software. Results. COPD patients were older (64.1 ± 0,7 vs 55.4 ± 0,9 years in asthma patients; p < 0,01), more often were males (98.7% vs 1.3%, p < 0.001) and smokers. Coronary heart disease (39.0% vs 25.3%; p < 0.010) and chronic heart failure (35.7% vs 17.5%; p < 0.001) were more common in patients with COPD, while rhinitis (42.4 % vs 3.9%; p < 0.001) and chronic kidney disease (13.1% vs 4.5%; p < 0.001) were more common in asthma patients. Allergic disease was 5-fold more often in asthma patients. Morning symptoms affected daily activity in 77.3% of COPD patients compared to 66.8% of asthma patients (p < 0.05). Generally, daytime activity was impaired in 55.2% of patients with COPD and in 12.7% of patients with asthma (p < 0.05). Excessive use of short-acting bronchodilators was noted at nighttime in 89.6% with COPD and 70.7% with asthma (p < 0.001). Other treatment was in line with guidelines for each the disease. The most convenient inhalational drug delivery device for COPD patients was a metered dosed inhaler, while patients with asthma preferred dry powder inhalers. Compliance of asthma patients was significantly higher than that of COPD patients (57.2% vs 27.8%; p < 0.001). The level of compliance did not change while fixed and free combinations of ICS and LABA or different inhalational devices were used in patients with COPD or asthma. Conclusion. There is a number of clinical signs to distinguish COPD and asthma quite easily in primary care facilities. Excessive use of short-acting bronchodilators and a low compliance of patients are issues requiring to be improved.

1. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. Updated 2018. Available at: http://www.ginasthma.org/gina-reports/

2. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease: 2019 Report. https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf

3. Vos T., Flaxman A.D., Naghavi M., Lozano R. et al. Years lived with isability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380 (9859): 2163–2196. DOI: 10.1016/S0140-6736(12)61729-2.

4. Barrecheguren M., González C., Miravitlles M. What have we learned from observational studies and clinical trials of mild to moderate COPD? Respir. Res. 2018; 19 (1): 177. DOI: 10.1186/s12931-018-0882-0.

5. Pokhaznikova M.A., Lebedev A.K., Andreeva E.A. et al. [Prevalence of chronic obstructive pulmonary disease according to spirometry in citizens of Saint Petersburg]. Vestnik sovremennoy klinicheskoy meditsiny. 2016; 9 (5): 35–40 (in Russian).

6. Avdeev S.N., Belevskiy A.S., Ezhov A.V. et al. [Therapeutic approaches to acute exacerbation of COPD in Russian Federation: results of NIS CLOUD multicenter non-interventional observational study]. Pul'monologiya. 2018; 28 (4): 411–423. DOI: 10.18093/0869-0189-2018-28-4-411-423 (in Russian).

7. Janson C., Johannessen A., Franklin K. et al. Change in the prevalence asthma, rhinitis and respiratory symptom over a 20 year period: associations to year of birth, life style and sleep related symptoms. BMC Pulm. Med. 2018; 18 (1): 152. DOI: 10.1186/s12890-018-0690-9.

8. Partridge M.R., Dal Negro R.W., Olivieri D. Understanding patients with asthma and COPD: insights from a European study. Prim. Care Respir. J. 2011; 20 (3): 315–323. DOI: 10.4104/pcrj.2011.00056.

9. Fofanova T.V., Ageev F.T., Smirnova M.D. et al. [National questionnaire of adherence to treatment: validation and implementation to ambulatory clinical practice]. Sistemnye gipertenzii. 2014; 11 (2): 13–16.

10. Kamada T., Kaneko M., Tomioka H. Comparison of respiratory system impedance in asthma and COPD: A prospective observational study. Respirology. 2018; 23 (5): 478–484. DOI: 10.1111/resp.13240.

11. Kitaguchi Y., Yasuo M., Hanaoka M. Comparison of pulmonary function in patients with COPD, asthma-COPD overlap syndrome, and asthma with airflow limitation. Int. J. Chron. Obstruct. Pulmon. Dis. 2016; 11: 991–997. DOI: 10.2147/COPD.S105988.

12. Partridge M.R., van der Molen T., Myrseth S.E., Busse W. Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study. BMC Pulm. Med. 2006; 6: 13. DOI: 10.1186/1471-2466-6-13.