New resources from the AAFP are available to help family physicians and their patients better understand the differences -- and the similarities -- between chronic obstructive pulmonary disease (COPD) and asthma.
A four-page booklet aimed at physicians,(517 KB PDF) "COPD and Asthma: Differential Diagnosis," addresses the diagnostic differences between COPD and asthma, how to help patients self-manage their illness, and the importance of short- and long-term monitoring. It also provides guidance on how to maximize lung function and manage exacerbations and airflow limitations. An expanded version of the physician resource is available online.
An accompanying patient education handout(146 KB PDF) titled "COPD and Asthma: What You Need to Know" defines COPD and asthma in simple terms and outlines common symptoms and treatment options.
These resources were supported by Boehringer Ingelheim Pharmaceuticals.
- New resources from the AAFP are available to help family physicians and their patients better understand the differences -- and the similarities -- between chronic obstructive pulmonary disease (COPD) and asthma.
- A four-page booklet aimed at physicians addresses the diagnostic differences between COPD and asthma, how to help patients self-manage their illness, and the importance of short- and long-term monitoring.
- An accompanying patient education handout defines COPD and asthma in simple terms and outlines common symptoms and treatment options.
Copies of the physician booklet and patient brochure were mailed earlier this month to AAFP members and internal medicine physicians who subspecialize in pulmonology in the 14 states that have the highest prevalence of COPD. Those states are Alabama, Arkansas, Florida, Illinois, Indiana, Kentucky, Michigan, Mississippi, Missouri, Ohio, Oklahoma, South Carolina, Tennessee and West Virginia.
COPD and asthma are key priorities for the AAFP, according to Clare Hawkins, M.D., M.Sc., lead physician for the Houston location of Aspire Health, which provides specialized medical care for patients facing a serious illness.
"The number of people who get ill and (are) hospitalized makes this a big public health priority, especially in disadvantaged populations," said Hawkins, who was one of four family physicians who worked to develop the materials that aim to raise awareness on differentiating, diagnosing and managing the two conditions.
COPD is the third leading cause of death in the United States, according to the American Lung Association.(www.lung.org) An estimated 12.7 million Americans have been diagnosed with COPD, and 24 million U.S. adults have evidence of impaired lung function.
Asthma, which afflicts more than 22.5 million children and adults in this country, has become more prevalent in recent years, says the CDC's National Asthma Control Program.(www.cdc.gov) According to July 2013 figures,(www.cdc.gov) the condition is responsible for nearly 440,000 hospitalizations, 1.8 million emergency department visits and 14.2 million physician office visits.
"Family doctors do a good job and are in the right position to help patients with respiratory illness," Hawkins told AAFP News. "It's worth digging a little deeper to delineate their symptoms and the severity of their disease."
COPD and asthma are often incorrectly conflated and so may be underdiagnosed, he added. "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."
Although the two diseases may present with similar symptoms, several features are helpful in distinguishing the two and are listed in the physician resource. For example, the onset of COPD typically occurs at age 40 years or older; asthma generally has an onset before age 20. Asthma symptoms vary over time, while COPD symptoms are persistent and worsen slowly over time. Asthma symptoms immediately respond to bronchodilator treatments, and the condition is usually managed long term with inhaled corticosteroids. Patients with COPD, on the other hand, receive only limited relief from rapid-acting bronchodilator treatment.
Because COPD has a gradual onset, patients often don't realize they have it, Hawkins explained. A few carefully worded questions, however, can help physicians identify patients who might have the disease.
"We're asking doctors not to ask, 'Do you ever get short of breath?'" he said, because this can often be attributed to deconditioning or age. Instead, Hawkins noted, "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.
COPD symptoms are best managed by improving overall lung function with bronchodilators or combination therapy, but not with inhaled corticosteroids alone, according to the physician resource. Exacerbations may require bronchodilators, steroids and/or antibiotics.
Mild asthma is best managed with a short acting beta-agonist as needed. Inhaled corticosteroids are effective for controlling symptoms in patients with persistent asthma and at reducing exacerbations. Other controller therapy can be used, but patients with asthma should not rely solely on bronchodilators.
A variety of inhaled combination medications were released in 2016, including various combinations of long-acting beta-agonists, long-acting anti-muscarinic agents and inhaled corticosteroids, said Hawkins. The AAFP's physician education resource should help physicians make the right treatment choices for specific patients according to their diagnosis and severity.
Smoking exacerbates both diseases, and those who smoke should receive counseling about smoking cessation at every visit and, when appropriate, support to help them quit.
"It's critically important that physicians make consistent, caring messages about smoking cessation," Hawkins said. "Family physicians are very effective at helping their patients quit, but it often takes repeated, caring messages delivered over time."
The AAFP's Ask and Act tobacco cessation program provides targeted physician resources to help patients quit smoking.
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