Bronchial Asthma and COPD Similarities AND Differences

By

Dr: Adel Hamada

Assistant Lecturer of Chest Diseasaes Chest Diseases Department Faculty of Medicine Zagazig University

Asthma

Definition

COPD

a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning

a preventable and treatable disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and is associated with an abnormal inflammatory response in the lungs to noxious particles or gases, primarily caused by cigarette smoking. Although COPD affects the lungs, it also produces significant systemic consequences

These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment.

Pathogenesis of asthma

Pathogenesis of COPD
Noxious Particles and Gases
Host Factors

Antioxidants

Lung Inflammation

Antiproteinases

Oxidative Stress

Proteinases

COPD Pathology

COPD inflammation is different from asthma inflammation

Asthma
Sensitizing agent

COPD
Onset
Noxious agent

Eosinophils CD4+ T-lymphocytes Mast cells

Inflammatory cells

Neutrophils CD8+ Tlymphocytes Macrophages

Reversible

Airflow limitation

Not fully reversible

Asthma

Risk factors

COPD

Genetics: Alpha one antitrypsin deficiency others environmental:

Smoking.
Air pollution:(indoor and outdoor). Recurrent respiratory tract infections

Trigger factors:

Respiratory tract infections Dusty weather Air pollution

Clinical Features of Asthmatic Patients

intermittent wheezing, coughing, and breathlessness

During an attack: decreased peak flow, tachypnea, use of accessory muscles to breathe

Clinical Features of COPD Patients

Mild COPD: no abnormal signs, smokers cough,little or no breathlessness Moderate with/without COPD: breathlessness cough

wheezing,

with/without sputum Severe COPD: breathlessness on any exertion/at rest, wheeze and cough

prominent, lung inflation is usual, cyanosis,

peripheral edema, and

polycythemia in advanced disease

Differential Diagnosis: COPD and Asthma

COPD
Onset in mid-life

ASTHMA
Onset early in life (often
childhood)

Symptoms slowly
progressive

Symptoms vary from day to day Symptoms worse at night/early

morning

Long smoking history

Allergy, rhinitis, and/or eczema

also present

Family history of asthma

Diagnosis
History examination spirometry Chest x ray Others

Asthma treatment
Goals of Asthma Management

control

Control by what measure?

How Control is achieved ?

Asthma in pregnancy

No anti asthmatic drugs are contraindicated in pregnancy All anti asthmatic drugs are safe during pregnancy and lactation

COPD treatment
reduce COPD symptoms. reduce the frequency and severity of exacerbations. and improve health status and exercise tolerance.

Avoid risk factors

Smoking cessation Decreased Exposure to Biomass Fuel

Therapeutic Options: COPD Medications

Beta2-agonists Short-acting beta2-agonists Long-acting beta2-agonists Anticholinergics Short-acting anticholinergics Long-acting anticholinergics Combination short-acting beta2-agonists + anticholinergic in one inhaler Methylxanthines Inhaled corticosteroids Combination long-acting beta2-agonists + corticosteroids in one inhaler Systemic corticosteroids Phosphodiesterase-4 inhibitors Influenza and pneumococcal vaccination should be offered depending on local guidelines.

COPD and Asthma: Different Diseases

COPD Affects elderly, especially smokers Slowly progressive inflammatory cells Neutrophils Macrophages CD8+ cells Partially reversible Asthma Affects all ages, including children Episodic course Inflammatory cells Eosinophils Mast cells CD4+ Macrophages Fully reversible

10%

Wheezy bronchitis

19