copd and asthma differential diagnosis aafp

0000003864 00000 n Asthma is suspected largely on a person’s report of characteristic symptoms; the diagnosis is confirmed by doing pulmonary function tests. 13. Physicians must also rule out other potential causes of respiratory symptoms. 5. 0000018615 00000 n Patients typically have symptoms of chronic bronchitis and emphysema, but the classic triad also includes asthma (see the image below). Damit verbunden ist schließlich eine massive Einschränkung der körperlichen Belastbarkeit. 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. Despite their similarities, they require different treatment methods and both are underdiagnosed and undertreated. 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. 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. Asthma-COPD overlap is characterized by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD. Direct costs also include home care and home oxygen therapy. 0000003835 00000 n 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. 0000013168 00000 n COPD typically occurs in individuals 40 years of age and older. In some patients with chronic asthma, a clear distinction from COPD is not possible using current imaging and physiological testing techniques. AAFP Digital Assistant Pilot Opportunities Available . 0000009775 00000 n Unlike COPD, which typically develops later in life, asthma most often begins in childhood. All rights Reserved. Deaths: Final Data for 2010, Chronic obstructive pulmonary disease (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. Medications are used to reduce symptoms, reduce the frequency and severity of exacerbations, and improve exercise tolerance. 0000043980 00000 n National Heart, Lung, and Blood Institute. Centers for Disease Control and Prevention. Chronic obstructive pulmonary disease (COPD) is a progressive disease state characterized by airflow limitation that is not fully reversible. National Center for Health Statistics. 0000010593 00000 n COPD Surveillance – United States, 1999-2011. Most can be excluded without an extensive evaluation. 14. 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. 0000003734 00000 n Once airflow obstruction is determined with spirometry, the next step is to determine the underlying cause and differentiate between asthma and COPD. 21. Respir Care. Other potential diagnoses are easier to distinguish from COP D2: American Lung Association. The recommended duration of antibiotic therapy is 5 to 10 days. In the last decade, the proportion of people with asthma in the United States grew by nearly 15%. 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. 0000058879 00000 n 10. National Asthma Control Program. of Medicine, Mount Sinai School of Medicine, New York, NY 10029. 0000065560 00000 n Any disease that impairs air flow through obstructed airways may cause wheezing. Accessed October 28, 2015. GOLD defines COPD as “a common preventable and treatable disease, characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lungs to noxious particles or gases.”3 Airflow limitation in COPD may be improved with use of bronchodilators. 0000009208 00000 n Differential diagnosis of COPD must take into consideration the symptom complex obtained from the patient’s history and physical examination findings. A written asthma action plan can help patients recognize and appropriately address worsening symptoms. 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. Centers for Disease Control and Prevention. The differential diagnosis of chronic obstructive pulmonary disease (COPD) includes: Asthma — COPD and asthma can be difficult to distinguish clinically and may co-exist. 10 This test is considered moderately sensitive with low specificity for the diagnosis of asthma. What are the signs and symptoms of COPD? Guidelines for the diagnosis and management of Asthma (EPR-3) July 2007. 2. J Allergy Clin Immunol. Patient resources on COPD treatment, starting with “stop smoking” can be found at at familydoctor.org. 0000025684 00000 n When diagnosing asthma, the key element is reversibility, so spirometry should be performed both pre- and post-bronchodilator use. Copyright © 2020 American Academy of Family Physicians. Both asthma and COPD are treatable. 1223 0 obj <> endobj xref 1223 74 0000000016 00000 n Differentiating chronic obstructive pulmonary disease (COPD) from asthma can be complicated, especially in older adults and individuals who smoke. 0000007972 00000 n 17. 0000026361 00000 n Asthma care quick reference. Pathological changes may begin years before symptoms appear. 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. Asthma-COPD overlap syndrome (ACOS), which shares features with both asthma and COPD, should also be considered. Most recent asthma data. The CDC reports the following statistics: These disparities in asthma care and burden suggest that culturally competent clinical and educational approaches are needed. 2012;85:204-205. Guidelines from the National Asthma Education and Prevention Program. 0000059350 00000 n Patient's history and physical evaluation give major hints of the underlying disease. Chronic obstructive pulmonary disease (COPD) is estimated to affect 32 million persons in the United States and is the third leading cause of death in this country. More than one in four African-American adults and one in five Hispanic adults cannot afford their asthma medications. Accessed March 20, 2015. National Heart, Lung, and Blood Institute. 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. In the course of a differential diagnosis, some of the more common investigations would include asthma, congestive heart failure, bronchiectasis, tuberculosis , and obliterative bronchiolitis. Use tools to effectively diagnose chronic obstructive pulmonary disease (COPD) and asthma and help patients self-manage these chronic illnesses. The states with the highest COPD prevalence are clustered along the Ohio and lower Mississippi Rivers.5. Accessed March 20, 2015, 3. However, early identification of COPD offers patients the opportunity to increase physical activity, improve quality of life, and stop smoking. 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. 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. For more information, see the CKS topic on Bronchiectasis. 