The clinical examination may suggest asthma or COPD, but no set of clinical findings is diagnostic.3,16 In addition, home lung function tests are not an established way to diagnose COPD, although they are useful for monitoring.3,16, There is a strong likelihood of correct diagnosis if a patient presents with three or more of the features listed above for either asthma or COPD in the absence of features of the alternative diagnosis. Most can be excluded without an extensive evaluation. Concordance of the differential diagnosis tools was moderate (clinical diagnosis versus spirometry and between the two questionnaires), low (clinical diagnosis versus questionnaires), and very low (spirometry versus differential diagnosis). Barnett SB, Nurmagambetov TA. Spirometry should be performed to make the diagnosis of COPD.3, As noted previously, asthma is the most common alternative diagnosis to COPD, and its symptoms (e.g., shortness of breath, chronic cough, etc.) Women are more likely to have asthma than men, yet boys are more likely to have asthma than girls.11 Adults ages 18 to 24 are more likely to have asthma than older adults.11 Many patients outgrow their asthma. Pathological changes may begin years before symptoms appear. Usually the level of severity of asthma—mild, moderate, or moderate to severe—is based on the level of treatment.6, Exacerbation Management and Lung Function, Smoking cessation is key for all patients who smoke and have COPD. This free recorded webcast covers best practices for care coordination, co-morbidities associated with COPD, environmental factors, how social determinants of health influence the condition, and more. Long-acting formulations are preferred. 0000059350 00000 n Prepare for the ABFM exam with the AAFP’s Family Medicine Board Review Express Livestream, February 18-21 and get the same in-depth Board review but with all the conveniences of your home or office. COPD and asthma share common features such as chronic airway inflammation and remodeling and chronic airflow obstruction, while they involve numbers of differences. With proper management, … Centers for Disease Control and Prevention. 0000065560 00000 n Bronchodilator reversibility of FEV1  greater than 12% and 200 mL, Bronchodilator reversibility of FEV1/FVC less than 0.7, Class 1: FEV1 greater than or equal to 80% (Mild), Class 2: FEV1 greater than 80% (Moderate), Class 4: FEV1 less than 30% (Very Severe). 20. ACOS is therefore identified by the features that it shares with both asthma and COPD.”3,6, COPD worsens over time, so routine follow-up and monitoring is essential. 0000058879 00000 n The prevalence of COPD varies considerably by state, from less than 4% in Washington and Minnesota to greater than 9% in Alabama and Kentucky. Any disease that impairs air flow through obstructed airways may cause wheezing. Accessed September 6, 2015. Centers for Disease Control and Prevention. 0000003734 00000 n Patients should be trained to use inhaler devices properly in order to manage their condition effectively. Further diagnostic measures comprise lung function analysis including spirometry, plethysmography and--in severe cases--blood gas analysis. Damit verbunden ist schließlich eine massive Einschränkung der körperlichen Belastbarkeit. Table 1. Exacerbations of chronic obstructive pulmonary disease. It is estimated that 12.7 million individuals 18 years of age and older in the United States have been diagnosed with COPD.4 However, approximately 24 million adults in the United States have evidence of impaired lung function, which indicates that COPD may be underdiagnosed. The most effective treatment for COPD or asthma is a partnership between the patient and his or her physician. 0000043980 00000 n Suspected in patients with a history of smoking, occupational and environmental risk factors, or a personal or family history of chronic lung disease. 8. More than one in four African-American adults and one in five Hispanic adults cannot afford their asthma medications. They develop exercise intolerance because of air trapping and exertional dyspnea-related chest expansion.3 Consequently, they minimize their exercise and attribute deconditioning to normal aging. 0000023748 00000 n Together, these conditions account for 20% of visits to family physicians. Centers for Disease Control and Prevention. Deaths: Final Data for 2010, Chronic obstructive pulmonary disease (COPD). 0000007972 00000 n Both conditions affect the lungs, and often have similar symptoms, such as shortness of breath. 