Differentiating chronic obstructive pulmonary disease from asthma in clinical practice

Abstract

Asthma and chronic obstructive pulmonary disease (COPD) represent a substantial proportion of primary care practice. In adults, differentiating asthma from COPD can be difficult but it is important because of the marked differences in treatment, disease progression, and outcomes between these two conditions. The symptoms present in both conditions are non-specific and overlapping. Under-diagnosis and misdiagnosis of COPD and over diagnosis of asthma are commonly reported. The diagnosis of obstructive respiratory diseases has been considered a challenge for many years. An increasing understanding of the clinical heterogeneity of asthma and chronic obstructive pulmonary disease, together with the inadequacy awareness of the current definitions, has led to attempts in developing a new taxonomy for airways diseases. Defining the various phenotypes is a research priority with great clinical relevance because of the potential to inform on the risk factors, underlying pathophysiological processes, natural history, monitoring and most important, the treatment. This is mainly because of the overlap between asthma and COPD and the difficult diagnosis of COPD in the early stages. In this context it will be very important to make the monitoring of disease progression by lung function and other domains in relation to initial clinical or physiological characteristics and especially according to phenotypes.