Do patients with asthma–COPD overlap need specific management?

Jadwiga Wedzicha

Dr Jadwiga Wedzicha is a professor of respiratory medicine at the National Heart and Lung Institute, Imperial College London, United Kingdom, and editor in chief of the American Journal of Respiratory and Critical Care Medicine.

What is the current opinion on asthmachronic obstructive pulmonary disease (COPD) overlap? Do these patients need specific management?

Jadwiga Wedzicha, MD, PhD: Asthma–COPD overlap is not uncommon in COPD because both asthma and COPD are common disorders. And the issue is: Do these patients need specific management?

And as I said in my talk, these are the patients who need inhaled corticosteroids at an earlier stage. So, these are the group of patients [in whom] one can use a long-acting beta2-agonist (LABA)/inhaled corticosteroid (ICS) compound [preparation] on earlier. Indeed, if an asthma–COPD patient is breathless as well, significantly breathless, you will actually move to early triple therapy. That’s LABA, long-acting muscarinic antagonist (LAMA), and ICS.

Patients with asthma–COPD [overlap] also tend to have more exacerbations. So, education is very important... and treatment of their exacerbations. Technically, asthmatic patients have more treatable exacerbations, [treatable] with steroids. So, by treating exacerbations, you’re preventing lung function decline.

As for biologics, yes, I expect these are the group of patients who would respond to biologics that are being developed for asthma. And I think we will subsequently see studies performed with biologics in patients with asthma and COPD. Thank you.

See also
  • The 3 most important recent advances in treating obstructive pulmonary diseases Dr Jadwiga Wedzicha from Imperial College London, United Kingdom, shares her views on the 3 most important recent advances in treating obstructive pulmonary diseases.
  • Dual versus triple inhaler therapy in patients with asthma Dr Derek Chu, assistant professor at the Faculty of Health Sciences at McMaster University, discusses the use of dual versus triple inhaler therapy in asthma.
  • Asthma exacerbation Asthma exacerbation: a rapid overview of key investigations and principles guiding the acute management.
  • COPD exacerbation Chronic obstructive pulmonary disease (COPD) exacerbation: the key diagnostic investigations and management principles that you need to keep in mind.
  • Oral corticosteroids in COPD exacerbations The recent European Respiratory Society (ERS) guidelines recommend oral corticosteroids in outpatients with COPD exacerbations, but it is a weak recommendation that may not be followed. Are there any evidence-based indications on who should receive oral corticosteroids?
  • The future of medicine today: Biologics in asthma Dr Parameswaran Nair, professor of medicine in the Division of Respirology at McMaster University, explains how to choose from the currently available biologics for asthma.
  • Prevalence of asthma–COPD overlap syndrome Epidemiological studies indicate that patients with asthma–COPD overlap constitute about 1/3 of patients with obstructive airway diseases. However, in daily practice the coexistence of asthma and COPD does not seem to be diagnosed often. What are the possible reasons for this discrepancy?

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