Comorbid Asthma and COPD: Common and Costly

Asthma and chronic obstructive pulmonary disease (COPD) occur together at an alarming rate.

Some studies indicate that about 17% of asthma patients overall have COPD, with comorbidity increasing with age. By age 65, at least half of patients with 1 diagnosis will actually have both conditions, called asthma-COPD overlap syndrome (ACOS).

ACOS is linked to rapid disease progression, more exacerbations, increased hospitalizations, a greater number of comorbidities, and a lower health-related quality of life. Clearly, comorbid asthma and COPD is costly.

The journal Value in Health recently published a retrospective analysis that zeroed in on health care use, costs, and comorbidities in ACOS patients.

The researchers employed medical and pharmacy claims from large commercial health plans in the United States. Patients ages 6 years or older with a diagnosis of asthma and 1 or more asthma exacerbation were included.

This structure ensured that patients included in the study had uncontrolled asthma.

The researchers established 2 matched arms: those with asthma alone (n=26,060) and those with ACOS (n=6505). Overall, the rate of ACOS was 25%.

Mean annual all-cause health care costs were $22,393 for ACOS patients and $11,716 for asthma patients, demonstrating that ACOS doubles costs.

Of those costs, 29% were attributed to asthma, which was twice as high among ACOS patients.

Inpatient hospitalization and emergency department visits were key cost drivers. ACOS patients were more likely to use both, and they experienced more than 2.5 times the number of asthma-related exacerbations than patients with asthma alone.

ACOS patients were also more likely to have other comorbidities.

The researchers concluded that clinicians need to treat asthma and COPD not as unique diseases, but as related conditions with different pathological mechanisms.

Because asthma, COPD, and other comorbidities have overlapping symptoms, disease management approaches should consider the tendency for treatments to interact and how the conditions share pathophysiology and alter the expression of each other.