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Editorials |

Coexisting Asthma and COPD: Confused Clinicians or Poor Prognosticator?

David M. Mannino, MD, FCCP
Author and Funding Information

Lexington, KY

Correspondence to: David M. Mannino, MD, FCCP, Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, 121 Washington Ave, Lexington, KY 40536; e-mail: dmannino@uky.edu


Chest. 2008;134(1):1-2. doi:10.1378/chest.08-0365
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In theory, asthma and COPD are distinct disease processes.12 We are all familiar with the distinctions that clearly separate the two: one is a disease with its origins in childhood, is related to allergies and eosinophils, and is best treated by targeting inflammation; whereas, the other is related to adults who smoke and to neutrophils, and is best treated with bronchodilating agents and the removal of risk factors.3 We take great pains to ensure that we do not “misdiagnose” asthma as COPD. Current guidelines34 ask us to use the “postbronchodilator” measurement of lung function with the suggestion that if an obstructed person “reverses,” they, in fact, have asthma rather than COPD. If a person demonstrates “reversibility” (ie, a significant improvement in their lung function) but remain obstructed, we consider them to have “COPD with partial reversibility.” Thus, in theory, the distinction between asthma and COPD is pretty well defined. In practice, however, this distinction is much less clear.

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