COPD diagnosis is suspected in a patient with symptoms of dyspnea, chronic cough, or sputum production. Key clinical indicators that increase the probability of a COPD diagnosis are progressive persistent dyspnea, worsening with exercise, recurrent wheezing, chronic cough, recurrent lower respiratory infections and a history of risk factors. However, spirometry is required to establish COPD diagnosis.1 
COPD needs to be accurately diagnosed for optimal management. Therefore, differential diagnoses, such as asthma, congestive heart failure, bronchiectasis, tuberculosis, obliterative bronchiolitis, and diffuse panbronchiolitis, should be considered to make a clear distinction from COPD.1 Asthma is difficult to distinguish from COPD by current imaging modalities or physiological tests in some patients.1 
View this article to know how to <a href="https://pro.campus.sanofi/copd/articles/copd-vs-asthma-learn-the-difference" style="color:#0563c1; text-decoration:underline">differentiate between COPD and asthma</a>.
After establishment of COPD diagnosis, further assessment is required to guide treatment. The goals of initial assessment of COPD are to determine the severity of airflow obstruction, impact of disease on patient’s health status, and risk of future events. 1
There are various tools for COPD monitoring. Read this article to find out more about the <a href="https://pro.campus.sanofi/copd/articles/key-tools-to-measure-the-success-of-copd-management" style="color:#0563c1; text-decoration:underline">key tools to measure the success of COPD management</a>. 
Spirometry
Spirometry is one of the useful tools for pulmonary function test for COPD.2 It is readily available, non-invasive, reproducible and objective.1 During early stages of COPD when respiratory symptoms may be absent, spirometry can help identify COPD.1
Key variables associated with spirometry

Assessment of lung function by spirometry, particularly the post-bronchodilator FEV1, plays an important role in determining COPD severity and guiding treatment.5 Possible dosage protocols for measuring post-bronchodilator FEV1 are 10-15 minutes after a short-acting beta2-agonist (dose: 400 mcg) or 30-45 minutes a short-acting anticholinergic (dose: 160 mcg) or a combination of both drug classes.1 A decline in FEV1 over time is indicative of disease progression.5
GOLD grades and severity of air flow obstruction in COPD (based on post-bronchodilator FEV1)1

A refined GOLD ABE assessment tool, combining severity of exacerbations and symptoms, was proposed to guide pharmacological treatment. The level of symptoms is assessed based on the modified Medical Research Council (mMRC) dyspnea scale or COPD assessment test (CAT™)
Different grades of disease severity based on GOLD ABE assessment tool1

Additional clinical assessments1
Other clinical assessments may be required in specific patients to characterize severity and guide management, make a differential diagnosis, identify comorbidities or underlying other abnormalities.1

Symptom assessment using validated questionnaires
COPD impacts patient lives beyond dyspnea.1 The severity of airflow obstruction correlates weakly with symptom severity and impairment in health status.1 Therefore, changes in FEV1 are unable to capture the impact of COPD on patient’s health in its entirety.7,8 Short patient-centered questionnaires are the most efficient and accurate tools to assess severity of symptoms, limitation in activities of daily living and health-related quality of life (HRQoL).6 
Understand which <a href="https://pro.campus.sanofi/copd/articles/quality-of-life-and-symptom-measurement-in-copd-patients" style="color:#0563c1; text-decoration:underline">validated tools can be used to measure quality of life and symptoms</a> in patients with COPD.
The implementation of quick and easy-to-use questionnaires in routine clinical practice can enable physicians fully comprehend the HRQoL of their patients, improve transparency, and prescription of appropriate treatment and effective COPD monitoring.7,8
The modified Medical Research Council (mMRC) dyspnea scale 
Dyspnea is a subjective measure; therefore, it shows poor association with objective evaluation of lung function, exercise capacity, and other outcomes.5 The mMRC dyspnea scale is a simple to administer questionnaire, which assess the severity of dyspnea by grading its impact on daily activities on a scale of 0 to 4.6 Patients are required to select on a self-applied scale one of five statements that most closely describe their everyday activities or situation levels provoking breathlessness and level of impairment.5,8
COPD assessment test (CAT™)
For routine use in clinical practice, the CAT is a reliable, validated, practical, simple short patient-centered questionnaire, which can quantify COPD impact on patient health.6,7 The CAT items are broad and encompass several effects of COPD on patient’s health.7 The CAT scores 8 items on a scale of 1 to 5 with a maximum total score of 40. 
Read the <a href="https://www.catestonline.org/hcp-homepage/clinical-practice.html" style="color:#0563c1; text-decoration:underline">CAT HCP user guide and FAQ</a> to learn more about COPD assessment test
Functional parameters assessed using CAT™1,8

