Asthma and COPD

Asthma, a reversible bronchial reactive airway disease process, is heterogeneous clinical condition involving bronchoconstriction, airway wall thickening, and mucus production. Obstructive expiratory airflow limitations cause symptoms of wheezing, cough, and chest tightness. Triggers and symptoms vary over time, with diagnosis confirmed by history and response in spirometry testing. Treatment remains inhaled beta-agonists (short and long acting), steroids (inhaled and oral/intravenous), inhaled muscarinics, and inhaled anticholinergics. Additional therapies can be used for severe, frequent exacerbations refractory to first-line preventative and emergency treatments. Overlap of chronic obstructive pulmonary disease (COPD) with asthma can occur, with treatment geared toward improving airflow, ventilator work support (NIV), and mechanical ventilation, if necessary. Ventilatory support of the severe asthmatic can be quite challenging with air-trapping and ventilator synchrony.