Respiratory  |  COPD Pathway - Asthma




Respiratory

COPD Pathway - Asthma

Eliminate Asthma

Asthma

  • Pattern of symptoms suggests asthma, e.g., wheeze, nocturnal wakening, significant variability of symptoms.
  • Non-smoker, but history of atopy/hayfever.
  • Bronchodilator response of much greater than  200 ml or + 12% of FEV1 and/or FVC.
  • Patients with airflow obstruction that is completely reversible do not have COPD.
  • A trial of oral steroids may be considered regardless of the result of the bronchodilator response testing: 20 - 30 mg daily for 2 weeks, then repeat spirometry.


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However, there is some overlap between asthma and COPD:

  • Most patients with COPD have some (but incomplete) reversibility of airflow obstruction.
  • Some patients with chronic asthma develop persisting / irreversible airflow obstruction.
  • Patients with early onset asthma who smoke are at high risk of developing COPD.
  • Some patients with COPD have steroid-responsive airflow obstruction caused by eosinophilic airway inflammation.

Clinical Features Differentiating COPD and Asthma

 

COPD

Asthma

Smoker or ex-smoker

Nearly all

Possibly

Symptoms < 35 years old

Rare

Common

Chronic productive cough

Common

Uncommon

Breathlessness

Persistent and progressive

Variable

Night time waking with breathlessness and/or wheeze

Uncommon

Common

Significant diurnal or day to day variability of symptoms

Uncommon

Common


Source:
Chronic Obstructive Pulmonary Disease. Nice Guidelines, 2004.


Notes:

  • "Significant" improvement of the FEV1 or FVC has been defined as a >200 ml and > 12% improvement after bronchodilator. This is not sufficient for a diagnosis of asthma.
  • A negative bronchodilator response does not predict a negative steroid trial.
  • A positive trial of oral steroids does not predict a response to inhaled cortico-steroids - clinical assessment is required.
  • A negative bronchodilator response does not exclude effectiveness of bronchodilator treatments.
  • There may be symptomatic benefit of bronchodilator therapy for the patient in spite of relatively little change detectable by simple spirometry: less air trapping, less exertional dynamic hyperinflation.


Last updated : Wednesday, September 09, 2015
Next review date : Thursday, September 08,2016


Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.