Blood eosinophil count
In the ECLIPSE study, 37.4% of patients with COPD had persistently raised blood eosinophil count (≥2%) over 3 years.9 When not confounded by use of inhaled corticosteroids (ICS), blood eosinophil count has a potential role as a prognostic biomarker for declining lung function.1

Blood eosinophil count can serve as a surrogate marker for sputum eosinophils to guide oral corticosteroid treatment of COPD exacerbations.9 It can help identify patients who are suitable for addition of ICS to regular bronchodilator therapy, allowing corticosteroid use in a more tailored way.1 
Do you know <a href="https://pro.campus.sanofi/copd/articles/blood-eosinophils-as-a-biomarker-in-patients-with-copd" style="color:#0563c1; text-decoration:underline">how blood eosinophil count can help guide treatment</a>?
Physiological test 
In case of a substantial gap between perceived symptoms and severity of airflow obstruction, a better understanding of the lung physiology is required, which may require additional assessments.1 Thus, in patients with persistent symptoms after initial treatment, additional clinical assessment, including measurement of lung volumes, diffusion capacity, exercise testing and/or lung imaging may be considered. 1

Chronic Obstructive Pulmonary Disease (COPD) is typically suspected in patients with symptoms like dyspnea, chronic cough, or sputum production. Accurate diagnosis is crucial for effective management, with spirometry being essential for confirmation. Distinguishing COPD from similar conditions, such as asthma, is challenging yet vital. This article provides clear guidance on differentiating COPD from asthma and highlights key tools like spirometry and validated questionnaires for monitoring disease progression and guiding treatment. Understanding and applying these tools can significantly enhance patient outcomes in COPD management.

CHRONIC-OBSTRUCTIVE-PULMONARY-DISEASE-(COPD)

RESPIRATORY

What tests can help diagnose and monitor your patients with COPD?

The overlapping signs and symptoms of COPD and asthma can make it challenging to distinguish between the two conditions.2 Certain patient groups pose a challenge for accurate diagnose of COPD due to confounding clinical features.2&nbsp;
COPD and asthma are obstructive lung disorders with distinct epidemiological features and pathophysiology. 3,4 Furthermore, these two conditions have different guideline-recommended management strategies and treatment goals.4 Thus, there is a need to make a clear distinction between the two conditions for accurate diagnosis and optimal management.
COPD is a chronic, usually progressive disease, typically associated with smoking and diagnosed in middle and relatively older age group (&gt;40 years old).2,3 It is characterized by airflow obstruction that is not fully reversible or irreversible.2,4
On the contrary, asthma is characterized by bronchial hyperresponsiveness, inflammation of airways, and airflow obstruction.2 Typically, asthma is an allergic disorder2 and associated with atopy.4 It presents during childhood, though it can be diagnosed in adulthood as well.3
Distinguishing between COPD and asthma4

<h3 style="line-height: 1.2; margin-top: 8px; margin-bottom: 8px;">Type 2 inflammation in COPD and asthma</h3>
Both COPD and asthma are associated with chronic inflammation of the respiratory tract.5 Although cells and mediators involved in inflammation are different between the two disease entities, some patients with COPD have an inflammatory pattern (type 2 inflammation) similar to that in asthma.5,6&nbsp;
Type 2 inflammation, associated with eosinophilic inflammation, is characteristic of asthma, while COPD is mostly associated with neutrophilic inflammation.4,7 However, evidence has suggested that increased eosinophil count in the airways and type 2 inflammation may be present in a subgroup of patients with COPD as well, even without coexisting asthma.6,7 Notably, type 2 inflammation is associated with increased risk of exacerbations in asthma and in moderate to severe COPD.8
Click <a href="https://pro.campus.sanofi/copd/articles/an-overview-of-the-impact-of-type-2-inflammation-in-copd-insights-from-dr-surya-bhatt" style="text-decoration:none">here</a> to gather more insights from Dr. Surya Bhatt on the impact of type 2 inflammation in COPD.

