I have been asthmatic all my life (except the first year!) and am now 73. My asthma is pretty well controlled with daily Symbicort and Ventolin occasionally when needed. I can ride a cycle 15 miles (but admit to struggling with hills although I do have other conditions which could have a bearing on this: I have Paroxysmal Tachycardia (an arrythmia) and Polymialgia Rhumatica which affects muscles (but I take steroids for this)).
My question is: I have for years had an annual visit to my GP surgery (or more recently, a telephone chat) for my 'asthma review'.
I was very surprised to be asked by my surgery to now undertake a 'COPD review' - only a few months after my last asthma review. This would be with an external company and take the form of a questionnaire (by 'phone).
Firstly, I don't think I have COPD. Or do I?
Secondly, would being diagnosed with COPD be detrimental in any way (wondering about travel insurance which is very difficult and expensive already due to various conditions)?
Thirdly, can one choose to have one or the other?! Thinking that I think there's a crossover between them... Are there official statistics that put one into the asthma or COPD camp?
Apologies but fourthly, I have just remembered that I heard about a Pulmonary Rehabilitation course and asked to join one three years ago, which I did. I have just dug out the results sheet which shows my spirometry (CAT) test score as 12/40. I don't know how to quantify that.
I am a bit bewildered by my sudden COPD label and if anyone can help answer my queries I would be very very grateful.
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Rostom
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Hi Rostom. It is actually possible to have both asthma and COPD. I’m 46, I’ve been asthmatic since I was 8, and had COPD since I was 37. I’ve also got Bronchiectasis and sleep apnea, but that’s another story.
So I’m a 46 (nearly 47) year old man, with 4 lung/respiratory conditions.
I didn’t choose to have one or the other, they just happened. I was stupid in my youth and was an asthmatic smoker. And in 2004 when I was 28, I had a huge bout of pneumonia. When I was diagnosed with the COPD in 2013, the consultant said the smoking wasn’t the cause, although it didn’t help. The pneumonia had scarred my lungs to a point that led to the COPD on top of the asthma. And then a year later in 2014, I was diagnosed with the Bronchiectasis.
So, you see, you don’t choose to have one or the other, but being asthmatic, with other factors possibly, can lead to having COPD. Your GP’s might just be covering all bases, and the COPD review is just to get an idea of whether you may have it or not. If they suspect you do, you’d probably be referred to the hospital for all sorts of tests, including a spirometry test, to confirm it.
When you have your COPD review, I’d ask why you’re having it, as you don’t recall being diagnosed with it, only asthma.
As for point 2…. travel insurance becomes notoriously difficult for folks with pre-existing conditions such as COPD to obtain. But not impossible. I managed to get some through the post office once a few years back.
This is just a thank you for taking the trouble to help with my query.
I have contacted my GP to ask why my asthma has suddenly turned into COPD and await a telephone conversation with him/her. I will update when I know more. Many thanks, Rostom.
Hi Rostom. I would give the surgery a ring and query the appointment. If they then say it is not an error and you do have copd it might be an idea to book a telephone (or face to face if you prefer) appointment with your GP to ask when and how this diagnosis was made. ( Asthma, when not at its best and copd give the same kind of readings on spirometry. They are distinguished by reversibility testing. Both are classed as obstructive conditions.)
Many thanks for your response to my query. I have written in to my GP's surgery and await a telephone conversation at which I am sure they will sort me out (one way or the other...). I will try and update in case others have a similar problem. Thank you for your response. Regards, Rostom.
I would definitely be querying this, as it seems like they've sprung this review on you without a diagnosis. I have noticed from posts in this forum that there is a tendency for some medics to assume that any older person, or anyone who has been near a cigarette at some point, who has a lung condition must have COPD, not asthma. I agree with Troilus that it would help to push back with the surgery and ask why you've been given this diagnosis.
I wonder if they may also think you have COPD because you did pulmonary rehab? It tends to be offered only to people with COPD (though some people with asthma can be offered it and may benefit). So that may be where it comes from?
In terms of the CAT score, it's not spirometry. Or at least, it might include spirometry as part of the overall score, but it's mainly a questionnaire about any COPD/breathing symptoms affect you. So like the Asthma Control Test (ACT) or Asthma Control Questionnaire (ACQ), if you've done those (the ACQ usually includes spirometry in the overall score). I looked it up and it seems like the lower your score on the CAT is the better ie lower score means fewer symptoms/less effect of symptoms. It shouldn't be used by itself for diagnosis of COPD, especially as your score was on the lower end plus looking at the questions, they could easily apply to someone with asthma too.
