Asthma & COPD: Diagnosis and Management

Asthma & COPD

Differentiating Asthma vs COPD

| Feature | Asthma | COPD |

|---------|--------|------|

| Age of onset | Usually <40 | Usually >35, smoker |

| Variability | Episodic, reversible | Progressive, less reversible |

| Spirometry | FEV1/FVC <0.70, reversible (12%, 200 mL post-bronchodilator) | FEV1/FVC <0.70, fixed |

| Trigger | Allergens, exercise, cold | Smoking, infection |

Asthma Severity

• Mild–moderate: SpOÔéé >92%, PEFR >50%, able to speak in sentences
• Severe: PEFR 33–50%, RR >25, HR >110
• Life-threatening: PEFR <33%, SpOÔéé <92%, silent chest, cyanosis, exhaustion

Acute Asthma Treatment

1. Oxygen: target SpOÔéé 94–98%
2. Salbutamol nebulised 2.5–5 mg (back-to-back if severe)
3. Ipratropium 0.5 mg nebulised (add if severe/life-threatening)
4. Prednisolone 40–50 mg oral (or IV hydrocortisone 100 mg)
5. IV magnesium sulphate 1.2–2 g over 20 min (life-threatening)
6. ICU referral / intubation if deteriorating

COPD GOLD Classification (post-bronchodilator FEV1 % predicted)

• GOLD 1: ÔëÑ80%; GOLD 2: 50–79%; GOLD 3: 30–49%; GOLD 4: <30%

COPD Management Ladder

• All: smoking cessation, vaccinations, pulmonary rehab
• SABA/SAMA PRN → LABA or LAMA → LABA+LAMA → add ICS if frequent exacerbations (eos ÔëÑ300)
• Exacerbation: controlled OÔéé (target 88–92%), salbutamol, ipratropium, prednisolone 30 mg ├ù 5 days, antibiotics if purulent sputum