What are the differences in management between Asthma and Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

Asthma and COPD management differ significantly, with asthma focusing on controlling inflammation and preventing triggers, and COPD emphasizing bronchodilation and reducing exacerbations. The most recent and highest quality study, 1, published in 2023, highlights the importance of personalized management plans for individuals living with COPD, including confirming diagnosis with spirometry, evaluating symptom burden, and implementing pharmacological and nonpharmacological treatments. Key differences in management approaches include:

• Asthma management primarily using inhaled corticosteroids (ICS) like fluticasone or budesonide as first-line therapy, often combined with long-acting beta-agonists (LABAs) such as salmeterol or formoterol in moderate to severe cases.
• COPD management typically starting with long-acting bronchodilators such as tiotropium (a long-acting muscarinic antagonist or LAMA) or salmeterol/formoterol (LABAs), with ICS added for patients with frequent exacerbations or high eosinophil counts. Both conditions may require oxygen therapy in advanced stages, but pulmonary rehabilitation is particularly important for COPD, as noted in 1 and 1. Smoking cessation is crucial for both conditions but especially vital in COPD to slow disease progression, as emphasized in 1 and 1. Asthma management is more focused on achieving complete symptom control and normal lung function, while COPD management accepts some persistent symptoms while working to reduce exacerbations and maintain quality of life, reflecting the more reversible nature of asthma versus the progressive nature of COPD, as discussed in 1.

From the FDA Drug Label

Inflammation is an important component in the pathogenesis of asthma. Corticosteroids have been shown to have a wide range of actions on multiple cell types (e.g., mast cells, eosinophils, neutrophils, macrophages, lymphocytes) and mediators (e.g., histamine, eicosanoids, leukotrienes, cytokines) involved in inflammation. These anti-inflammatory actions of corticosteroids contribute to their efficacy in asthma. Inflammation is also a component in the pathogenesis of COPD. In contrast to asthma, however, the predominant inflammatory cells in COPD include neutrophils, CD8+ T-lymphocytes, and macrophages The effects of corticosteroids in the treatment of COPD are not well defined and ICS and fluticasone propionate when used apart from Wixela Inhub® are not indicated for the treatment of COPD.

The management of asthma and COPD differs in terms of the underlying inflammatory processes and the role of corticosteroids.

• Asthma is characterized by inflammation involving multiple cell types, and corticosteroids are effective in reducing this inflammation.
• COPD, on the other hand, has a different inflammatory profile, with a predominance of neutrophils, CD8+ T-lymphocytes, and macrophages, and the effects of corticosteroids are not well defined. It is essential to note that the use of ICS (Inhaled Corticosteroids), such as fluticasone propionate, is not indicated for the treatment of COPD when used alone, but may be used in combination with a LABA (Long-Acting Beta2-Adrenergic Agonist), such as salmeterol, for the treatment of COPD 2.

From the Research

Management of Asthma and COPD

The management of asthma and Chronic Obstructive Pulmonary Disease (COPD) involves various approaches, including lifestyle interventions, medication, and self-management strategies.

• Combined lifestyle interventions (CLIs) have been shown to be effective in managing both asthma and COPD, with improvements in quality of life, respiratory symptoms, and exercise capacity 3.
• These interventions often target multiple lifestyle factors, such as diet, physical activity, and smoking cessation.
• For asthma, inhaled corticosteroids (ICSs) and long-acting inhaled beta(2)-agonists (LABAs) are recommended treatment options, with combination therapies (e.g., fluticasone/salmeterol) frequently being more effective than monotherapies 4.
• Self-management support is also crucial, with health professionals helping patients recognize deteriorating symptoms, adhere to maintenance therapy, and promote healthy lifestyles 5.

Asthma-COPD Overlap (ACO)

Asthma-COPD overlap (ACO) is a condition where patients present with features of both asthma and COPD.

• The diagnosis and management of ACO are still controversial, with recent guidelines providing insight into diagnostic modalities and treatment choices 6.
• Therapeutic options for ACO range from bronchodilator therapy to immunomodulatory therapy, highlighting the heterogeneity of this condition.
• Additional research is needed to improve understanding of the pathogenesis and outcomes in ACO.

Key Differences in Management

While there are similarities in the management of asthma and COPD, there are also key differences.

• Asthma management often focuses on controlling symptoms, maintaining activities, and minimizing risks of exacerbation, with a strong emphasis on self-management and adherence to medication 5.
• COPD management, on the other hand, may involve more emphasis on smoking cessation, pulmonary rehabilitation, and oxygen therapy, in addition to medication and self-management strategies 3.