0000006381 00000 n Both asthma and COPD are treatable. Accessed September 10, 2015. Armstrong, C. ACP updates guideline on diagnosis and management of stable COPD. Spirometry is the gold standard for diagnosis of both asthma and COPD.3 The Global Initiative for Chronic Obstructive Lung Disease (GOLD), the Global Strategy for Asthma Management and Prevention, and the Global Initiative for Asthma (GINA) 2014 note this test in the diagnostic criteria for both asthma and COPD. 0000026361 00000 n The more severe an individual’s COPD, the higher the associated costs. 6. 0000036771 00000 n 0000032974 00000 n A major challenge facing primary care providers is diagnostic confusion between COPD and asthma. It establishes severity/stage based on FEV1 and FEV1/FVC. A diagnosis of chronic obstructive pulmonary disease (COPD) is based on a variety of things, from symptoms to family history. Accessed March 20, 2015. 17. 0000012603 00000 n 0000007330 00000 n Indirect costs include lost workdays and disruption of life. Some may require the judicious use of select tests. Eur Respir J. Be sure their action plan describes what steps to take when their symptoms change. According to a clinical description from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Global Initiative for Asthma (GINA), ACOS “is characterized by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD. Jones PW, Harding G, Berry P, et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. Other potential diagnoses are usually easier to distinguish from COPD In 2010, COPD was the primary diagnosis in 10.3 million physician office visits, 1.5 million emergency department (ED) visits, and 699,000 hospital discharges.8 According to the American Lung Association, the United States spent $29.5 billion in direct costs and $20.4 billion in indirect costs for COPD in 2011.2 Much of the direct cost of COPD is for hospitalizations following exacerbations. National Health Interview Survey. For example, in 2008, children missed 10.5 million days of school and adults missed 14.2 million days of work due to asthma.11 It is estimated that approximately nine people in the United States die from asthma each day and more women than men die from asthma.11, Individuals aged 65 to 74 years are more likely to report COPD.5 Low economic status is a risk factor for the disease, as those individuals with an annual household income of less than $25,000 were more likely than any other income group to have visited a hospital or emergency department for COPD.5 This risk may be related to disproportionately high cigarette usage, indoor and outdoor pollutants, crowding, poor nutrition, or infections. Multi-race and African-American adults are more likely to have asthma than white adults. COPD is commonly misdiagnosed — former smokers may sometimes be told they have COPD, when in reality they may have simple deconditioning or another less common lung condition. 0000005221 00000 n Accessed September 8, 2015. Bronchial provocation can be useful when asthma is a differential diagnosis, but spirometry is near normal or normal. Despite their similarities, they require different treatment methods and both are underdiagnosed and undertreated. Patients who have COPD most commonly present with persistent and progressive dyspnea, chronic cough, and/or sputum production.3 Although COPD cannot be diagnosed on the basis of any of these symptoms alone, COPD should be considered as a possible diagnosis in any patient who presents with one or more of them. In these patients, current management is similar to that of asthma. According to the National Institutes of Health (NIH), asthma is more common and more severe among women; children; low-income, inner-city residents;13 and African-American and Puerto Rican communities.13 In general, these populations experience above-average rates of ED visits, hospitalizations, and mortality.13 These rates are higher than differences in asthma prevalence would suggest. National Center for Health Statistics. 0000010593 00000 n Stay Dialed In on the Fight for Family Medicine, AAFP Digital Assistant Pilot Opportunities Available. 0000025684 00000 n 0000003622 00000 n 0000011164 00000 n Asthma care quick reference. National Heart, Lung, and Blood Institute. Spirometry should be obtained to diagnose airflow obstruction in patients who have respiratory symptoms, particularly dyspnea.17 Without obtaining spirometry, it is difficult to distinguish older adults who have asthma from those who have COPD. However, patients should first be asked about treatment adherence, inhaler techniques, comorbidities, and level of exposure to allergens.14 For adults and adolescents, a combination of low-dose ICS with a long-acting β2-agonist (LABA), plus an as-needed SABA, is the preferred step-up treatment. Social, economic, and cultural factors—ranging from lack of access to quality health care to differences in health beliefs between patients and their physicians—contribute to a greater burden of asthma on some patients.13 In addition, gaps in the implementation of clinical practice guidelines for asthma contribute to the ongoing problem of asthma-related health disparities among at-risk groups.13. 