Abstract
Chronic obstructive pulmonary disease (COPD) and asthma are two of the most common chronic diseases worldwide. Both diseases are heterogenous and complex, and despite their similarities, they differ in terms of pathophysiological and immunological mechanisms. Mounting evidence supports the presence of several phenotypes with various responses to treatment. A systematic and thorough assessment concerning the diagnosis of both asthma and COPD is crucial to the clinical management of the disease. The identification of different biomarkers can facilitate targeted treatment and monitoring. Thanks to the presence of numerous immunological studies, our understanding of asthma phenotypes and mechanisms of disease has increased markedly in the last decade, and several treatments with monoclonal antibodies are available. There are compelling data that link eosinophilia with an increased risk of COPD exacerbations but a greater treatment response and lower all-cause mortality. Eosinophilia can be considered as a treatable trait, and the initiation of inhaled corticosteroid in COPD patients with eosinophilia is supported in many studies. In spite of advances in our understanding of both asthma and COPD in terms pathophysiology, disease mechanisms, biomarkers, and response to treatment, many uncertainties in the management of obstructive airways exist.
Highlights
Chronic obstructive pulmonary disease (COPD) and asthma affect more than 600 million individuals globally
Based on the idea that COPD is characterized by neutrophilic inflammation, the presence of eosinophilic airway inflammation has been used to discriminate between asthma and COPD
Asthma and COPD compose a great burden for public health worldwide, and the need for early identification of cases and intervention is still of great importance
Summary
Chronic obstructive pulmonary disease (COPD) and asthma affect more than 600 million individuals globally. Asthma is characterized by variable airflow limitation, airway hyperresponsiveness, and airway inflammation [1] It has several phenotypes with distinct aetiologies that can be classified based on triggers, clinical presentation, and inflammatory type [2]. COPD is characterized by chronic inflammation of the lungs with the presence of neutrophils, macrophages, and T-lymphocytes. Based on the idea that COPD is characterized by neutrophilic inflammation, the presence of eosinophilic airway inflammation has been used to discriminate between asthma and COPD. This notion is flawed because around 40% of COPD patients exhibit eosinophilic inflammation even when adjusting for asthma [5]. These patients exhibit characteristics similar to those of asthma patients, and the term asthma–COPD overlap (ACO) has been used to describe this subset of patients who simultaneously exhibit characteristics of both diseases [6]
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