title: New scoring system for the differentiation of chronic obstructive pulmonary disease and asthma.
abstract: OBJECTIVE
  It 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.
  
  
  METHODS
  First, 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).
  
  
  RESULTS
  The 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).
  
  
  CONCLUSIONS
  The new scoring system that was developed in this study may be a useful tool for differentiating between COPD and asthma in primary care.
authors.affiliation: Division of Pulmonary Allergy and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea; Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Lee
authors.forename: Seunghee
authors.initials: S
authors.lastname: Baek
authors.forename: Yousang
authors.initials: Y
authors.lastname: Ko
authors.forename: Mi-Yeong
authors.initials: MY
authors.lastname: Kim
authors.forename: Hyun-Kyung
authors.initials: HK
authors.lastname: Lee
authors.forename: Tae-Bum
authors.initials: TB
authors.lastname: Kim
authors.forename: You Sook
authors.initials: YS
authors.lastname: Cho
authors.forename: Hee-Bom
authors.initials: HB
authors.lastname: Moon
authors.forename: Sang-Do
authors.initials: SD
authors.lastname: Lee
authors.forename: Yeon-Mok
authors.initials: YM
authors.lastname: Oh
mesh_terms: D000328:Adult; D001249:Asthma / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: asthma; chronic obstructive pulmonary disease; differential diagnosis; primary care physician