2012;85:204-205. Assess asthma severity at the initial visit to determine initial treatment, Use written asthma action plans to guide patient self-management, Use inhaled corticosteroids to control asthma, Assess and monitor asthma control and adjust treatment if needed, Schedule follow-up visits at periodic intervals, Control environmental exposures that worsen the patient’s asthma, Presence and degree of inflammation (irritation from smoking is the primary cause of COPD), Presence and degree of airflow limitation, including bronchoconstriction, edema, and mucus, Presence and degree of airways remodeling, Recurrent cough, wheezing, sputum production, dyspnea, or repeated acute lower respiratory tract infections, Symptoms are variable to intermittent in asthma, Symptoms are chronic and usually progressive in COPD, Previous treatment for or diagnosis of asthma or COPD. The median prevalence in the United States is 5.8%.5 The states with the highest prevalence of COPD—Alabama, Illinois, Kentucky, Oklahoma, Tennessee, and West Virginia—are clustered along the Ohio and lower Mississippi rivers.5, The Global Initiative for Asthma (GINA) defines asthma as “a heterogeneous disease, usually characterized by chronic airway inflammation. Patients typically have symptoms of chronic bronchitis and emphysema, but the classic triad also includes asthma (see the image below). AAFP Digital Assistant Pilot Opportunities Available . Asthma vs. COPD. More than one in four African-American adults and nearly one in seven Hispanic adults cannot afford routine physician visits. Centers for Disease Control and Prevention (CDC). As a member, you'll receive a variety of exclusive products, programs, services, and discounts totaling more than $3,800 in member savings. 0000048075 00000 n AAFP’s tobacco cessation program, Ask and Act, encourages family physicians to ASK their patients about tobacco use, then ACT to help them quit. The states with the highest COPD prevalence are clustered along the Ohio and lower Mississippi Rivers.5. 0000003545 00000 n 9. In some patients with chronic asthma, a clear distinction from COPD is not possible using current imaging and physiological testing techniques. Differential Diagnosis for Chronic Obstructive Pulmonary Disease. Weiter vor allem eine im Verlauf der Krankheit immer stärker werdende Atemnot. Centers for Disease Control and Prevention. Patient resources on COPD treatment, starting with “stop smoking” can be found at at familydoctor.org. 0000013168 00000 n Chronic obstructive pulmonary disease (COPD) fact sheet. The major differential diagnosis is asthma, and in some cases, a clear distinction between COPD and asthma is not possible. Trends in COPD (chronic bronchitis and emphysema): morbidity and mortality. Identifying and Diagnosing COPD . National Center for Health Statistics. For more information, see the CKS topic on Bronchiectasis. Differentiating chronic obstructive pulmonary disease (COPD) from asthma can be complicated, especially in older adults and individuals who smoke. 0000001776 00000 n 14. . Therefore, they do not experience dyspnea and may respond to open-ended questions by saying that they are “breathing fine.” If these patients do not have exacerbations, their COPD may not interfere with their lives. National Asthma Control Program. 13. 0000003391 00000 n COPD typically occurs in individuals 40 years of age and older. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with variable expiratory airflow limitation.”6 It is a disease of reversible airways obstruction that has many different phenotypes (i.e., observable characteristics such as clinical presentation and triggers), each which has a different genetic/environmental cause and responds differently to treatment. The diagnosis of COPD should be confirmed by a postbronchodilator FEV 1 /FVC ratio less … In the last decade, the proportion of people with asthma in the United States grew by nearly 15%. 0000010222 00000 n If it’s not asthma, that’s important to know, because the strategy for obtaining ideal control of your symptoms is likely to be different than the strategy for treating asthma. 0000092784 00000 n Copyright © 2020 American Academy of Family Physicians. Expiratory airflow obstruction is the cardinal sign of both asthma and COPD. Accessed September 8, 2015. 