29 November 2017

New resource for asthma-COPD overlap

Clinical Respiratory

Patients with asthma-COPD overlap should be diagnosed and treated differently to people with either condition alone, according to a new resource for GPs.

The standalone paper, released today by the National Asthma Council Australia and the Lung Foundation Australia, draws attention to the roughly one in five patients with obstructive airway disease who have both asthma and COPD. 

“There is already a section in the Australian Asthma Handbook on asthma-COPD overlap but not as detailed as this,” said Dr Kerry Hancock, a GP who consulted on the paper. 

Patients with co-existing asthma and COPD tended to have more flare-ups, make greater use of health services and had a higher mortality than patients who had asthma or COPD alone, she said. 

However, patients with both conditions tended to get excluded from clinical studies.  

“There is a paucity of evidence around how this large group of patients should be managed from a pharmacotherapy point of view,” said Dr Hancock, who is also an executive member of the National COPD Program at the Lung Foundation of Australia. 

The central message from the paper was that patients with COPD who had any features or history of asthma should receive regular inhaled corticosteroids (ICS) in addition to their long-acting beta2 agonist and/or a long-acting muscarinic antagonist. 

Current guidelines do not recommend ICS for patients with mild to moderate COPD. In asthma management, long-acting bronchodilators are always used in combination with ICS.  

“There are now quite good guidelines around which patients with COPD benefit from ICS and which ones don’t. But if they’ve got asthma, then they need ICS,” Dr Hancock said. 

Patients with asthma-COPD overlap initially present with respiratory symptoms, such as cough, wheeze, shortness of breath and maybe sputum production. Spirometry is essential to confirm airflow limitation in the patient with asthma-COPD overlap. 

Distinguishing between typical asthma in childhood and typical COPD in a heavy smoker was straightforward, the paper said. It could be difficult, however, to distinguish COPD from asthma in adults who had features of both conditions.  

To make the diagnosis of asthma-COPD overlap the GP would need to ask: “Does this patient with COPD also have co-existing asthma? Or, is that patient who has long-standing asthma now developing features of COPD?”, Dr Hancock said.

Patients presenting with shortness of breath in their 70s, for instance, might not immediately link their symptoms to their history of childhood asthma, so it was important that GPs undertook a thorough history to elicit features of asthma, she said. 

Development of the resource was supported by an unrestricted educational grant from AstraZeneca Australia. The National Asthma Council Australia and Lung Foundation Australia maintained strict editorial independence.