New resources from the American Academy of Family Physicians (AAFP) are available to help effectively diagnose chronic obstructive pulmonary disease (COPD) and asthma, and help patients self-manage the chronic conditions.
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. An accompanying patients handout, “COPD and Asthma: What You Need to Know” defines COPD and asthma in simple terms and outlines common symptoms and treatment options.
Paper copies of the brochures were provide to AAFP members and internal medicine physicians who specialize in pulmonology in states with the highest number of patients with the diseases.
According to Dr. Clare Hawkins, lead physician for the Houston location of Aspire Health, asthma and COPD and key priorities for the AAFP.
“The number of people who get ill and hospitalized makes this a big public health priority, especially in disadvantaged populations,” Hawkins said in a news release. Hawkins is one of four family physicians who helped develop the resource materials.
COPD and asthma are common conditions but the different lung diseases have some similar symptoms, such as shortness of breath. Together, they account for 20% of visits to family physicians. Despite similarities they require different treatments.
“Family doctors do a good job and are in the right position to help patients with respiratory illness,” Hawkins said. “It’s worth digging a little deeper to delineate their symptoms and the severity of their disease. Patients will assume that their breathing disorder is from asthma, when it may really be from COPD. Physicians might think of a series of upper respiratory infections as viral infections instead of underlying asthma or COPD.”
Differentiating COPD from asthma can be complicated, especially in older adults and individuals who smoke. Both are underdiagnosed and undertreated.
Initial diagnosis of the conditions requires the identification of patients at risk of, or likely to have chronic airways disease. Physicians must also rule out other potential causes of respiratory symptoms. Asthma-COPD overlap syndrome (ACOS), which shares features with both asthma and COPD, should also be considered.
The primary features of COPD include: onset after age 40; persistence of symptoms despite treatment; abnormal lung function between symptoms; heavy exposure to risk factors, such as tobacco smoke or biomass fuels; symptoms that worsen slowly over time; limited relief from rapid-acting bronchodilator treatment; and severe hyperinflation or other changes on chest X-ray.
The primary features of asthma include: onset before age 20 years; symptoms that vary over time, often limiting activity; a record of variable airflow limitation; family history of asthma or other allergic condition; lung function that may be normal between symptoms; symptoms that vary either seasonally or from year to year; symptoms that improve spontaneously or have an immediate response to bronchodilator treatment or to inhaled corticosteroids (ICS) over a period of weeks; and normal chest X-ray.
Asthma patients immediately respond to bronchodilator treatments, and the disease is typically managed long-term with the use of inhaled corticosteroids. However, in patients with COPD only limited relief is reached from rapid-acting bronchodilators.
According to Dr. Hawkins, becuase COPD has a gradual onset, patients often don’t realize they have it, so specific and carefully worded questions can help physicians identify patients who might have the disease.
“We’re asking doctors not to ask, ‘Do you ever get short of breath’,” Hawkins said because that symptoms can be attributed to other reasons. “You should ask: ‘Are you able to do the activities you were doing last year or the year before? Are you able to do the activities your friends are doing?'”
An accurate diagnosis of either asthma, COPD or both will lead to better treatment and fewer exacerbations. According to the physician resource, symptoms of COPD are best-managed by improving the patient overall lung function with bronchodilators or combination therapy, but not with inhaled corticosteroids alone. COPD exacerbations may require steroids, bronchodilators, and/or antibiotics.
Mild asthma is best-managed with a short acting beta-agonist, and inhaled corticosteroids are effective for controlling symptoms and to reduce exacerbations. Other treatments to control exacerbations can be used, but patients with asthma should not rely solely on bronchodilators.
In 2016, many inhaled combination drugs became available. They included combinations of long-acting anti-muscarinic agents, inhaled corticosteroids, and long-acting beta-agonists. The AAFP’s physician education resource should help doctors make the right choice for certain patients according to their diagnosis and disease severity.
The most effective treatment for COPD or asthma should result from a partnership between the patient and his or her physician. Patient self-management of COPD or asthma should be supported by encouraging smoking cessation, providing routine monitoring, promoting medication regimen adherence, and encouraging physical fitness. Patients should be trained to use inhaler devices properly in order to manage their condition effectively.
“It’s critically important that physicians make consistent, caring messages about smoking cessation,” Dr. Hawkins said. “Family physicians are very effective at helping their patients quit, but it often takes repeated, caring messages delivered over time.”
AAFP’s tobacco cessation program, “Ask and Act,” encourages family physicians to “ask” patients about tobacco use, then “act” to help them quit. This resource can be found here.