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VOLUME 66 , ISSUE 1 ( January-March, 2024 ) > List of Articles


Challenges in Differentiating Asthma and Chronic Obstructive Pulmonary Disease for Treatment: A Simplified Algorithm Based on Spirometry and Blood Eosinophil

Deependra K Rai

Keywords : Asthma, Chronic obstructive pulmonary disease, Peripheral blood eosinophil count, Spirometry

Citation Information : Rai DK. Challenges in Differentiating Asthma and Chronic Obstructive Pulmonary Disease for Treatment: A Simplified Algorithm Based on Spirometry and Blood Eosinophil. Indian J Chest Dis Allied Sci 2024; 66 (1):35-36.

DOI: 10.5005/jp-journals-11007-0102

License: CC BY-NC 4.0

Published Online: 03-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Treatment of both chronic obstructive pulmonary disease (COPD) and asthma now shifted from conventional to personalized therapy and a one-size-fits-all approach is ineffective in all cases. Treatment of both chronic obstructive disease treatment is driven by the history of symptoms, exacerbation, and blood eosinophil level, while asthma is by symptoms, airflow limitation, and blood or sputum eosinophil level. Although understanding of asthma and COPD has been deeper and deeper in the last few years, the treatment seems to be still complicated. Treatment of both diseases seems to be interrelated and overlapping and there is an unmet need for a simplified approach. Bronchial asthma patients may have fixed airflow obstruction (FAO), may have neutrophilic inflammation, may have inhaled corticosteroids (ICS) resistance, similarly, COPD patients may have reversible airflow limitation, eosinophilic inflammation, and ICS responsiveness. Treatment of both diseases depends upon the severity of symptoms, FAO, and blood eosinophil level. I am putting here a simplified approach to the treatment of asthma and COPD based on blood eosinophils and spirometry which would be a great help to clinicians in deciding the treatment.

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  1. Guerra S, Martinez FD. Epidemiology of the origins of airflow limitation in asthma. Proc Am Thorac Soc 2009;6(8):707–711. DOI: 10.1513/pats.200908-085DP.
  2. Lee JH, Haselkorn T, Borish L, et al. Risk factors associated with persistent airflow limitation in severe or difficult-to-treat asthma: Insights from the TENOR study. Chest 2007;132(6):1882–1889. DOI: 10.1378/chest.07-0713.
  3. Rai DK, Kumar S, Ranjan A, et al. Characteristics of bronchial asthma with persistent airflow limitation. Indian J Allergy Asthma Immunol 2019;33(1):51–55. DOI: 10.4103/ijaai.ijaai_35_18.
  4. Hanania NA, Celli BR, Donohue JF, et al. Bronchodilator reversibility in COPD. Chest 2011;140(4):1055–1063. DOI: 10.1378/chest.10- 2974.
  5. Albert P, Agusti A, Edwards L, et al. Bronchodilator responsiveness as a phenotypic characteristic of established chronic obstructive pulmonary disease. Thorax 2012;67(8):701–708. DOI: 10.1136/thoraxjnl-2011-201458.
  6. Janson C, Malinovschi A, Amaral AFS, et al. Bronchodilator reversibility in asthma and COPD: Findings from three large population studies. Eur Respir J 2019;54(3):1900561. DOI: 10.1183/13993003.00561- 2019.
  7. Gibson PG, Simpson JL. The overlap syndrome of asthma and COPD: What are its features and how important is it? Thorax 2009;64(8): 728–735. DOI: 10.1136/thx.2008.108027.
  8. Barnes PJ. Against the Dutch hypothesis: Asthma and chronic obstructive pulmonary disease are distinct diseases. Am J Respir Crit Care Med 2006;174(3):240–243. DOI: 10.1164/rccm.2604008.
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