Asthma-COPD overlap syndrome (RESP)

Question 1

Define asthma-COPD overlap syndrome.

Answer 1

• condition in which you have symptoms of both asthma and COPD (in adults >40)
• ‘persistent airflow obstruction with features of asthma’
• airflow limitation not completely reversible after bronchodilation

Question 2

What are patients with asthma-COPD overlap syndrome predisposed to? (5)

Answer 2

• frequent exacerbations
• worsened QOL
• more rapid decline in lung function
• higher mortality
• hospital admission

Question 3

What are the asthmatic/steroid responsiveness features of COPD? (4)

Answer 3

• any previous secure diagnosis of asthma or atopy
• higher blood eosinophil count
• substantial variation in FEV1 over time (>400ml)
• substantial diurnal variation in peak expiratory flow (>20%)

Question 4

What are some clinical features of asthma-COPD overlap syndrome? (4)

Answer 4

• wheeze
• cough (with or without mucus)
• tightness in chest
• SOB (exertional dyspnoea with variability)

Question 5

What features does asthma-COPD overlap syndrome have in addition to COPD alone? (3)

Answer 5

• response to bronchodilators (symptoms significantly reduced by treatment)
• reversibility of airflow
• eosinophilic inflammation

Question 6

What are examination findings like for asthma-COPD overlap syndrome?

Answer 6

Mixed asthma and COPD picture

Question 7

What are some risk factors for asthma-COPD overlap syndrome? (2)

Answer 7

• age>40 (may have had symptoms in childhood/early adulthood)
• multiple exacerbations

Question 8

What is the 1st line investigation for asthma-COPD overlap syndrome?

Answer 8

Spirometry - FEV1 shows substantial variation over time >400ml

Question 9

What would PEF show for asthma-COPD overlap syndrome?

Answer 9

Substantial diurnal variation >20%

Question 10

What might bloods show for asthma-COPD overlap syndrome?

Answer 10

Eosinophilia

Question 11

What might you see on chest x-ray for asthma-COPD overlap syndrome?

Answer 11

• hyperinflation
• COPD

Question 12

What are some differential diagnoses for asthma-COPD overlap syndrome? (3)

Answer 12

• asthma
• COPD
• pneumonia

Question 13

How do we manage asthma-COPD overlap syndrome?

Answer 13

• SABA or SAMA as required
• LABA + ICS regularly
• if patient remains breathless/exacerbations: LABA + LAMA + ICS
• use combined inhalers where possible, avoid use of LABA monotherapy
• vaccinations
• (make decisions based on the more prominent phenotype - asthma or COPD)

Question 14

What do ICS and LABAs do?

Answer 14

• ICS - reduce inflammation in airways
• LABA - can help keep airways open

Question 15

What type of inflammation do we target in asthma-COPD overlap syndrome?

Answer 15

Eosinophilic, neutrophilic or paucigranulocytic airway inflammation

Question 16

What is a complication of asthma-COPD overlap syndrome?

Answer 16

Infective exacerbations - higher mortality