GOLD 2021 Strategy Report: Implications for Asthma–COPD Overlap

Figures & data

Table 1 Summary of Characteristics of COPD and Asthma

	COPD	Asthma
Definition	Disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities usually caused by environmental exposure to noxious particles or gases	Disease usually characterized by chronic airway inflammation causing respiratory symptoms that vary over time, and variable expiratory airflow limitation
Symptoms	Dyspnea, cough, sputum production	Wheezing, dyspnea, chest tightness, cough
Risk factors	Smoking, occupational exposures, environmental exposures	Smoking, family history of asthma or allergy, history of allergic rhinitis or eczema, childhood respiratory infection, exposure to irritants
Spirometry	Post-bronchodilator FEV1/FVC <0.70	Positive bronchodilator reversibility (in adults: increase in FEV1 of >12% and >200mL 10–15 mins after salbutamol)
Indicators	Age >40 years; dyspnea, chronic cough and/or chronic sputum production; recurrent lower respiratory tract infections; exposure to environmental risk factors; family history of COPD	Symptoms vary over time and in intensity; symptoms triggered by infections, exercise, allergen or irritant exposure; respiratory symptoms in childhood; family history of allergy or asthma
Comorbidities	Cardiovascular disease, lung cancer, osteoporosis, anxiety and depression, metabolic syndrome and diabetes, GERD, bronchiectasis, obstructive sleep apnea and cognitive impairment	Obesity, GERD, anxiety and depression, food allergy and anaphylaxis, rhinitis, sinusitis and nasal polyps
Role of blood eosinophils	Predict response to ICS	Predict future exacerbations and possible undertreatment
Other disease markers	Decline in FEV1 or markers of chronic hyperinflation	Sputum eosinophils and FeNO levels

Note: Data from these studies.^4,25

Abbreviations: COPD, chronic obstructive pulmonary disease; FeNO, fractional exhaled nitric oxide; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GERD, gastroesophageal reflux disease; ICS, inhaled corticosteroids.

Figure 1 Assessments to guide treatment choice for patients with COPD presenting with asthma symptoms.

Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; FeNO, fractional exhaled nitric oxide; ICS, inhaled corticosteroid; IgE, immunoglobulin E; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist.

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2021 report) 2020; 2020. Available from: https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf. Accessed February 2, 2021.

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Global Initiative for Asthma. Global strategy for asthma management and prevention (2020 report); 2020. Available from: https://ginasthma.org/wp-content/uploads/2020/04/GINA-2020-full-report_-final-_wms.pdf. Accessed May 13, 2020.

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