0000057943 00000 n 2011;127(1):145-52. Beim Asthma kommen die Beschwerden Husten und Atemnot … More information from the Global Initiative for Chronic Obstructive Lung Disease’s (GOLD) Asthma, COPD, and Asthma-COPD Overlap Syndrome can be found here. Spirometry is recommended in all symptomatic patients to make the diagnosis and assess severity. 0000011561 00000 n 0000023332 00000 n Asthma-COPD overlap syndrome (ACOS), which shares features with both asthma and COPD, should also be considered. What are the signs and symptoms of COPD? In outpatient clinical practice, an accurate differential diagnosis is often very difficult, particularly in adult smokers, requiring specific lung function tests [4, 5]. Support patient self-management of COPD or asthma by encouraging smoking cessation, providing routine monitoring, promoting medication regimen adherence, and encouraging physical fitness. The differential diagnosis of chronic obstructive pulmonary disease (COPD) includes: Asthma — COPD and asthma can be difficult to distinguish clinically and may co-exist. 2003 Dec;48(12):1204-13. 0000012040 00000 n On-Demand Webinar: Spectrum of COPD Treatment. The differential diagnosis of COPD is pre-sented in . Because the diseases lead to multiple hospitalizations, frequent emergency room visits, and constant medical expenses, AAFP considers COPD and asthma top priorities. 1.8 million emergency department visits (2011), 14.2 million physician office visits (2010). Chronic obstructive pulmonary disease among adults—United States, 2011. The difficulty of differential diagnosis of asthma and COPD supports the value of objective measurement of lung function in the elderly. An as-needed short acting β2-agonist (SABA) alone is considered the first step in treatment for asthma.14 Regular daily low-dose ICS treatment, plus an as-needed SABA, is highly effective to reduce asthma-related exacerbations, symptoms, hospitalizations, and mortality. In the course of a differential diagnosis, some of the more common investigations would include asthma, congestive heart failure, bronchiectasis, tuberculosis , and obliterative bronchiolitis. Another option for adults and adolescents to reduce the risk of exacerbations is a combination of low-dose ICS with formoterol.14 For children ages 5 to 11 years, increasing the ICS dose is preferred to an ICS/LABA combination.14, Long-term ICS therapy is recommended for patients who have asthma and are at high risk of exacerbations.14 The flu vaccine reduces the risk of death and hospitalizations for anyone six months and older with asthma.20, For COPD, initial treatment should provide appropriate management of symptoms with bronchodilators or combination therapy, but not with ICS alone. 2013;309:2223-2231. 18. African-Americans are two to three times more likely to die from asthma than any other racial or ethnic group. National Heart, Lung, and Blood Institute. 0000024099 00000 n Centers for Disease Control and Prevention. 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Additionally, there are combinations of a long-acting bronchodilator and anticholinergic as well as long-acting anti-muscarinic agents (LAMAs) on the market and in development. 5. Deaths: Final Data for 2010. The diagnostic profile of asthma or COPD can be assembled from a careful history that considers age; symptoms (in particular, onset and progression, variability, seasonality or periodicity, and persistence); history; social and occupational risk factors (including smoking history, previous diagnoses, and treatment); and response to treatment.3. DIFFERENTIAL DIAGNOSIS : A major differential diagnosis is asthma. Direct costs also include home care and home oxygen therapy. However, some individuals who have COPD have significant interference with function or frequent exacerbations, and these patients have progressive decline in lung function.3, Distinguishing between COPD and asthma can have important implications in terms of management and life expectancy. %PDF-1.5 %���� Instruct patients who have asthma to monitor their symptoms, possibly with peak expiratory flow (PEF) meter recordings. J Allergy Clin Immunol. A chest X-ray is not needed to make a diagnosis, but is often obtained to exclude other diagnoses (e.g., tuberculosis and bronchiectasis). 1223 0 obj <> endobj xref 1223 74 0000000016 00000 n 0000030941 00000 n 2009;34:648-654. According to the Centers for Disease Control’s (CDC) National Asthma Control Program, asthma is getting worse. 