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Distinguishing asthma from COPD in primary care settings

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Two of the most common conditions seen in general practice are asthma and COPD. Although both conditions are treated with inhaled medication, the doses and types of treatment used vary for each condition and some inhaled therapies are licensed for use in asthma or COPD, but not both.

In this article, we will discuss how to recognise the difference between asthma and COPD through careful history taking and assessment.

Case study: Binny, age 23
Binny is studying for her finals at university. She is experiencing a tight chest and cough, which is worse at night and on exercising. She thinks this is stress-related and wants advice about how to reduce her stress levels.

Although clinicians should always listen to, and address,a patient's concern about their symptoms, it is important not to be led down the road of an individual's self-diagnosis. There are many reasons why Binny might be experiencing a tight chest and cough, including stress, but a careful history and assessment will ensure an objective diagnosis is made. Binny's description of cough and a tight chest at night and in response to exercise is typical of asthma, so further clues should be sought to identify whether this is a likely diagnosis.

The BTS/SIGN asthma guidelines give examples of factors which make a diagnosis of asthma more or less likely.1

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