Ask the Allergist: Does Chronic Asthma Lead to COPD?



Chipps

Q: I’ve had asthma all my life. Am I at risk for developing chronic obstructive pulmonary disease, or COPD?

Bradley Chipps, MD: Not every adult with asthma develops COPD; they are two different conditions. However, we are seeing a significant number of patients who have features of both asthma and COPD – and distinguishing between the two is not always easy.

Asthma is an inflammatory lung disease often associated with allergies, and symptoms vary over time and in intensity. COPD is a progressive disease characterized by persistent airflow limitation and inflammation, commonly associated with exposure to noxious particles or gases – primarily cigarette smoke, either from personal use or secondhand exposure, or environmental pollutants, including biomass fuels from poorly vented gas stoves. 

While asthma does not automatically lead to COPD, a person whose lungs have been damaged by frequent flares of poorly controlled asthma is at increased risk of developing COPD – if they are living or working in environments where they are exposed to airborne pollutants. 

Q: At what age does the diagnosis change?

A: COPD usually develops after the age of 40, but a person’s diagnosis is not likely to change – you don’t stop having asthma and start having COPD. Some develop Asthma/COPD Overlap Syndrome (ACOS), which is now being recognized more widely in the medical community.

Q: Can you stop the progression of COPD if you catch it early enough? 

A: Yes, you can stop the progression. Each person’s situation is different, but most importantly, you have to reduce your exposure to the smoke or pollution that is damaging your lungs.

COPD symptoms are similar to those of poorly controlled asthma. Some factors that point to possible COPD include recurrent cough, sputum production, difficulty breathing, wheezing, or lower respiratory tract infections; history of smoking tobacco; and exposure to secondhand smoke or other environmental pollutants.

COPD diagnosis requires pulmonary function tests, so patients should see a respiratory specialist who can measure lung function – likely a pulmonologist or allergist – and perform the appropriate evaluation and treatment of other diseases that commonly accompany ACOS, such as heart disease, diabetes, osteoporosis and lung infections.

Q: What’s the treatment for ACOS?

A: Treatment for ACOS usually involves aggressive medication with three drugs instead of two: an inhaled corticosteroid, a long-acting bronchodilator and an anticholinergic (muscarinic antagonist), along with treatment of common comorbidities such as heart disease. I also recommend pneumonia and annual flu vaccinations, smoking cessation assistance and pulmonary rehabilitation, or exercise programs.


Bradley Chipps, MD, FACAAI, FAAAAI, FAAP, FCCP, is a board-certified allergist/immunologist and pediatric pulmonologist with Capital Allergy and Respiratory Disease Center in Sacramento, California. He serves on the Board of Regents with the American College of Allergy, Asthma & Immunology (ACAAI). 


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