Elevating COPD Management: Enhancing Treatment and Improving Patient Outcomes - Episode 9
Exploring the Relationship Between COPD and Asthma
Panelists discuss the nuanced relationship between chronic obstructive pulmonary disease (COPD) and asthma through the lens of type 2 inflammation, emphasizing that while both diseases share inflammatory pathways and a treatable trait, they remain distinct conditions with differing manifestations and treatment responses; they highlight that asthma-COPD overlap affects 15% to 20% of patients, but type 2 inflammation is a separate COPD subtype rather than evidence of dual diagnosis, underscoring the importance of precise phenotyping to guide personalized treatment strategies that balance efficacy, safety, and patient-specific factors.
The recognition that COPD and asthma share a treatable trait in type 2 inflammation has added nuance to our understanding of their relationship. While both diseases involve some common inflammatory pathways, their manifestations and responses to therapies are not identical. For example, certain biologic agents targeting interleukin pathways show differing efficacy between asthma and COPD, underscoring the complexity of the overlap. Eosinophils, while a useful biomarker, are not a perfect indicator of type 2 inflammation, and many medications affect multiple pathways. This illustrates that despite shared features, COPD and asthma remain distinct conditions with overlapping but not identical inflammatory profiles.
Asthma-COPD overlap occurs in about 15% to 20% of patients, yet type 2 inflammation represents a subtype of COPD itself, distinct from asthma. Clinical trials in COPD typically exclude patients with a history of asthma to better understand type 2 inflammation within COPD alone. This distinction is important, as not all patients with COPD with type 2 inflammation have asthma, nor do they necessarily present clinically with asthma-like features. Consequently, type 2 inflammation should be viewed as a treatable trait present across both diseases, rather than a sign that a patient has both asthma and COPD. This perspective helps clarify treatment goals and avoids conflating distinct disease processes.
Managing patients with features of both asthma and COPD requires careful clinical judgment to identify the dominant drivers of disease and tailor treatment accordingly. Priorities include reducing exacerbations, controlling symptoms, and maintaining lung function stability. Comorbidities and patient-specific factors, including potential adverse effects of medications, must also be considered. Some therapies are approved for both asthma and COPD, easing treatment choices, while others may be more condition-specific. When type 2 inflammation is suspected, biologics may be favored over therapies targeting neutrophilic or non–type 2 pathways, especially given considerations around safety and tolerability in older patients with COPD. Overall, personalized care that balances efficacy and safety remains key.