0000030941 00000 n The American Lung Association (ALA) estimates that there may be as many as 24 million American adults living with COPD (Healthline, 2018). 1991 Nov;58(6):466-71. COPD and asthma share common features such as chronic airway inflammation and remodeling and chronic airflow obstruction, while they involve numbers of differences. It establishes severity/stage based on FEV1 and FEV1/FVC. 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. Get information to help you prepare your practice, counsel your patients and administer the vaccine. Bronchodilators increase FEV1 by alternating smooth muscle tone.3 The two classes of bronchodilators are β2-agonists and anticholinergics. As a member, you'll receive a variety of exclusive products, programs, services, and discounts totaling more than $3,800 in member savings. Learn More; search close Chronic Obstructive Pulmonary Disease (COPD) and Asthma: Differential Diagnosis. Accessed September 10, 2015. Indirect costs include lost workdays and disruption of life. 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. Accessed September 8, 2015. Author A S Teirstein 1 Affiliation 1 Dept. DIFFERENTIAL DIAGNOSIS : A major differential diagnosis is asthma. 0000047768 00000 n Die typischen Beschwerden der COPD sind einerseits Husten sowie Auswurf. Physicians are an important part of effective asthma management, but patients in some minority groups may not see a physician regularly as part of their asthma care. 7. 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. Accessed September 8, 2015. 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. 0000057943 00000 n The AAFP booklet “ COPD and Asthma: Differential Diagnosis ” for physicians, highlights the importance of short- and long-term monitoring, maximizing lung function, and managing exacerbations and airflow limitations. 0000065006 00000 n In 2010, more than 70,000 women and approximately 64,000 men died of COPD.9 For more than a decade, more women than men have died of COPD.8 According to the CDC, the rate of mortality due to COPD declined for men in the United States between 1999 (57.0 per 100,000) and 2010 (47.6 per 100,000), but there was no significant change in the mortality rate for women (35.3 per 100,000 in 1999 and 36.4 per 100,000 in 2010).10, In 2010, asthma was the primary diagnosis in 14.2 million physician office visits and there were 1.8 million ED visits for asthma in 2011.1 Nearly 1 in 5 children who had asthma went to an emergency department for care in 2009.11 According to one study, asthma costs the United States $56 billion each year.12 In 2009, the average yearly cost of care for a child who had asthma was $1,039.11 In addition to direct medical costs, indirect costs of asthma include missed school and work days. Chronic obstructive pulmonary disease among adults—United States, 2011. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Development and first validation of the COPD Assessment Test. Some people have coexisting asthma and COPD. Global Initiative for Asthma (GINA). 0000006381 00000 n Global Initiative for Chronic Obstructive Lung Disease (GOLD). 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. 0000028360 00000 n According to the Centers for Disease Control’s (CDC) National Asthma Control Program, asthma is getting worse. 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. This consideration could lead to diagnosis at an earlier stage in the disease at which interventions are more likely to help.3, Though the most common diagnostic dilemma is differentiating COPD from asthma, many other illnesses share symptoms and/or physical findings with COPD. African-American children are two times more likely to have asthma than white children. Armstrong, C. ACP updates guideline on diagnosis and management of stable COPD. Understand the importance of short- and long-term monitoring, maximizing lung function, and managing exacerbations and airflow limitations. 18. More information from the Global Initiative for Chronic Obstructive Lung Disease’s (GOLD) Asthma, COPD, and Asthma-COPD Overlap Syndrome can be found here. 0000066417 00000 n 0000021784 00000 n 2013;144(1):284-305. 15. 0000001776 00000 n 0000058345 00000 n More than one in four African-American adults and nearly one in seven Hispanic adults cannot afford routine physician visits. Leuppi JD, Schuetz F, Bingisser R, et al. Free COPD, Asthma Resources Now Available for Physicians and Patients. Take into account clinical characteristics and epidemiological factors to narrow down the diagnosis. 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. 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. 0000004926 00000 n Centers for Disease Control and Prevention. Ford, IS, Croft JB, Mannino DM, et al. Sleep/Work/Play Asthma Control Questionnaire, Medical Research Council (MRC) Dyspnea Index (the MRC breathlessness scale), Symptoms that vary over time, often limiting activity, Symptoms that vary either seasonally or from year to year, A record (e.g., spirometry, peak expiratory flow [PEF]) of variable airflow limitation, Family history of asthma or other allergic condition, Symptoms that improve spontaneously or have an immediate response to bronchodilator treatment or to inhaled corticosteroids (ICS) over a period of weeks, Heavy exposure to risk factors, such as tobacco smoke or biomass fuels, Symptoms that worsen slowly over time (i.e., progressive course over years), Severe hyperinflation or other changes on chest X-ray. 0000016739 00000 n The American Academy of Family Physicians (AAFP) is now providing updated resources, including a booklet and brochure, focusing on the differences and similarities between asthma and chronic obstructive pulmonary disease (COPD).. Asthma’s impact on the nation. Differential Diagnosis for Chronic Obstructive Pulmonary Disease. Centers for Disease Control and Prevention. 0000011164 00000 n 6. 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They differ in preferred treatment and prognosis performed both pre- and post-bronchodilator use addition, monitor and. C. ACP updates guideline on diagnosis and assess severity, Differenzialdiagnose und Diagnose von copd and asthma differential diagnosis aafp!
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