C33-18 Real-World Clinical Burden of Severe Asthma With Comorbid COPD: Findings From the INSIGHTS Pragmatic Registry

Background In patients with severe asthma (SA), comorbid chronic obstructive pulmonary disease (COPD) is associated with increased morbidity, but contemporary real-world data are limited. This study evaluated the burden of SA with comorbid COPD using a newly developed pragmatic asthma registry. Methods We conducted a retrospective cohort analysis using the INSIGHTS Pragmatic Registry, an asthma registry sourcing electronic health record data from U.S. integrated delivery networks, linked to administrative claims and death registry data. We selected adults aged ≥40 years who met the ATS/ERS definition of SA. Patients with and without comorbid COPD were analyzed separately. Patients with comorbid COPD had evidence of COPD within 12 months of meeting SA criteria. Clinical burden was assessed via asthma and COPD annualized exacerbation rates (AERs: # exacerbations per person, per year [95% CI]). Results A total of 2,319 SA patients were included: 1,272 who demonstrated comorbid COPD and 1,047 who did not. SA patients with comorbid COPD were older (mean age 62 versus 55 years) and more often male (38% versus 29%). Common comorbidities were more prevalent among SA patients with comorbid COPD versus those without, including hypertension (73% versus 48%), dyslipidemia (52% versus 34%), depression (42% versus 26%), diabetes (39% versus 25%), and gastroesophageal reflux disease (37% versus 24%). SA patients with comorbid COPD had AERs of 0.49 (0.47, 0.52) for asthma and 1.38 (1.34, 1.42) for COPD. In SA patients without comorbid COPD, the asthma-specific AER was 0.55 (0.52, 0.57). AERs requiring hospitalization were also much higher among SA patients with comorbid COPD (0.05 [0.04, 0.05] asthma-related and 0.20 [0.19, 0.22] COPD-related hospitalizations) compared to those without comorbid COPD (0.01 [<0.01, 0.01] asthma-related hospitalizations). Conclusions SA patients with comorbid COPD experienced greater clinical burden than those without comorbid COPD, including higher respiratory exacerbation rates and hospitalizations. These results suggest an additive effect of the two conditions and highlight the value in specifically studying clinical outcomes and treatment effectiveness in patients with SA and comorbid COPD.