Chronic obstructive pulmonary disease (COPD) and asthma
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SUMMARY OF PRACTICE POINTS
| LEVEL OF EVIDENCE |
| Always attempt to make a firm diagnosis in patients with airflow limitation, because the natural history and optimal management of COPD and asthma differ significantly. |
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| Consider COPD in all at-risk patients because early diagnosis and treatment improves outcomes. |
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| Consider COPD in patients who have other smoking-related diseases. |
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| Consider COPD in all smokers and ex-smokers older than 35 years. |
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| Set up a system to alert you to consider COPD in at-risk patients: smokers, elderly patients, patients with a diagnosis of asthma who do not respond to treatment as expected. |
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| Investigate breathlessness in patients at risk for COPD, even when the patient attributes it to ageing or poor fitness. |
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| Investigate further whenever a patient mentions consistent sputum production or persistent cough. |
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| The diagnosis of COPD is based on the demonstration of airflow limitation that is not fully reversible. |
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| Anticholinergic bronchodilators and SABAs are effective in managing symptoms |
I |
| Tiotropium and LABAs provide sustained relief of symptoms, improve exercise performance and reduce the frequency of severe exacerbations in moderate-to-severe COPD. |
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| Short-course oral corticosteroids reduce the severity and duration of exacerbations. |
[√I |
| Long-term use of oral corticosteroids is not recommended. |
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| Pulmonary rehabilitation reduces dyspnoea, anxiety and depression, improves exercise capacity and quality of life and may reduce hospitalisation rates in patients with COPD. |
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| Inhaled corticosteroids should be reserved for those with severe COPD and frequent exacerbations. |
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| Assessment of walking distance and the patient's report of symptomatic improvement are appropriate guides to effectiveness of therapy. |
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Chronic obstructive pulmonary disease (COPD) is a progressive, disabling disease characterised by symptoms of breathlessness during physical activity and/or daily cough with or without sputum, airway inflammation and airflow limitation that is not fully reversible.
- The precursor conditions that most commonly lead to COPD are small-airway narrowing (with or without chronic bronchitis) and emphysema caused by smoking.1
- Chronic bronchitis, emphysema and asthma overlap within COPD (Figure 1).
- COPD is characterised by intermittent acute exacerbations of symptoms (sputum production, breathing difficulties or both), which are usually due to respiratory tract infection, and can be significantly disabling.
Consider the possible diagnosis of COPD in all those who are at risk (e.g. smokers and ex-smokers, elderly patients) or who show airflow limitation that is not fully reversible.
An understanding of COPD is relevant to asthma management because:
- asthma and COPD have different prognoses and require different management1,2
- both asthma and COPD can overlap or coexist
- asthma and COPD have many common features, and may be difficult to distinguish3
- both asthma and COPD are under-diagnosed in the elderly.4,5
For more information on the diagnosis and management of COPD, see:
The COPD-X Plan: Australian and New Zealand guidelines for the management of chronic obstructive pulmonary disease 2006 (http://www.copdx.org.au/)
| Figure 1. Overlap of bronchitis, emphysema and asthma within COPD (represented by the shaded area). |
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| Adapted from ALF and TSANZ COPDX plan 20061 with permission |
Patients with well-controlled asthma usually have no airflow limitation. Symptoms may sometimes be experienced in the absence of airflow limitation in patients with chronic bronchitis or, infrequently, those with emphysema.
Content Created (Thursday, 16 November 2006)
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COPD and asthma 
