What are the assessment findings in Asthma (Chronic Obstructive Pulmonary Disease) and Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

Assessment findings in both asthma and COPD include wheezing, shortness of breath, cough, and chest tightness, but the key distinction lies in the episodic nature of asthma symptoms with reversible airflow obstruction, whereas COPD symptoms are more persistent and progressive with less reversibility. The goals of assessment in COPD, as outlined in the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report 1, are to determine the level of airflow limitation, define its impact on the patient's health status, and identify the risk of future events. In asthma, the diagnosis is established by determining that episodic symptoms of airflow obstruction or airway hyperresponsiveness are present, airflow obstruction is at least partially reversible, and a history of specific symptoms and triggers is noted, as per the Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007 1. Key assessment findings in asthma include:

• Episodic symptoms of airflow obstruction or airway hyperresponsiveness
• Airflow obstruction that is at least partially reversible, measured by spirometry
• History of symptoms such as cough, wheeze, difficulty breathing, and chest tightness
• Symptoms that occur or worsen in the presence of specific triggers like exercise, viral infections, or allergens. In contrast, COPD assessment focuses on the presence and severity of spirometric abnormality, current nature and magnitude of symptoms, history/future risk of exacerbations, and presence of comorbidities, as outlined in the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report 1. The most critical distinction between asthma and COPD lies in the reversibility of airflow obstruction, with asthma typically showing >12% improvement in FEV1 after bronchodilator administration, whereas COPD demonstrates less reversibility. Pulmonary function tests, including spirometry, are essential in establishing the diagnosis and assessing the severity of both conditions, with the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report 1 recommending spirometry after administration of a short-acting inhaled bronchodilator to minimize variability. A detailed medical history and physical examination are also crucial in assessing both conditions, with the Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007 1 providing guidance on the key elements to include in the medical history and physical examination. Overall, a comprehensive assessment is essential in distinguishing between asthma and COPD, guiding therapy, and improving patient outcomes.

From the FDA Drug Label

Trial 5 enrolled subjects with a diagnosis of asthma and a history of at least 1 asthma exacerbation in the previous year treated with systemic corticosteroid The efficacy of fluticasone propionate and salmeterol inhalation powder 250 mcg/50 mcg and fluticasone propionate and salmeterol inhalation powder 500 mcg/50 mcg in the treatment of subjects with COPD was evaluated in 6 randomized, double-blind, parallel-group clinical trials in adult subjects aged 40 years and older Two (2) of the 3 clinical trials primarily designed to evaluate the efficacy of fluticasone propionate and salmeterol inhalation powder on lung function were conducted in 1,414 subjects with COPD associated with chronic bronchitis The assessment findings that are in asthma include:

• Asthma exacerbation: defined as a deterioration of asthma requiring the use of systemic corticosteroids for at least 3 days or an in-patient hospitalization or emergency department visit due to asthma that required systemic corticosteroids
• Serious asthma-related events: including hospitalization, endotracheal intubation, and death The assessment findings that are in COPD include:
• Lung function: as defined by predose and postdose FEV1
• Exacerbations: defined as a deterioration of COPD requiring the use of systemic corticosteroids for at least 3 days or an in-patient hospitalization or emergency department visit due to COPD that required systemic corticosteroids 2

From the Research

Assessment Findings in Asthma and COPD

• Asthma assessment findings include the use of inhaled corticosteroids (ICSs) to decrease the risk of asthma exacerbations, as well as the implementation of "as-needed" ICS strategies to empower patients to adjust their ICS intake in response to symptom fluctuation 3.
• COPD assessment findings involve the use of spirometric tests to confirm a new diagnosis of COPD, and to distinguish between COPD and asthma, particularly in older patients with respiratory complaints 4.
• Patient-reported outcome measures, such as the COPD assessment test and the asthma control questionnaire, can be used to assess patient-reported outcomes in asthma and COPD patients, and to recommend treatment strategies 5.

Diagnostic Tests

• Diagnostic tests, such as spirometry and inhalation challenge tests, can be used to increase or decrease the probability of an asthma diagnosis, but a thorough history is also important 6.
• The COPD assessment test (CAT) can be used to compare the health-related quality of life and severity of airflow limitation in patients with asthma, COPD, and asthma-COPD overlap syndrome (ACOS) 7.

Key Differences between Asthma and COPD

• Asthma and COPD have different patterns of inflammation in the lungs, with asthma characterized by increased expression of inflammatory proteins and COPD characterized by a different type of inflammation 4.
• Asthma and COPD also have different responses to treatment, with asthma responding well to inhaled corticosteroids and COPD responding well to bronchodilators 4.