Asthma-COPD overlap syndrome
From IDWiki
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
- Diagnosis of COPD based on risk factors, history, and spirometry
- History of asthma, either as a past history or as current symptoms and spirometry consistent with asthma
- 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