COPD guidelines are now very keen on combining symptoms and spirometry and other things for assessment and treatment, not just looking at one thing like they used to. Though they're often not applied, or they use the ones from 6 years ago even though it's free to download the latest set. (I'm not a doctor or nurse, but my job involves technical/scientific writing about medical topics and treatments; I've done a fair bit of work on asthma and COPD, though not claiming to be an expert).
Re travel insurance - definitely good not to have another condition on there, though I've found it hard enough to get it with severe asthma! Also, it may help in general to use an insurance broker - that was how I got mine before. Not cheap but a lot cheaper than some options.
You may also find it helpful to call the asthma nurses to chat things through: 0300 2225800 or WhatsApp 07378 606 728 Monday-Friday 0915-5pm
Thank you very much for your reply. I took your advice and contacted the lovely people at Asthma + Lung and an understanding nurse listened carefully and gave me her opinion. She doubts whether I would have COPD as my spirometry of some ten years ago was negative for COPD and I have not gone downhill too much since then. COPD should not be confirmed by ticking a box or attending/not attending a course, it needs proper updating of another spirometry test and examination etc.,, which is your opinion, too.
The nurse did suggest one condition that I am not familiar with, 'fixed airways disease'. It was explained to me that all the years of coughing as a child (before steroids or the wonderful medicines available today) would have caused almost constant inflammation and contributed to my airways becoming stiff. However, after my initial euphoria of (in her opinion) not being labelled as a COPD bod, my husband looked this condition up and then told me not to research it as it was not a particularly wonderful thing to have! I have taken his advice and hope that I don't have this. Out of the frying pan.....?!
Thanks for the travel broker advice, it's on my list as I have been refused insurance before during 'pre-existing screening'. My problem is unrelated to asthma but it is not on the list of conditions that the screening staff hold, so they automatically upscale it to the more serious illness that they do have before them. No amount of pleading or reasoning will change their minds. When everything is added up it's too much for them and 'computer says no', despite my eating the NHS smarties twice a day and being fitter than many people I know of my age! I will try again when I think of booking a trip away but thanks, anyway.
I will update here when I hear back from my GP's surgery but many thanks for your very helpful post. Regards, Rostom.
In the merging of practices locally all patient management seem to disappear. I was plagued by a private company contracted to invite people to a diabetes programme, which I refused, so they continued to email, call and text me. It took a while for a nurse to confirm I didn't actually have diabetes or prediabetes. It was a very stressful time and to be told I 'had to be told some test results face to face' but there were no appointments available and I wasn't allowed to know further detail. It took a while to sort out as it confused anyone I saw for a year or so after. Now three years later in my latest review they say they can't take the 'prediabetic' marker off as it's now in my medical 'history' so I'm 'at risk'. It's very hard to manage your conditions when there's confusion like this.
Then I was referred for physio (for another condition) which then led to being called up to book on an 'exercise' course and when I asked what type (as I've seen a few specialist physios) it turned out to be a 'weight management' programme. I did laugh, as again, people who'd never met me, or looked at accurate notes were mistakenly referring me to pointless courses for some reason and based on what in the notes - usually a misreading or error. I've struggled to gain weight and have to work hard to keep up my BMI. It turns out there was new funding to help people lose weight, so they were sending us to that. It's all 'exercise' eh?
I did a pulmonary rehab course for my asthma and have been mistaken or included with COPD on many occasions so it doesn't worry me as much as it used to. The replies here have been great. As long as my symptoms are under control and I can access treatment when I need it, I don't really mind what it's called now!
My GP said I had COPD on the grounds I'd played at being a smoker in my teens &20s. He gave me an extra mediaction which helped my breathing not at all, so I thought I'd save the nhs money and not take it. Like others, I think this is a bit of a fashion.
I have never smoked, being a fairly sick asthmaic wheezy child.
My antipathy to smoking was helped by my being burnt by my mother! My mother was at the hairdresser in 'the old days', sitting under a 'domed' dryer. I was sitting on the floor by her feet when she flicked her cigarette outwards and connected with..... me. Not good! Additionally, as soon as I entered a party or room full of people - and smoke - my very carefully applied makeup just slid off my face, so not a good look!
