8. Asthma-COPD overlap is characterized by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD. 20. Asthma vs. COPD. 0000010222 00000 n National Heart, Lung, and Blood Institute. Learn More; search close Chronic Obstructive Pulmonary Disease (COPD) and Asthma: Differential Diagnosis. Centers for Disease Control and Prevention. The Guidelines for the Diagnosis and Management of Asthma14 provides guidelines that emphasize the importance of asthma control and introduces approaches for monitoring asthma in high-risk groups and other patients with asthma. ACOS is therefore identified by the features that it shares with both asthma and COPD.”3,6, COPD worsens over time, so routine follow-up and monitoring is essential. The differential diagnosis of COPD is pre-sented in . Of the patients diagnosed with COPD, 71.4% were treated with ICs, and 12% of those classified as having asthma were not receiving ICs. Many asymptomatic patients who have COPD will never require oxygen therapy or experience more severe symptoms. JAMA. The more severe an individual’s COPD, the higher the associated costs. Spirometry should be obtained to diagnose airflow obstruction in patients who have respiratory symptoms, particularly dyspnea.17 Without obtaining spirometry, it is difficult to distinguish older adults who have asthma from those who have COPD. Weiter vor allem eine im Verlauf der Krankheit immer stärker werdende Atemnot. Likewise, many people who have COPD may not be diagnosed until the disease is advanced and interventions are less effective.To diagnose your condition, your doctor will review your signs and symptoms, discuss your family and medical history, and discu… Global Initiative for Asthma (GINA). 0000066134 00000 n Beim Asthma kommen die Beschwerden Husten und Atemnot … Therefore, they do not experience dyspnea and may respond to open-ended questions by saying that they are “breathing fine.” If these patients do not have exacerbations, their COPD may not interfere with their lives. Spirometry is recommended in all symptomatic patients to make the diagnosis and assess severity. AAFP’s tobacco cessation program, Ask and Act, encourages family physicians to ASK their patients about tobacco use, then ACT to help them quit. Differentiating chronic obstructive pulmonary disease (COPD) from asthma can be complicated, especially in older adults and individuals who smoke. 1.8 million emergency department visits (2011), 14.2 million physician office visits (2010). 6. Eur Respir J. Chronic obstructive pulmonary disease among adults—United States, 2011. Support patient self-management of COPD or asthma by encouraging smoking cessation, providing routine monitoring, promoting medication regimen adherence, and encouraging physical fitness. Physicians are an important part of effective asthma management, but patients in some minority groups may not see a physician regularly as part of their asthma care. Any disease that impairs air flow through obstructed airways may cause wheezing. Unlike COPD, which typically develops later in life, asthma most often begins in childhood. Spirometry is crucial to the early and accurate diagnosis of asthma and COPD. Centers for Disease Control and Prevention. Short-acting β2-agonists are preferred in the acute setting.3 Systemic steroids may shorten recovery time, improve FEV1, and improve hypoxemia, but long-term management of COPD with oral steroid medicines is not recommended due to steroid myopathy.19 A five-day course of prednisone (40 mg per day) is recommended.3 Evidence related to the use of inhaled corticosteroids to manage COPD is controversial. 2013;144(1):284-305. Accessed September 8, 2015. Accessed September 6, 2015. 0000003864 00000 n National Heart, Lung, and Blood Institute. COPD typically occurs in individuals 40 years of age and older. 0000003999 00000 n More than one in four African-American adults and nearly one in seven Hispanic adults cannot afford routine physician visits. However, given the higher incidence of asthma in certain populations, the risks of COPD and asthma may overlap.3, In light of the common features of asthma and COPD, an approach that focuses on the features that are most helpful in distinguishing asthma from COPD is recommended. 0000043980 00000 n Deaths: Final Data for 2010. J Allergy Clin Immunol. GOLD defines COPD as “a common preventable and treatable disease, characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lungs to noxious particles or gases.”3 Airflow limitation in COPD may be improved with use of bronchodilators. According to the National Institutes of Health (NIH), asthma is more common and more severe among women; children; low-income, inner-city residents;13 and African-American and Puerto Rican communities.13 In general, these populations experience above-average rates of ED visits, hospitalizations, and mortality.13 These rates are higher than differences in asthma prevalence would suggest. In some patients with chronic asthma, a clear distinction from COPD is not possible using current imaging and physiological testing techniques. Because the diseases lead to multiple hospitalizations, frequent emergency room visits, and constant medical expenses, AAFP considers COPD and asthma top priorities. For example, in 2008, children missed 10.5 million days of school and adults missed 14.2 million days of work due to asthma.11 It is estimated that approximately nine people in the United States die from asthma each day and more women than men die from asthma.11, Individuals aged 65 to 74 years are more likely to report COPD.5 Low economic status is a risk factor for the disease, as those individuals with an annual household income of less than $25,000 were more likely than any other income group to have visited a hospital or emergency department for COPD.5 This risk may be related to disproportionately high cigarette usage, indoor and outdoor pollutants, crowding, poor nutrition, or infections. 