A seasoned allergist and fellow from the American College of Allergy, Asthma and Immunology (ACAAI) recently presented a study during the institution’s Annual Scientific Meeting on the overlapping symptoms of chronic obstructive pulmonary disease (COPD) and asthma. One of the challenges physicians face in making an accurate diagnosis between the two are the similarities between symptoms, as both manifest with coughing, difficulty breathing, bronchospasms, wheezing and activity intolerance. It is important to properly distinguish between the two diseases, however, as their treatments tend to be completely different. Arlington Heights-based ACAAI is comprised of over 6,000 allergists and immunologists, and allied health professionals.
Dr. William Busse‘s findings suggest that as many as 50% of older adults with obstructive airway disease have ambiguous symptoms associated with both asthma and COPD, which underscores the need for more thorough patient assessment. “Based on symptoms alone, it can be difficult to diagnose COPD vs. asthma,” Dr. Busse said in a recent press release. “The pathway to a diagnosis of COPD or asthma — smoking vs. a long-term persistence of asthma — can be quite different. In every patient, but in older patients in particular, we need to take a thorough history and perform a physical examination, as well as measurements of lung functions. In patients with COPD and asthma, the changes in lung function may be severe, and it is not often readily apparent, which is the predominant, underlying condition — asthma or COPD. Treatment will differ depending on diagnosis.”
On one hand, lung function issues in asthma develop because of inflammation, which prompts physicians to prescribe inhaled corticosteroids. Problems with COPD, on the other hand, are due to exposure to lung irritants such as cigarette smoking, and only respond to anti-inflammatories such as corticosteroids in the event of an exacerbation. According to Dr. Michael Foggs, the ACAAI president, the treatment of choice for COPD is a bronchodilator, including beta blockers, while corticosteroid use in COPD have been associated with pneumonia.
Bronchodilators can be applicable in both conditions, but people with asthma are advised to avoid known triggers, while COPD patients are advised to stop smoking and avoid exposure to cigarette smoke. This is, of course, not to say asthmatics don’t have to avoid smoking, as this aggravates their condition and can reduce the effect of corticosteroids.
Dr. Busse concluded his presentation with a note to allergists on the importance of individualizing patient assessment and care, and for patients to be thorough and honest about their medical history, in order to receive appropriate and effective medical care.