Thanks for your reply. Regards, Rostom.
PS May I ask the name of the drug that you felt did not help you?
You seem pretty fit to me. Having any sort of diagnosis wouldn’t change that, but it might target the treatment better. Having said that, Symbicort is used for both asthma and COPD, and I use it because I have both. So this might prove to be an academic exercise in your case, but there can be no harm in having a “second opinion”. However, I don’t believe either COPD or asthma can be properly diagnosed without spirometry, do you might want to suggest that at some stage.
Many thanks for your reply. I am sure that you are correct regarding having a decent diagnosis which is unreliable with spirometry. I had a spirometry test some (ten or more...) years ago at the local hospital and the result was entirely normal then. I do not feel I have gone downhill since then. In fact, these Covid years have been wonderful for me! My husband and I were rather hermit-like for the first Covid year. Result? Not one cold, or chest infection. I have relaxed a little (but still wear a mask if on public transport or when shopping, etc) and have caught Covid twice but had a hospital infusion as I am clinically subnormal, or whatever the phrase is but was relatively okay. Incidentally, each time I knew who had given me Covid (such good friends...).
I will update my GP's comments after I have spoken to him/her.
Hello 😀My consultant once told me that anyone who has asthma long enough will find it eventually becomes COPD. My understanding is that asthma is reversible obstruction whereas COPD is irreversible obstruction. I have both. Nowadays this is often classified as ACOS (Asthma & Copd, overlap syndrome). Re insurance, it is more complex with COPD but whether it would make much difference to you, given your other comorbidities, I do not know.
I wish I was as fit as you, and I'm 62! Well, 62 until Saturday 😆
Very useful by the way - and very sensible, so many of us seem to have overlapping conditions - or 'multisystemic' as I said to a consultant today (it would help if they spoke to each other a bit).
Thanks for your input to my questions. I am interested as to how and why my surgery made me jump from one camp into the other but accept that there must be a morphing stage from one into the other - but surely not as an administrative exercise!
The label of ACOS is very interesting, too. There is obviously much that I do not know about my lungs and 'tubes'! I hve had great trouble in the past with travel insurance companies as they often do not have my particular conditions on their 'lists' and their default position is to upscale them into a more serious (ergo, expensive!) category - very annoying! I wonder if they would know of ACOS?
Happy Birthday for Saturday! Isn't it horrible having a January birthday? A granddaughter has offered me her May birthday instead of mine and I think I may take her up on it! I am 74 today. Happy Birthday me!!
Many thanks for your kind response. Regards, Rostom.
Happy birthday indeed! I hope you had, or are having, a good birthday! Yes, I agree, a January birthday isn't great. At school, my birthday always sat in the middle of winter exams. Also, I have a lifetime's trail of birthdays with people claiming they gave me an extra special/expensive Christmas present which was also my birthday present! No chance of a birthday picnic, swim, or holiday! How I envied my sister with her birthday in August! It's lovely to meet a fellow 'birthday victim'!
I've found the All Clear insurance company very competitive, though as I've never had to make a claim, I've no idea how good they are when called upon.
So I have been asthmatic most of my life and I have lots and lots of other health issues with lots of long lables I admit I used to be a smoker so of course I was told I had asthma and copd so I asked to have the theory proven so I did the test which was negative which I was glad of I use a bipap for 12 hours a day for a rare lung disease but I do seem to get the copd diagnosis everytime so I stood up for finding out as I have lots of lables and felt I needed to have a proven disease only so I would speak to gp maybe and ask for where they feel the need to change or add things but I needs to be proven before given the lables good luck xxxxx and I think you are doing amazingly well with what you do have I am not so lucky
This is just a little update - I am not quite at the end of this process yet...
I have had two conversations with my GP: he told me that in order to define which condition I have, I must first have a chest x-ray (undertaken last week and reported as all clear).
The reason for the x-ray is that the Spirometry people will not test me unless I have an up-to-date (within the last three months) chest x-ray, so this will be my second within seven months.
I now wait for a Spirometry test and it is this alone that will decide whether I have asthma or COPD.
Of course, none of the above actually tells me why it was suddenly decided that I 'have' COPD!
I will update after my Spirometry test (in case anyone should be remotely interested!)
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