CHEST Guidelines-Considerations-for-the-Correct-Diagnosis-of-COPD-a

Considerations-for-the-Correct-Diagnosis-of-COPD-a

Pdf Summary

The article by Antonio Anzueto, MD, and Marc Miravitlles, MD, addresses the challenges in diagnosing and treating Chronic Obstructive Pulmonary Disease (COPD), highlighting its frequent misdiagnosis and inappropriate treatment. COPD is distinct from asthma, although some patients may exhibit features of both, known as asthma-COPD overlap (ACO). Correct diagnosis is critical for proper treatment with bronchodilators and inhaled corticosteroids (ICS). Patients with COPD benefit from long-acting bronchodilators as initial therapy, whereas those with asthma are recommended ICS monotherapy.<br /><br />Diagnosis of COPD should consider symptoms like dyspnea, chronic cough, and a history of exposure to risk factors, confirmed through spirometry. In contrast, asthma diagnosis hinges on variable symptoms like wheezing and airflow limitation. Differentiating between COPD, asthma, and ACO is complex, with ACO patients showing features responsive to ICS due to elevated eosinophil levels.<br /><br />For COPD management, bronchodilators are primary, with LAMA/LABA combinations preferred for more severe cases due to their efficacy in improving lung function and reducing exacerbations over monotherapies. ICS use in COPD is limited due to increased pneumonia risks and other adverse effects, warranting usage in combination with LABAs for severe conditions only. Inappropriate ICS prescribing remains an issue, leading to unnecessary side effects and healthcare resource use.<br /><br />The article emphasizes the need for precision in diagnosis to ensure effective treatment, with blood eosinophil counts serving as potential biomarkers for gauging ICS response. Clinicians must navigate these complex diagnoses to optimize treatment, tailoring approaches to individual patient needs while maintaining economic considerations in care strategies.

Keywords

COPD

asthma

misdiagnosis

bronchodilators

inhaled corticosteroids

asthma-COPD overlap

spirometry

dyspnea

LAMA/LABA

eosinophil counts