Characteristics of patient-reported worsenings of asthma and/or COPD and concordance with physician-reported exacerbations

<bold>Background:</bold> Exacerbations of asthma and/or COPD are important clinical outcomes but reports of symptom worsening by patients and physicians may differ. <bold>Methods:</bold> NOVELTY (<ext-link>NCT02760329</ext-link>) is an international observational study of patients with physician-assigned asthma and/or COPD. Patient-reported episodes of worsening (PREW) were recorded 3-monthly. Physician recording of exacerbations included information on start date, medications, and medical care. We evaluated characteristics of patients who reported any PREW during the last 3 months of the first follow-up year, by physician-reported exacerbations over the same period. <bold>Results:</bold> Among 5,214 patients with asthma and/or COPD, during the 3 month period, PREW were reported by 56%, 55% and 50% patients with asthma, asthma+COPD, and COPD, respectively. In contrast, an exacerbation was reported, respectively, for 9%, 16% and 12% of patients. Nearly half of PREW events without corresponding exacerbations were treated. Patients with PREW and no exacerbations (vs. both PREW & exacerbation) were more likely male, more frequently current smokers, had higher lung function, lower intensity of respiratory symptoms and fewer physician visits. They also exhibited different comorbidity profile, e.g. less GERD, allergy, bronchiectasis in asthma, less emphysema in COPD. <bold>Conclusion:</bold> Patients with asthma and/or COPD frequently report episodes of treated and untreated PREW without a concomitant diagnosis of exacerbation by their health-care provider. This highlights potential under-reporting of exacerbations in obstructive lung disease, particularly among patients with perceived milder disease or with fewer physician visits.