Click <a href="https://pro.campus.sanofi/copd/articles/role-of-type-2-inflammation" style="text-decoration:none">here</a> to read more about the role of type 2 inflammation in COPD exacerbations.
<h3 style="line-height: 1.2; margin-top: 8px; margin-bottom: 8px;">COPD and asthma overlap&nbsp;</h3>
The Global Initiative for Asthma (GINA) 2024 strategy report terms COPD and asthma overlap as a simple description for patients with symptoms of both COPD and asthma.1 The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024 report emphasizes that these two conditions are separate but does acknowledge that they may coexist.5 Asthma reportedly coexists in approximately 27% of patients with COPD.3 In case of a concurrent diagnosis, 2024 GOLD report recommends managing the disease using the asthma guidelines.5
Characteristics of COPD and asthma overlap vs COPD alone3

Bronchodilator response: COPD vs asthma
Abnormal levels of forced expiratory volume in 1 minute (FEV1) and forced vital capacity (FVC) are suggestive of airflow obstruction.4 Pre-bronchodilator spirometry can be used for initial assessment of airflow obstruction in symptomatic patients.5 Post-bronchodilator spirometry is needed for COPD diagnosis and assessment; FEV1/FVC ratio of &lt;0.7 is considered diagnostic for COPD.5 Post-bronchodilator spirometry can also be useful in distinguishing between classical asthma presentation and COPD.4 Airflow obstruction is often fully reversible in classical asthma, while it is irreversible or partially reversible in COPD.4 However, the degree of reversibility may vary in an individual patient and coexistence of COPD and asthma may confound bronchodilator response.4,5 Therefore, post-bronchodilator spirometry should not be considered as the only criterion for differentiating COPD from asthma.4
Click <a href="https://pro.campus.sanofi/copd/articles/key-tools-to-measure-the-success-of-copd-management" style="text-decoration:none">here</a> to know about the key tools to measure COPD severity.
<h3>COPD and asthma treatment guidelines</h3>
COPD management5
The treatment goals of COPD exacerbations are to reduce symptoms and future risk of exacerbations. 2024 GOLD report proposes a tailored approach for COPD management, based on the severity of symptoms and exacerbation risk.&nbsp;
Treatment can be escalated/de-escalated based upon predominant symptoms (treatable traits) of breathlessness and exercise limitation, and the continued occurrence of exacerbations whilst on maintenance therapy.&nbsp;
Click <a href="https://pro.campus.sanofi/copd/articles/gold-recommendations-for-treatment-and-management-of-copd" style="text-decoration:none">here</a> to read the 2024 GOLD recommendations for COPD management.&nbsp;
Initial pharmacological treatment for COPD5&nbsp;

Asthma management1
The GINA goal of asthma management is to achieve the best possible long-term outcomes for the individual patient, including symptom control and minimizing risk of asthma-related mortality, exacerbations, persistent airflow limitation and treatment side effects.
Click <a href="https://ginasthma.org/2024-report/" style="text-decoration:none">here</a> to download the 2024 GINA report to understand how to manage patients with asthma&nbsp;
Personalized management for adults and adolescents to control symptoms and minimize future risk.1

COPD and asthma are lung diseases marked by airway inflammation. Uncover differences and overlaps in COPD and asthma, including causes, symptoms, and treatment.

COPD vs asthma: Learn the difference

What is the role of type 2 inflammation in COPD?&nbsp;
A deeper look into the underlying pathophysiology and drivers of chronic inflammation, particularly type 2 inflammation, can help us better understand COPD. The key cytokines involved in type 2 inflammation are elevated during acute exacerbations of COPD, and can play a role in mucus hypersecretion in lungs.&nbsp;
Watch the video below to get an understanding on type 2 inflammation and its role in COPD.&nbsp;

<h2>The Genesis of Inflammation in COPD</h2>
COPD is traditionally associated with exposure to harmful stimuli such as cigarette smoke, air pollution, and respiratory infections. Dr. Bhatt explains that these insults lead to epithelial damage in the respiratory tract, which is the first step in a cascade of inflammatory responses. "In response to any kind of insult, there is some element of epithelial injury and damage," Dr. Bhatt notes, outlining the release of damage-associated molecular patterns (DAMPs), also known as alarmins. These include IL-33, IL-25, and TSLP (thymic stromal lymphopoietin), each playing a crucial role in the amplification of inflammation.
<h2>Type 2 Inflammation: Beyond Eosinophils</h2>
While eosinophilic inflammation (driven by IL-5) has been the traditional focus in Type 2 inflammation, Dr. Bhatt emphasizes the significant roles of IL-4 and IL-13. These interleukins contribute to various pathological processes in COPD:
<ol>
 <li>
 Epithelial Barrier Disruption: IL-4 and IL-13 can compromise the integrity of the epithelial barrier, making it more susceptible to environmental insults.</li>
 <li>
 B Cell Class Switching and IgE Production: These cytokines facilitate B cell transformation and increase IgE levels, which are critical in allergic responses and may exacerbate respiratory symptoms.</li>
 <li>
 Mast Cell and Basophil Degranulation: This leads to further release of inflammatory mediators, worsening inflammation and symptom severity.</li>
 <li>
 Goblet Cell Hyperplasia and Mucus Overproduction: Particularly driven by IL-13, this results in excessive mucus production, a hallmark of COPD that contributes to airway obstruction and difficulty clearing infections.</li>
 <li>
 Airway and Alveolar Remodeling: Chronic inflammation driven by these cytokines can lead to structural changes in the lung, reducing its functionality over time.</li>
</ol>