2013;309:2223-2231. Unterschiede, Differenzialdiagnose und Diagnose von Asthma und COPD. Other potential diagnoses are easier to distinguish from COP D2: Diagnosing and managing asthma. Stay Dialed In on the Fight for Family Medicine, AAFP Digital Assistant Pilot Opportunities Available. Bronchodilator reversibility of FEV1  greater than 12% and 200 mL, Bronchodilator reversibility of FEV1/FVC less than 0.7, Class 1: FEV1 greater than or equal to 80% (Mild), Class 2: FEV1 greater than 80% (Moderate), Class 4: FEV1 less than 30% (Very Severe). Table 1. 0000003305 00000 n African-American and Hispanic children visit emergency departments for asthma care more often than white children. 0000055353 00000 n A written asthma action plan can help patients recognize and appropriately address worsening symptoms. Take into account clinical characteristics and epidemiological factors to narrow down the diagnosis. 0000014984 00000 n Physicians must also rule out other potential causes of respiratory symptoms. 0000024099 00000 n 0000004926 00000 n Patient's history and physical evaluation give major hints of the underlying disease. However, some individuals who have COPD have significant interference with function or frequent exacerbations, and these patients have progressive decline in lung function.3, Distinguishing between COPD and asthma can have important implications in terms of management and life expectancy. 0000020149 00000 n Armstrong, C. ACP updates guideline on diagnosis and management of stable COPD. Patient resources on COPD treatment, starting with “stop smoking” can be found at at familydoctor.org. Another option for adults and adolescents to reduce the risk of exacerbations is a combination of low-dose ICS with formoterol.14 For children ages 5 to 11 years, increasing the ICS dose is preferred to an ICS/LABA combination.14, Long-term ICS therapy is recommended for patients who have asthma and are at high risk of exacerbations.14 The flu vaccine reduces the risk of death and hospitalizations for anyone six months and older with asthma.20, For COPD, initial treatment should provide appropriate management of symptoms with bronchodilators or combination therapy, but not with ICS alone. COPD and asthma share common features such as chronic airway inflammation and remodeling and chronic airflow obstruction, while they involve numbers of differences. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. MMWR Morb Mortal Wkly Rep. 2012;61:938-943. Accessed September 6, 2015. Author A S Teirstein 1 Affiliation 1 Dept. 0000008898 00000 n Guidelines for the diagnosis and management of Asthma (EPR-3) July 2007. 0000057943 00000 n According to the Centers for Disease Control’s (CDC) National Asthma Control Program, asthma is getting worse. African-American adults are hospitalized for asthma more often than white adults. 0000025684 00000 n 0000005796 00000 n 0000065006 00000 n Development and first validation of the COPD Assessment Test. 0000032974 00000 n 0000003545 00000 n 2. 0000002744 00000 n Copyright © 2020 American Academy of Family Physicians. Current medications for COPD have not been shown to lessen the long-term decline in lung function.3. 0000029397 00000 n National Vital Statistics Report. The diagnostic profile of asthma or COPD can be assembled from a careful history that considers age; symptoms (in particular, onset and progression, variability, seasonality or periodicity, and persistence); history; social and occupational risk factors (including smoking history, previous diagnoses, and treatment); and response to treatment.3. The most effective treatment for COPD or asthma is a partnership between the patient and his or her physician. Therefore, it is vital to concentrate efforts on evaluating a patient’s asthma stage and using stepped therapy and self-management that includes an asthma action plan. 1. 14. Both asthma and COPD are treatable. Indirect costs include lost workdays and disruption of life. 17. Together, these conditions account for 20% of visits to family physicians. Sleep/Work/Play Asthma Control Questionnaire, Medical Research Council (MRC) Dyspnea Index (the MRC breathlessness scale), Symptoms that vary over time, often limiting activity, Symptoms that vary either seasonally or from year to year, A record (e.g., spirometry, peak expiratory flow [PEF]) of variable airflow limitation, Family history of asthma or other allergic condition, Symptoms that improve spontaneously or have an immediate response to bronchodilator treatment or to inhaled corticosteroids (ICS) over a period of weeks, Heavy exposure to risk factors, such as tobacco smoke or biomass fuels, Symptoms that worsen slowly over time (i.e., progressive course over years), Severe hyperinflation or other changes on chest X-ray. More than one in four African-American adults and one in five Hispanic adults cannot afford their asthma medications. Travel Medicine Livestream | March 19-20 | Become better informed about guidance and recognize travel-related disease and risks as you see your patients before or after their travels. Jones PW, Harding G, Berry P, et al. Data and Statistics. Accessed September 8, 2015. The American Lung Association (ALA) estimates that there may be as many as 24 million American adults living with COPD (Healthline, 2018). They develop exercise intolerance because of air trapping and exertional dyspnea-related chest expansion.3 Consequently, they minimize their exercise and attribute deconditioning to normal aging. Most recent asthma data. High school graduates and adults with incomes greater than $75,000 are less likely to have asthma. Free COPD, Asthma Resources Now Available for Physicians and Patients. Accessed March 20, 2015. Flu and people with asthma. 1223 0 obj <> endobj xref 1223 74 0000000016 00000 n Accessed October 28, 2015. 0000026361 00000 n 12. 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