A new study entitled “AIMAR survey on complex forms of bronchial asthma and COPD, their management and perception of critical issues” published in Multidisciplinary Respiratory Medicine journal describes a study called “AIMAR” that is designed to assess the most current measures for management of patients with complex forms of bronchial asthma and chronic obstructive pulmonary disease.
Bronchial asthma and chronic obstructive pulmonary disease (COPD) are both characterized by inflammation and obstruction of the airways. Despite sharing some common symptoms, they are classified as two distinct syndromes affecting lungs’ airways. However, in some patients, particularly elderly ones, the distinction between both diseases is extremely challenging when making a diagnosis, and they may exhibit overlapping syndromes, thus termed a ‘complex’ of asthma and COPD. This is the case, for example, of someone who has asthma and also smokes. These patients’ diagnoses and management are often disregarded in major international guidelines, such as GOLD for COPD and GINA for asthma, which focus on pure forms of each disease.
Therefore, the AIMAR study was undertaken to address how often clinicians identify complex forms of asthma/COPD in adult and elderly patients; how therapy is managed in these patients concerning goals and follow-up treatments; and clinicians’ difficulties in the diagnosis, treatment, monitoring, and evaluation of these patients.
The study resulted in 252 questionnaires from a wide range of clinicians, including pneumologists (n = 180), general practitioners (n = 32), allergologists (n = 8), internal medicine specialists (n = 20) and other specialists (n = 12).
The analysis of the questionnaire highlighted that, in fact, complex forms of bronchial asthma and COPD are frequently observed, particularly in patients with a previous history of asthma. Diagnosis was acknowledged as challenging if based on symptoms alone, however, a history of asthma and allergies is helpful. Furthermore, several risk factors were identified as important, such as smoking, obesity, bronchial hyperreactivity, and genetic predisposition. Concerning therapeutic goals, the study identified reduced inflammation and exacerbations, and this is usually achieved via monotherapy of inhaled corticosteroid (ICS) or combination of ICS and long acting β2-agonist (LABA), while the use of bronchodilator alone is to be avoided in these patients. Finally, the study concluded that the most limiting factor for the treatment of these patients is treatment continuity and integration between general practitioners and specialists.