spirometric assessment in the Management of chronic obstructive pulmonary disease among adults with uncontrolled asthma
DOI:
https://doi.org/10.5281/zenodo.22815231Keywords:
asthma-COPD overlap, spirometry, airflow obstruction, bronchodilator reversibility, uncontrolled asthmaAbstract
Background: Asthma-COPD overlap, persistent airflow limitation with features of both asthma and COPD, is common among adults whose asthma remains poorly controlled, and these patients have more exacerbations and faster decline than either phenotype alone [1,2].
Objective: This review synthesizes evidence on spirometric assessment, bronchodilator reversibility, post-bronchodilator FEV1/FVC, and FEV1 trajectory, for identifying and managing COPD features in uncontrolled asthma.
Methods: We reviewed cohort studies, consensus statements, and trials addressing spirometric phenotyping, fixed obstruction, reversibility variability, and treatment response in overlap populations.
Findings: Persistent post-bronchodilator FEV1/FVC below 0.70 identifies a subgroup with accelerated decline and exacerbation risk approaching COPD alone [4,6]; reversibility is often present but variable, limiting its use as a single cut-point [7]; combined spirometric and inflammatory assessment improves selection for triple therapy [8,30].
Conclusions: Serial spirometry, read alongside symptoms and exacerbation history rather than a single threshold, should anchor a stepwise assessment pathway for uncontrolled asthma, guiding earlier escalation to combined bronchodilator and anti-inflammatory therapy [1,31].
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