COPD and Asthma

Many adults have features of both asthma and Chronic Obstructive Pulmonary Disease (COPD) known as the Asthma–COPD overlap.

Asthma and COPD are heterogeneous conditions,
each with several different underlying causes. The
definitions of asthma and COPD are not mutually
exclusive, and a significant proportion of adults with
obstructive respiratory disease have clinical features
of both conditions.

Asthma–COPD overlap is not a single, well-defined disease entity, but includes a range of airway disease phenotypes with different causal mechanisms

Asthma–COPD overlap is not a single disease, but is likely to have many underlying causes. It can develop in smokers, ex-smokers or non-smokers, particularly at older ages. Patients with asthma–COPD overlap are at higher risk than patients with either condition alone, with more symptoms, more flare-ups, greater need for health care utilisation, and higher mortality. Asthma–COPD overlap should be considered in adults when they have a history of asthma or have asthma-like symptoms, and spirometry before and after bronchodilator shows expiratory airflow limitation that is not completely reversible. Specialist referral may be needed if there is doubt about the diagnosis, and to optimise treatment. Treatment of patients with asthma–COPD overlap involves long-term inhaled corticosteroid (ICS) treatment to reduce the risk of asthma flare-ups. Most patients should also have a trial of a long-acting beta2 agonist (LABA) and/or long-acting muscarinic antagonist (LAMA). The use of LABAs or LAMAs without concomitant ICS should be avoided in patients with any features of asthma, or a history of asthma, because this increases the risk of hospitalisation and death. Management also includes treatment of comorbid conditions, smoking cessation, adequate physical activity, pulmonary rehabilitation, regular vaccinations, self-management education including an up-to-date written action plan, and regular follow-up.

Diagnosis is based on the probability of asthma or
COPD, according to the presence of clinical features of
Either.
Based on history, physical examination and other
investigations, identify features typical of asthma and
typical of COPD.
Typical features of history include chronic or recurrent
cough, sputum production, dyspnoea, wheezing,
recurring acute lower respiratory tract infections, exposure to tobacco smoke or other airborne pollutants,
a previous diagnosis of asthma or COPD, and the use of
inhaled respiratory medicines

Most patients with asthma or COPD do not use their inhalers properly, and most have not had their technique checked or corrected by a health professional
Incorrect inhaler technique when using maintenance treatments increases the risk of severe flare-ups and hospitalisation for people with asthma or COPD
Poor asthma symptom control is often due to incorrect inhaler technique
Incorrect inhaler technique when using inhaled corticosteroids increases the risk of side-effects like dysphonia and oral thrush
The steps for using an inhaler device correctly differ between brands
Checking and correcting inhaler technique can improve asthma outcomes.

Using your asthma or COPD inhaler properly is important. With the right technique, you can be sure the medicine is getting where it needs to.

Common errors

Not shaking the inhaler before use
Holding the inhaler in the wrong position
Not breathing out fully before pressing down on the inhaler
Pressing down on the inhaler too early or too late while breathing in
Pressing down on the inhaler more than once while breathing in
Breathing in too quickly
Not holding breath for long enough after breathing in
Having multiple puffs without shaking the inhaler in between
Using a spacer with your puffer can help reduce problems with timing and coordination, and will also help reduce the chance of side-effects like hoarseness or throat infections.

Common errors with dry powder inhalers
Tilting the inhaler while loading the dose (needs to be horizontal for Accuhaler or vertical for Turbuhaler)
Not breathing out fully before breathing in
Not breathing in completely
Breathing in too slowly or weakly
Breathing out into the inhaler
Not closing the inhaler after use
Using the inhaler past the expiry date or when empty