COPD and asthma exacerbations - two sides of the same coin?

1. Obstructive airway disease - exacerbations
Dr. Aditya Jindal
Interventional Pulmonologist & Intensivist
Jindal Clinics, SCO 21, Sec 20D, Chandigarh
DM Pulmonary and Critical Care Medicine (PGI Chandigarh), FCCP

2. Introduction
• Diagnostic confusion between COPD and asthma is common
• So called ‘ACOS’ or asthma – COPD overlap syndrome complicates
picture further
• Also, modern approach to phenotypes and endotypes creates a lot of
overlap
• Important to decide whether the difference between these two
diseases is valid or not, especially in the acute setting of
‘Exacerbations’

3. COPD
“a heterogeneous lung condition characterized by
chronic respiratory symptoms (dyspnea, cough,
expectoration, exacerbations) due to abnormalities of
the airways (bronchitis, bronchiolitis) and/or alveoli
(emphysema) that cause persistent, often progressive,
airflow obstruction”
o 2023 Global Initiative for Chronic Obstructive Lung
Disease

4. Asthma
Asthma is a heterogenous disease, usually
characterized by chronic airway inflammation. It is
defined by the history of respiratory symptoms, such as
wheeze, shortness of breath, chest tightness and
cough, that vary over time and in intensity, together
with variable expiratory airflow limitation.
o Global Initiative for Asthma (GINA) 2023 report

5. Am J Physiol Lung Cell Mol Physiol, 2022.

6. Dutch hypothesis
Asthma and COPD may have a
mutual origin and subsequent
expression of each disease is
explained by individual variables
encompassing genetic factors and
environmental exposures
British hypothesis
Postulates separate origins for
asthma and COPD driven by its
own individual genetic traits,
inflammatory profile and
treatment

7. The Overlap
COPD
Neutrophils
No airway
hyperresponsiveness
Less bronchodilator
response
Limited steroid
response
Wheezy
bronchitis
10%
Asthma
Eosinophils
Airway
hyperresponsiveness
Bronchodilator
response
Steroid
response

8. Acute exacerbation of COPD
• Transient periods of increased symptoms of dyspnea,
sputum purulence, and sputum volume
• Minor symptoms of nasal blockage/discharge, wheeze, sore
throat, cough, fever, chest tightness or discomfort,
fatigue/reduced energy, sleep disturbance, or limited
physical activity

10. Asthma exacerbations
Asthma Exacerbations: Pathogenesis, Prevention,
and Treatment. J Allergy Clin Immunol Pract
2017

11. How to ventilate obstructive and
asthmatic Patients. Intensive Care Med
2020

12. Unified airway approach to
management of exacerbations

13. Emerg Med Clin N Am, 2022

14. Emerg Med Clin N Am, 2022

15. Therapeutic
options at
the different
stages of
patient
management
How to ventilate obstructive
and asthmatic Patients.
Intensive Care Med 2020

16. Potential
advantages and
disadvantages of
traditionally
“Oslerian
approach” versus a
“Treatable-traits
approach” in
chronic
respiratory
diseases.

17. Main
treatable
traits
described
in patients
with
asthma-
COPD
overlap
Asthma-COPD overlap: a treatable trait or several treatable-traits? Eur
Ann Allergy Clin Immunol. 2020

18. Summary
1. Dutch vs British hypothesis debate is ongoing!
2. There are lots of similarities and also differences.
3. Exacerbations are more common in COPD as compared to asthma.
4. Approach to treatment follows a broadly similar path.
5. New approaches to treatment may yield better results in the future.