<h4>Acute Exacerbations and Mucus Production in COPD</h4>
Dr. Bhatt notes that IL-4 and IL-13 levels are elevated during acute exacerbations of COPD compared to stable states, underscoring the activation of these pathways during flare-ups. He also addresses the role of mucins in COPD, particularly MUC5AC, which is induced by IL-4 in human epithelial cells. IL-13 also shows a dose-dependent effect on MUC5A and enhances mucus production, marking it as a significant factor in COPD exacerbations.

<h2>The MUC5AC Connection</h2>
A significant aspect of Dr. Bhatt’s discussion revolves around mucin production, specifically driven by MUC5AC and its regulation by IL-4 and IL-13. "IL-4 can induce increased expression of MUC5AC in human epithelial cells," he explains, highlighting a dose-dependent increase in mucus production driven by IL-13. This pathway is particularly important as it contributes to the characteristic mucus hypersecretion observed in COPD patients.

<h2>In Summary</h2>
Dr. Surya Bhatt’s insights into the role of Type 2 inflammation in COPD underscore the complexity of this disease and the multifaceted nature of its inflammatory processes. Understanding these mechanisms not only sheds light on the pathophysiology of COPD but also opens new avenues for targeted treatments that could potentially modulate these inflammatory pathways, offering hope for better management of this debilitating disease.
As the field of COPD research continues to evolve, it is clear that integrating insights from experts like Dr. Bhatt will be crucial in developing more effective therapeutic strategies that address the underlying inflammation and its diverse manifestations in COPD patients.

Understanding type 2 inflammation is the key to managing symptoms and exacerbations of COPD.  

Decoding Type 2 Inflammation in COPD: An Expert’s Perspective 

What if you could identify higher-risk patients?&nbsp;&nbsp;
A deeper look at the inflammation behind exacerbations could ignite new thinking in COPD. Look for blood eosinophils, a biomarker of COPD with Type 2 Inflammation, which may help you identify those patients at increased risk of exacerbations.
Watch the video below to better understand exacerbations in COPD and better identify patients at risk.&nbsp;&nbsp;&nbsp;

Understanding type 2 inflammation may help shed light on why some patients continue to exacerbate. Watch this video to learn how.

One minute to ignite new thinking in COPD

Ignite new thinking in COPD -&nbsp;COPD, chronic obstructive pulmonary disease
In patients with COPD, exacerbations may :&nbsp;
<ul>
 <li>Increase the risk of another&nbsp;1</li>
 <li>Accelerate lung function decline&nbsp;2</li>
 <li>Increase morbidity and mortality risk&nbsp;1,3-6</li>
</ul>
Different types of chronic inflammation have an important role in COPD&nbsp;7-15 
 Type 2 inflammation and beyond type 2 inflammation 
 Identifying COPD patients with type 2 inflammation may help determine those at increased risk of exacerbations 16 
 Look for blood eosinophils, a biomarker of COPD with type 2 inflammation 17,18, a, b 
 EOS ≥ 300 cells/ μL à 32% increased risk of COPD exacerbations 16a,b 
 Understanding type 2 inflammation in COPD may shed light on why some patients continue to experience exacerbations
a Results from an observational analysis of 1553 patients with GOLD spirometry grade 2-4 COPD evaluating the relationship between blood eosinophil count and COPD exacerbation risk. b Stratified analysis confirmed that increased exacerbation risk was driven by subjects with a history of frequent exacerbations, defined as ≥2 exacerbations per year.

Read video transcript

Understanding type 2 inflammation may help shed light on why some patients continue to exacerbate. Watch this video to learn how.

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One minute to ignite new thinking in COPD

Latest COPD articles

What tests can help diagnose and monitor your patients with COPD?

COPD vs asthma: Learn the difference

Decoding Type 2 Inflammation in COPD: An Expert’s Perspective