VOL. 1, No. 2 / 3, July 2004

M. Romagnoli, et al: [2004] Med Hypotheses Res 1: 101-110.

Fixed Airflow Limitation Caused by COPD or
Asthma: From Definition to Management

Micaela Romagnoli, Enrico Clini* and Leonardo M. Fabbri

Fondazione e Ospedale Villa Pineta, Pavullo (MO) - Department of Pneumology and
Pulmonary Rehabilitation (M.R., E.C.) and Institute of Respiratory Diseases (L.M.F.),
University of Modena-Reggio Emilia, Modena, Italy

Abstract.  Patients with fixed airflow limitation are often classified as chronic
obstructive pulmonary disease (COPD), and some international guidelines recommend
classifying asthma with fixed airflow limitation as COPD. Indeed, both COPD (induced by
smoking or other noxious agents) and asthma may be associated with a decline of lung
function that should cause fixed airflow limitation. In the presence of fixed airflow
limitation, patients are often diagnosed COPD, even if the differential diagnosis between
asthma and COPD in these patients may be important as the natural history as well as the
response to treatment are different, depending on whether fixed airflow limitation is due
to asthma or COPD. The assessment of patients presenting with fixed airflow limitation
has recently highlighted that airway inflammation is markedly different in asthma and
COPD although characterized by the same degree of airflow limitation. Thus, asthma with
fixed airflow limitation maintains the same pathological characteristics as asthma with
completely reversible airflow limitation. In conclusion, subjects with asthma have distinct
characteristics compared with subjects with COPD. Despite the presence of fixed airflow
limitation both patients should be properly identified and treated.

*Address all correspondence to: Dr. Enrico Clini, Fondazione ONLUS e Ospedale Villa
Pineta, Via Gaiato 127, 41020 Pavullo n/F (MO).  Phone: 0536-42039. E-Mail:

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