Differentiating Asthma from COPD

Question 1

What are the common symptoms that suggest asthma?

Answer 1

Wheeze, nocturnal wakening, significant variability of symptoms.

Question 2

What are the typical characteristics of a person with asthma?

Answer 2

Non-smoker, history of atopy or hay fever.

Question 3

How is asthma differentiated from COPD using bronchodilator response testing?

Answer 3

Bronchodilator response of > +200 mL or +12% of FEV1 and/or FVC.

Question 4

Should a trial of steroids be considered for patients with suspected asthma?

Answer 4

Yes, a trial of steroids may be considered regardless of bronchodilator response.

Question 5

What are the key features used to diagnose COPD?

Answer 5

Airflow limitation not fully reversible
persistent breathlessness
cough
sputum production
FEV1/FVC ratio < 0.7 and FEV1 < 80% predicted.

Question 6

What is Asthma-COPD overlap syndrome (ACOS)?

Answer 6

Combination of asthma and COPD characteristics,
including incomplete reversibility of airflow obstruction and eosinophilic airway inflammation.

Question 7

Other considerations

Answer 7

A negative bronchodilator response does not predict a negative steroid trial.
A trial of response to inhaled steroids is preferred to a trial of oral steroids.
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.