Synopsis
Resolve chronic airway diagnostic uncertainty using objective evidence and treat demonstrated asthma and COPD traits without allowing an overlap label to replace careful clinical reasoning.
- Asthma and COPD can coexist, but 'overlap' has no single universally accepted diagnostic test and should not become a substitute for documenting each condition's evidence.
- Asthma is characterised by variable symptoms and variable expiratory airflow limitation; COPD requires persistent post-bronchodilator airflow obstruction in the right exposure and clinical context.
- A smoking history does not rule out asthma, and bronchodilator reversibility does not by itself rule out COPD; interpret magnitude, repetition, treatment and history together.
Key red flags
Previous life-threatening attack, repeated systemic corticosteroid, night waking, marked variability or escalating reliever use warrants an asthma-safe ICS-containing regimen while diagnostic refinement continues.
Investigation priorities
Determine obstruction, persistence and immediate bronchodilator response.
Management branches
The record contains asthma, COPD, overlap or conflicting airway labels.
- Retrieve age at symptom onset, childhood or allergic history, attacks, smoking and occupational exposure, prior objective tests and response to treatment.
- Check whether each historical diagnosis was based on acceptable spirometry, documented variability or only symptoms and a therapeutic trial.
Key medicines
Inhaled corticosteroid-formoterol AIR or MARTUse the exact licensed product, strength and as-needed or maintenance-and-reliever schedule selected under NICE and the local formulary.
Long-acting muscarinic antagonist add-onGive the locally formulary-approved inhaled once-daily or twice-daily product at its licensed device-specific adult dose after technique assessment.