Inclusion Criteria:  Asthma:  Patients were age 18 years and older. Patients had Asthma diagnosis record according to the International Classification of Disease 10th edition (ICD-10) codes J45,J45.x, J46, J46.x.  COPD:  Patients were age 18 years and older. Patients had COPD diagnosis record according to the International Classification of Disease 10th edition (ICD-10) codes J44 and J44.x.  ACO:  Patients were age 18 years and older. Patients had both COPD and Asthma diagnosis in a single record or within one year according to the International Classification of Disease 10th edition (ICD-10) codes J44, J44.x, J45,J45.x, J46 and J46.x.  Exclusion Criteria:  Asthma  Patients with any history of diagnosis of COPD. Patients had new diagnosis of COPD during Asthma follow up period.  COPD  Patients with any history of diagnosis of Asthma or bronchiectasis, interstitial lung disease(i.e. pulmonary fibrosis). Patients had new diagnosis of Asthma during COPD follow up period. ACO • Patients with any history of diagnosis of bronchiectasis, interstitial lung disease (i.e. pulmonary fibrosis).