Asthma-COPD overlap syndrome

Differentiating Asthma and COPD

	Asthma	COPD
Age of onset	<40 years	>40 years
Smoking	Not causal	>10 pack-years
Sputum	Infrequent	Often
Allergies	Often	Infrequent
Symptoms	Intermittent and variable	Persistent
Course	Stable, with exacerbations	Progressive, with exacerbations
Spirometry	Often normal	Never normalizes

Diagnostic Criteria (CTS 2017)

Required Criteria

1. Diagnosis of COPD based on risk factors, history, and spirometry
2. History of asthma, either as a past history or as current symptoms and spirometry consistent with asthma
3. Spirometry showing post-bronchodilator fixed FEV1/FVC <0.7

Supportive Criteria

• Bronchodilator improvement in FEV1 of 12% and 200 mL
• Sputum eosinophils >3%
• Blood eosinophils > 300 cell/uL

Management

• Same non-pharmacologic/preventative management as both COPD and asthma
• For puffers, try to use ones that are good in both
  • Don't use LABA monotherapy (b/c not good in asthma)
  • Don't use inhaled steroid alone (b/c not good in COPD)
• Puffers:
  • SABA prn
  • Next add ICS/LABA
  • Next add LAMA