Comparison of Features of Asthma , COPD , and ACOS

Respiratory diseases are common, affecting 300 million people worldwide (GINA 2016). The prevalence of asthma is increasing worldwide (GINA 2016; Maio 2016), including in the United States, where the prevalence rose by 14.8% in 2001–2010 (CDC 2012). This rise in prevalence was especially seen in children (GINA 2016). Asthma also affects population health because of increased morbidity and mortality. The WHO estimates that 13.8 million disability-adjusted life-years and 346,000 deaths worldwide are attributable to asthma annually (GINA 2016). As a result, the economic impact of asthma on expenditures is quite large, including both direct (e.g., medication and routine and urgent care) and indirect (e.g., decreased quality of life [QOL] and productivity, missed school/workdays) health care costs (GINA 2016). Because effective therapies exist, asthma-related morbidity and mortality can be blunted. Health care efforts should focus on optimizing therapy to prevent chronic symptoms and educating individuals to minimize symptoms and avoid exacerbations so that they can live normal lives. The prevalence of chronic obstructive pulmonary disease (COPD) is reported to be less than that of asthma (in most nations, less than 6%), but this figure is likely low because of underdiagnosis (GOLD 2016). The incidence of COPD is higher in those who currently smoke or have a history of tobacco use, those older than 40, and men (GOLD 2017). Chronic respiratory diseases, including COPD, were the third leading cause of death in the United States after heart disease and cancer in 2013 (CDC 2016). The direct and indirect costs of COPD approach $50 billion in the United States. Because most health care costs are related to treatment of exacerbations, costs rise ABBREVIATIONS IN THIS CHAPTER ACOS Asthma-COPD overlap syndrome BT Bronchial thermoplasty CAMP Childhood Asthma Management Program CAT COPD Assessment Test COPD Chronic obstructive pulmonary disease DLCO Carbon monoxide diffusion in the lung ENDS Electronic nicotine delivery systems EPR-3 Third Expert Panel Report of the National Heart, Lung, and Blood Institute FEV1 Forced expiratory volume in 1 second FVC Forced vital capacity ICS Inhaled corticosteroids LABA Long-acting β2-agonist LAMA Long-acting muscarinic antagonist mMRC Modified Medical Research Council respiratory questionnaire NRT Nicotine replacement therapy PDE Phosphodiesterase PFT Pulmonary function test PPSV23 Pneumococcal polysaccharide vaccine 1. Given patient information, distinguish between and assess the status of asthma, severe asthma, chronic obstructive pulmonary disease (COPD) (and its complications), and asthma-COPD overlap syndrome (ACOS). 2. Design an initial therapeutic regimen consistent with current treatment guidelines for asthma, severe asthma, COPD, and ACOS, and revise as appropriate according to therapeutic response. 3. Evaluate a patient’s asthma or COPD therapy to maximize outcomes and justify adjunctive therapy and modifications based on individuals’ needs, skill level, and preferences. 4. Judge the patient-specific effect of new and emerging therapies according to current understanding of the pathophysiology, available evidence, and drug-specific properties. Reviewed by Christopher K. Finch, Pharm.D., FCCP, FCCM, BCPS; and Jennifer L. Petrie, Pharm.D., BCPS By Theresa Prosser, Pharm.D., FCCP, BCPS, AE-C; and Suzanne G. Bollmeier, Pharm.D., BCPS, AE-C Asthma and COPD