New scoring system for the differentiation of chronic obstructive pulmonary disease and asthma

Background and objectiveIt remains difficult to differentiate between chronic obstructive pulmonary disease (COPD) and asthma in clinical practice, especially in a primary care setting. The purpose of this study was to develop a new scoring system for differentiating between COPD and asthma, and to evaluate its effectiveness. MethodsFirst, to identify important variables differentiating COPD from asthma, the data of 197 patients with COPD and 138 patients with asthma were assessed retrospectively. Secondly, a scoring system that was based on these variables was then developed, and its performance was internally validated using a bootstrapping-based method. Thirdly, the scoring system was externally validated using prospectively collected data from patients with COPD (n=104) or asthma (n=96). ResultsThe final scoring system was composed of the four variables: age of onset of breathlessness (<40 years, 0 points; 40-60 years, 2 points; >60 years, 4 points), continuous breathlessness (no, 0 points; yes, 1 point), diurnal variation of breathlessness (yes, 0 points; no, 1 point) and emphysematous change in chest X-ray (no, 0 points; yes, 1 point). The patients were classified by their total score into three categories: 0-2 points, probable asthma; 3-4 points, difficult-to-differentiate; 5-7 points, probable COPD. The new scoring system performed well in the external validation dataset (area under the curve, 0.86; 95% confidence interval: 0.813-0.911; P<0.001). ConclusionsThe new scoring system that was developed in this study may be a useful tool for differentiating between COPD and asthma in primary care. Despite efforts to differentiate between COPD and asthma, misdiagnosis is still a serious problem in general practice, especially in a primary care setting. This study suggests a new scoring system that may be a useful tool for differentiating between COPD and asthma in primary care.