REVIEWImproving the Differential Diagnosis of Chronic Obstructive Pulmonary Disease in Primary Care
Section snippets
METHODS
We conducted a literature search with no date limitations for all relevant articles using PubMed, a bibliographic database providing access to citations for biomedical articles from MEDLINE (1950s to present) and life science journals. We used the Medical Subject Headings chronic obstructive pulmonary disease or COPD and asthma, in association with the following search terms: diagnosis, differential diagnosis, mixed or comorbid disease, diagnostic techniques, spirometry, questionnaires, and
IMPORTANCE OF DIFFERENTIAL DIAGNOSIS
Differentiation between asthma and COPD is extremely important because treatment strategies differ for the 2 conditions, although smoking cessation is vital irrespective of disease.10, 19 Treatment of asthma includes the use of inhaled corticosteroids (ICSs) in patients with persistent disease9, 20 to suppress eosinophilia-based airway inflammation, leading to symptom control and restoration of pulmonary function.9, 21 However, responsiveness to ICSs is reduced in smokers with asthma, who may
Initial Diagnosis
A typical patient with COPD is likely to be 35 years or older and have a history of risk factors such as smoking or extended occupational exposures to toxins.10, 26 It is usually unrecognized until patients are in their sixties. Although COPD was once considered a disease of men, a higher prevalence of chronic bronchitis and emphysema has been reported in US women than US men in 2010.27 Furthermore, women's smaller lung size and differing lung geometry appear to increase their susceptibility to
CONCLUSION
For many years, COPD was deemed to be a disease of fixed airflow obstruction for which no beneficial treatment was available. This led to a largely nihilistic view of COPD among health care professionals, with little incentive to diagnose COPD accurately. However, early detection of airflow limitation and intervention for smoking abstinence can delay lung function decline, reduce the burden of COPD symptoms, and improve patients' quality of life.19, 84 Accurate differential diagnosis of asthma
Acknowledgments
We thank Mary Sayers of ACUMED, who provided medical writing services. This support was funded by Novartis Pharma AG.
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Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Primer for Emergency Physicians
2020, Journal of Emergency MedicineCitation Excerpt :One of the main goals of COPD management is to reduce the risk of future exacerbations, with clinicians implementing effective diagnosis and management strategies (1). Patients with COPD are likely to be ≥ 35 years of age with a history of risk factors such as smoking or extended occupational exposure (30). Occupations that place individuals at risk include those who are regularly exposed to exhaust or fumes, such as cooks, taxi/truck drivers, and factory, industrial, agricultural, and construction workers (31).
Immune-Related Pneumonitis After Chemoradiotherapy and Subsequent Immune Checkpoint Blockade in Unresectable Stage III Non–Small-Cell Lung Cancer
2020, Clinical Lung CancerCitation Excerpt :Patients with grade 1 pneumonitis are, by definition, asymptomatic at diagnosis32; however, in patients with grade 2 or higher pneumonitis, signs and symptoms include dyspnea and dry cough as well as, less frequently, hypoxia, fever, tachypnea, fine inspiratory crackles, and chest pain.29,39,41,83 Clinical conditions that can mimic IR-pneumonitis include infectious pneumonia, which may be viral, bacterial, or fungal in origin83,84; infective exacerbations of chronic obstructive pulmonary disease85; congestive heart failure; lymphangitic carcinomatosis; RT-pneumonitis; or the effects of systemic anticancer drugs or other agents.45,47,86 In the setting of ICB therapy after cCRT for stage III NSCLC, the ability to differentiate IR-pneumonitis from RT-pneumonitis is of particular relevance and may present diagnostic and management challenges.
Chronic Obstructive Pulmonary Disease Exacerbations: A Need for Action
2018, American Journal of MedicineCitation Excerpt :Under-diagnosis and misdiagnosis continue to be challenges in the primary care setting, with differential diagnosis between asthma and COPD being of particular concern.13,86 To combat these challenges, it is recommended that PCPs increase the use of spirometry as a diagnostic tool, proactively ask patients about symptoms, and use short questionnaires and management algorithms.13 Once a proper diagnosis is achieved, the focus should be on proper inhaler technique.
Common Presentations and Diagnostic Approaches
2014, Stiehm's Immune DeficienciesAwareness of COPD and Its Risk Factors Among the Adult Population of the Aseer Region, Saudi Arabia
2023, International Journal of COPDArtificial intelligence to differentiate asthma from COPD in medico-administrative databases
2022, BMC Pulmonary Medicine
Online Supporting Material
www.mayoclinicproceedings.com/content/85/12/1122/suppl/DC1
eAppendix
- 1
Dr Price has consultant arrangements with Boehringer Ingelheim, GlaxoSmithKline, Merck, Novartis, and Teva. He or his research team have received grants and support for research in respiratory disease from the following organizations in the past 5 years: UK National Health Service, Aerocrine, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck, Novartis, Nycomed, Pfizer, and Teva. He has spoken for Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Merck, Pfizer, and Teva. He has shares in AKL International, which produces phytopharmaceuticals. He is the sole owner of Research in Real-Life. Dr Yawn has received investigator-initiated research grants from Novartis, Boehringer Ingelheim, and GlaxoSmithKline related to studies of screening for chronic obstructive pulmonary disease (COPD). She has been paid to take part in advisory boards related to COPD for Boehringer Ingelheim, GlaxoSmithKline, and Novartis and for asthma by GlaxoSmithKline, Merck, and AstraZeneca. Dr Jones has been paid to take part in advisory boards related to COPD for Boehringer Ingelheim, GlaxoSmithKline, Novartis, Nutricia, Pfizer, and Teva in the past 3 years. He has spoken at scientific/educational meetings financed by Altana, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck Sharp & Dohme, Pfizer, Teijin, and Trinity-Chiesi in the past 3 years. He is a consultant for the global emPOWER educational program supported by Pfizer and Boehringer Ingelheim.