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Title: Distinguishing adult-onset asthma from COPD: a review and a new approach.
Austin Authors: Abramson, Michael J;Perret, Jennifer L ;Dharmage, Shyamali C;McDonald, Vanessa M;McDonald, Christine F 
Affiliation: Priority Research Centre for Asthma and Respiratory Disease, University of Newcastle, Newcastle, Australia
Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia ; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 9-Sep-2014
Publication information: International Journal of Chronic Obstructive Pulmonary Disease 2014; 9(): 945-62
Abstract: Adult-onset asthma and chronic obstructive pulmonary disease (COPD) are major public health burdens. This review presents a comprehensive synopsis of their epidemiology, pathophysiology, and clinical presentations; describes how they can be distinguished; and considers both established and proposed new approaches to their management. Both adult-onset asthma and COPD are complex diseases arising from gene-environment interactions. Early life exposures such as childhood infections, smoke, obesity, and allergy influence adult-onset asthma. While the established environmental risk factors for COPD are adult tobacco and biomass smoke, there is emerging evidence that some childhood exposures such as maternal smoking and infections may cause COPD. Asthma has been characterized predominantly by Type 2 helper T cell (Th2) cytokine-mediated eosinophilic airway inflammation associated with airway hyperresponsiveness. In established COPD, the inflammatory cell infiltrate in small airways comprises predominantly neutrophils and cytotoxic T cells (CD8 positive lymphocytes). Parenchymal destruction (emphysema) in COPD is associated with loss of lung tissue elasticity, and small airways collapse during exhalation. The precise definition of chronic airflow limitation is affected by age; a fixed cut-off of forced expiratory volume in 1 second/forced vital capacity leads to overdiagnosis of COPD in the elderly. Traditional approaches to distinguishing between asthma and COPD have highlighted age of onset, variability of symptoms, reversibility of airflow limitation, and atopy. Each of these is associated with error due to overlap and convergence of clinical characteristics. The management of chronic stable asthma and COPD is similarly convergent. New approaches to the management of obstructive airway diseases in adults have been proposed based on inflammometry and also multidimensional assessment, which focuses on the four domains of the airways, comorbidity, self-management, and risk factors. Short-acting beta-agonists provide effective symptom relief in airway diseases. Inhalers combining a long-acting beta-agonist and corticosteroid are now widely used for both asthma and COPD. Written action plans are a cornerstone of asthma management although evidence for self-management in COPD is less compelling. The current management of chronic asthma in adults is based on achieving and maintaining control through step-up and step-down approaches, but further trials of back-titration in COPD are required before a similar approach can be endorsed. Long-acting inhaled anticholinergic medications are particularly useful in COPD. Other distinctive features of management include pulmonary rehabilitation, home oxygen, and end of life care.
Gov't Doc #: 25246782
DOI: 10.2147/COPD.S46761
Journal: International journal of chronic obstructive pulmonary disease
Type: Journal Article
Subjects: adults
chronic obstructive pulmonary disease
Age of Onset
Anti-Inflammatory Agents.therapeutic use
Bronchodilator Agents.therapeutic use
Combined Modality Therapy
Diagnosis, Differential
Middle Aged
Predictive Value of Tests
Pulmonary Disease, Chronic Obstructive.diagnosis.epidemiology.immunology.physiopathology.therapy
Risk Factors
Treatment Outcome
Appears in Collections:Journal articles

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