CHEST CLINICAL COPD & ASTHMA IMMERSION PROGRAM - AUGUST 14, 2024-Maselli- Clinical Presentation, Diagnosis & Guideline Based Management

Maselli- Clinical Presentation, Diagnosis & Guideline Based Management

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The document outlines the clinical presentation, diagnosis, and guideline-based management of asthma and Chronic Obstructive Pulmonary Disease (COPD), highlighting key diagnostic criteria, symptoms, and treatment options for both conditions.<br /><br />### Asthma<br />**Clinical Presentation:** Symptoms often worsen at night or early morning, vary over time, and can be triggered by viral infections, exercise, or exposure to allergens. Common symptoms include wheezing, cough, dyspnea, and chest tightness.<br />**Diagnosis:** Includes clinical history, physical exam, spirometry, and response to inhaled corticosteroids. Spirometry confirming variable expiratory airflow limitation is crucial.<br />**Management:** The treatment follows a stepwise approach with inhaled corticosteroids (ICS) and β2-agonists forming the cornerstone. Management can be personalized based on biomarkers like blood eosinophils, FeNO, and total IgE levels. Advanced therapies include biologics targeting specific inflammatory pathways (e.g., IL-25, IL-33, TSLP).<br /><br />### COPD<br />**Clinical Presentation:** Symptoms often include a chronic cough with or without sputum production, chest tightness, wheezing, dyspnea, and fatigue. Exacerbations can worsen these symptoms.<br />**Diagnosis:** Primarily involves post-bronchodilator spirometry indicating a fixed airflow limitation (FEV1/FVC < 0.7). Routine spirometry is not recommended for asymptomatic population screening.<br />**Management:** The GOLD guidelines recommend inhaled bronchodilators (LAMA and LABA) and corticosteroids for maintenance therapy, based on symptom severity and history of exacerbations. Non-pharmacologic treatments like pulmonary rehabilitation, supplemental oxygen, and ventilatory support are also emphasized. Emerging biomarkers may assist in selecting specific therapies.<br /><br />### Summary<br />Asthma and COPD have distinct clinical features but share some treatment strategies, primarily involving inhaled therapies. Asthma treatment is typically stepwise and determined by symptom control and endotypes, whereas COPD management is based on symptom severity and exacerbation history. Both conditions benefit from guideline-based pharmacological and non-pharmacological interventions to improve patient outcomes.<br /><br />This comprehensive approach underscores the importance of personalized medicine in managing chronic airway diseases, utilizing both traditional therapies and advanced targeted treatments for optimal care.

Keywords

Asthma

COPD

Symptoms

Diagnosis

Management

Spirometry

Inhaled corticosteroids

Bronchodilators

Biomarkers

Personalized medicine

Chronic Obstructive Pulmonary Disease