Diagnostics/management

• Take a comprehensive history, including smoking history and toxin exposure.

• All patients require spirometry and diagnostic studies for asthma and diagnostic studies for COPD, if not already performed.

• The diagnosis of asthma-COPD overlap can be made when all of the following criteria are met:

  • Persistent airflow limitation (FEV1/FVC < 0.7) on PFTs (consistent with a diagnosis of COPD)

  • History of asthma and/or some clinical features of asthma

  • Episodic nature of symptoms

Do not wait for diagnostic confirmation before initiating treatment for asthma in patients with suspected asthma-COPD overlap; untreated patients are at risk of life-threatening acute asthma attacks

• Refer to a pulmonologist for any of the following:

  • Presence of symptoms atypical of asthma or COPD

  • Suspected chronic airway disease but minimal symptoms of asthma or COPD

  • Uncertain diagnosis or suspicion of an alternative diagnosis

  • Comorbidities causing difficulty with work-up or management

• All other patients

  • Initiate asthma treatment with low-dose or medium-dose ICS, even if the diagnosis is not yet confirmed.

  • Add LABA and/or LAMA as needed for the treatment of COPD according to the GOLD group classification system.

  • Optimize management of both underlying conditions with:

    • Adjunctive therapy for asthma (e.g., reduce trigger exposure, have an asthma action plan)

    • Supportive measures for COPD (e.g., smoking cessation, immunizations, pulmonary rehabilitation)

  • If no improvement after 2–3 months, refer to a pulmonologist.

Patients with concurrent asthma and COPD symptoms should never be treated with a LABA or LAMA alone; these must always be given in conjunction with an ICS