Do I have asthma or chronic obstructive airway disease? Doctors are telling me I have both!

By Faith Huang, adapted from an article here.

Some older adults with obstructive airway disease have overlapping characteristics of both asthma and chronic obstructive pulmonary disease (COPD).

Patients with asthma are used to symptoms of coughing, wheezing and shortness of breath. However, these are also symptoms of COPD. It can be difficult to tell the difference between the two conditions but it is important to do so as the optimal treatment regimen differs.

According to a presentation by Dr. William Busse at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting, as many as half of older adults with obstructive airway disease have overlapping characteristics of asthma and COPD, with this percentage increasing as people get older. “Based on symptoms alone, it can be difficult to diagnose COPD vs. asthma. The pathway to a diagnosis of COPD or asthma – smoking vs. a long-term persistence of asthma – can be quite different,” said allergist William Busse, MD, ACAAI fellow and presenter. “In every patient, but in older patients in particular, we need to take a thorough history and perform a physical examination, as well as measurements of lung functions…..Treatment will differ depending on diagnosis.”

Lung function changes in asthma are due to airway inflammation. For asthma, treatment is directed at reducing inflammation with mainly inhaled corticosteroids. The changes in lung function associated with COPD are caused by cigarette smoking and, exception with an exacerbation, are not particularly responsive to corticosteroids.

“The primary treatment in COPD is bronchodilators, including long-acting beta agonists. They help relax muscles around the airways in the lungs, allowing air to flow more freely,” said allergist Michael Foggs, MD, ACAAI president. “They should not be given alone to people with asthma. In COPD, but not asthma, inhaled corticosteroids have been associated with an increased risk for pneumonia, and in some cases, features of both asthma and COPD exist. For these patients a combination of inhaled corticosteroids and long-acting beta agonists is usually best.”

Some treatments for COPD and asthma are similar. Bronchodilators are used for both conditions, while other treatments tend to be more condition-specific. People with asthma are encouraged to avoid their specific triggers, like keeping pets out of the home or avoiding the outdoors when allergen concentrations are high. While people with COPD are also encouraged to avoid triggers, the emphasis in this condition is to stop smoking. Similarly, if a patient has asthma, smoking makes the underlying disease worse and reduces the response to inhaled corticosteroids.

Allergists who treat these conditions recognize that each patient, and their symptoms, must be treated according to their unique set of circumstances. Patient need to tell their allergists all their symptoms and complete medical history in order to receive the correct diagnosis and appropriately tailored therapy. Your board certified allergist can help by asking the right questions, and sometimes working together with your other doctors to specifically come up with a plan that will optimize your health.

If you have any questions or concerns, call (949) 364-2900  and schedule an appointment today with one of our doctors. You can also use our online Request an Appointment form to schedule a future date and time.

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