0000028360 00000 n 0000003999 00000 n Accessed October 28, 2015. The classification of severity of airflow in COPD is based on post-bronchodilator FEV1.3, The frequent admission of asthma patients to the hospital is used as a measure of inadequate primary care. Take into account clinical characteristics and epidemiological factors to narrow down the diagnosis. Accessed March 20, 2015. Bronchodilators increase FEV1 by alternating smooth muscle tone.3 The two classes of bronchodilators are β2-agonists and anticholinergics. Smoking incidence and childhood exposure to secondhand smoke are important risk factors for COPD that are more likely to be present in individuals of lower socioeconomic status. Of the patients diagnosed with COPD, 71.4% were treated with ICs, and 12% of those classified as having asthma were not receiving ICs. Chronic obstructive pulmonary disease (COPD). According to the AAFP, in 2010, COPD was the primary diagnosis in 10.3 million physician office visits, 1.5 million emergency department (ED) visits, and 699,000 hospital discharges. Understand the importance of short- and long-term monitoring, maximizing lung function, and managing exacerbations and airflow limitations. 0000004926 00000 n COPD Surveillance – United States, 1999-2011. Reducing asthma disparities. Data and Statistics, Guidelines for the diagnosis and management of Asthma (EPR-3) July 2007, Lung function that may be normal between symptoms, Persistence of symptoms despite treatment, Immediate response to bronchiodilator treatment or to inhaled corticosteroids (ICS) over a period of weeks, Limited relief from rapid-acting bronchodilator treatment. 0000003835 00000 n American Lung Association. 0000006093 00000 n Accessed March 20, 2015. Likewise, many people who have COPD may not be diagnosed until the disease is advanced and interventions are less effective.To diagnose your condition, your doctor will review your signs and symptoms, discuss your family and medical history, and discu… Respir Care. 0000025189 00000 n Diagnosis of diseases of chronic airflow limitation: asthma, COPD and asthma-COPD overlap syndrome (ACOS). Ford, IS, Croft JB, Mannino DM, et al. Find tools, tips, and up-to-date information to help you through virtual interviews and more. 4. Perform spirometry yearly to identify patients who are experiencing a rapid decline.14 Ask specific questions about the patient’s well-being (e.g., by using a questionnaire such as the COPD Assessment Test) every three months.3 Assess symptoms (e.g., cough, sputum production, dyspnea, limitations of activity, sleep disturbances) and smoking status at every visit. Differential diagnosis of COPD must take into consideration the symptom complex obtained from the patient’s history and physical examination findings. Short-acting β2-agonists are preferred in the acute setting.3 Systemic steroids may shorten recovery time, improve FEV1, and improve hypoxemia, but long-term management of COPD with oral steroid medicines is not recommended due to steroid myopathy.19 A five-day course of prednisone (40 mg per day) is recommended.3 Evidence related to the use of inhaled corticosteroids to manage COPD is controversial. Am Fam Physician. Guidelines from the National Asthma Education and Prevention Program. Accessed September 6, 2015. However, the absence of any of these features has less predictive value and does not rule out the diagnosis of either disease.3 In the absence of pathognomonic features, a diagnosis is made on the weight of evidence, provided there are no features that clearly make the diagnosis unlikely. Free COPD, Asthma Resources Now Available for Physicians and Patients. JAMA. of Medicine, Mount Sinai School of Medicine, New York, NY 10029. All rights Reserved. Patients with more rapid decline in lung function require evaluation for oxygen therapy, right heart failure, and end-of-life decision making.21. Individuals who smoke must also rule out other potential causes of respiratory symptoms decline in lung function, end-of-life. To increase physical activity, improve quality of life confirmed by doing pulmonary function tests heart failure, and some... As chronic airway inflammation and remodeling and chronic airflow obstruction is determined with spirometry, higher. Of patients at risk of, or likely to have asthma than any other or. Physicians must also rule out other potential causes of respiratory symptoms is important, because differ... Use inhaler devices properly in order to manage their condition effectively a differential diagnosis inhaled... 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Jb, Mannino DM, et al on Bronchiectasis early and accurate copd and asthma differential diagnosis aafp of COPD patients! And COPD and diabetes PEF ) meter recordings worsening symptoms COPD supports the value objective! Highest COPD prevalence are clustered along the Ohio and lower Mississippi Rivers.5 self-manage these chronic illnesses and...