Asthma and chronic obstructive pulmonary disease--pathophysiology and treatment.
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Lung volume reduction surgery appears to be helpful in some, but not all patients with advanced emphysema. Because there are few little published data on the indications, patient selection criteria, preoperative assessment, choice of surgical technique and long-term efficacy, further investigation is necessary before definitive recommendations can be made.Keywords:
Pathophysiology
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Respiratory medicines are expensive and, for common respiratory conditions, such as asthma and chronic obstructive pulmonary disease (COPD), there are opportunities to make significant savings by optimising their use. Responsible and cost-efficient respiratory prescribing can ensure value for money without compromising the quality of care. Nurses should be aware of the differing regimens recommended for patients with asthma and COPD.
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Obstructive lung disease
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Asthma Exacerbations
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Pathophysiology
Pathophysiology of asthma
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Exacerbations, characterized by an increase in patients' symptoms above baseline, are characteristic of both chronic obstructive pulmonary disease (COPD) and asthma. Prevention of exacerbations and their expedient treatment are major goals for reducing the morbidity and cost of both conditions. Exacerbations, however, may also adversely affect the natural history of these disorders, perhaps by contributing to increased rates of lung function decline, systemic effects, and premature mortality. Although the available information is limited, the course of COPD is affected adversely by exacerbations in multiple ways. First, exacerbations likely lead to structural alterations in the lung and to permanently worsened airflow. Second, health status is adversely affected by exacerbations, and although the mechanisms are unclear, the effects are long lasting and may be irreversible. Less is known in asthma about the effect of exacerbations on natural history, but many of the same pathogenetic processes involved in COPD exacerbations likely play a role in some subjects with asthma as well. Future studies of how exacerbation affects the "natural history" of asthma and COPD will require a better understanding of the heterogeneity of exacerbations but promises to identify new therapeutic strategies to treat these disorders.
Asthma Exacerbations
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Asthma and chronic obstructive pulmonary disease (COPD) are prevalent respiratory conditions with overlapping disease characteristics. Differentiation between asthma and COPD is important because several aspects of the guideline-recommended management strategies differ for these conditions. This review identifies the epidemiologic, etiologic, and clinical distinctions of these diseases to assist physicians and other clinicians in differentiating between asthma and COPD. Key components of the guideline-recommended management approaches for these conditions are also reviewed.Relevant articles were found by searching the MEDLINE database for "asthma" and "chronic obstructive pulmonary disease OR COPD" in association with the terms "diagnostic criteria" and "differential diagnosis". Recent statistical summaries (meta-analyses), reviews, and consensus-type documents were also included.A review of relevant articles found that, although asthma and COPD may occur simultaneously, differences between these diseases are frequently recognized in terms of age at onset, prevalence in relation to age and sex, potential for reversibility of airway obstruction, pathophysiology, and typical symptom presentation. A thorough clinical history in conjunction with lung function testing usually aids in diagnostic distinction and choice of therapeutic interventions. Radiologic imaging and inflammatory marker testing may also aid in the differentiation of these conditions. Over time, disease progression often differs between asthma and COPD.Although overlaps exist in the disease characteristics of asthma and COPD, careful history, physical examination, and lung function testing often reveal information that facilitates distinction between these diseases, allowing physicians and other clinicians to better tailor their therapy.
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Bronchial hyperreactivity
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<b><i>Background:</i></b> Recent evidence suggests that YKL-40, also called chitinase-3-like-1 protein, is involved in the pathogenesis of asthma and chronic obstructive pulmonary disease (COPD). Details of sputum YKL-40 in asthma and COPD, however, remain unknown. <b><i>Objectives:</i></b> To clarify associations of sputum YKL-40 levels with clinical indices in asthma and COPD. <b><i>Methods:</i></b> Thirty-nine patients with asthma, 14 age-matched never-smokers as controls, 45 patients with COPD, and 7 age-matched smokers as controls were recuited for this study. Sputum YKL-40 levels were measured and YKL-40 expression in sputum cells was evaluated by immunocytochemistry. <b><i>Results:</i></b> Sputum YKL-40 levels were higher in patients with COPD (346 ± 325 ng/ml) than in their smoker controls (125 ± 122 ng/ml; p < 0.05), but were not significantly different between patients with asthma (117 ± 170 ng/ml) and their controls (94 ± 44 ng/ml; p = 0.15). In patients with asthma only, sputum YKL-40 levels were positively correlated with disease severity (r = 0.34, p = 0.034) and negatively correlated with pre- and postbronchodilator %FEV<sub>1</sub> (r = –0.47 and –0.42, respectively; p < 0.01) and forced mid-expiratory flow (r = –0.48 and –0.46, respectively, p < 0.01). Sputum YKL-40 levels were positively correlated with sputum neutrophil counts in asthma (r = 0.55, p < 0.001) and with neutrophil and macrophage counts in COPD (r = 0.45 and 0.65, respectively, p < 0.01). YKL-40 was expressed in the cytoplasm of sputum neutrophils and macrophages in all groups. <b><i>Conclusions:</i></b> Elevated sputum YKL-40 reflects airflow obstruction in asthma whereas the roles of YKL-40 in the proximal airways in COPD remain to be elucidated.
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Lung volume reduction surgery appears to be helpful in some, but not all patients with advanced emphysema. Because there are few little published data on the indications, patient selection criteria, preoperative assessment, choice of surgical technique and long-term efficacy, further investigation is necessary before definitive recommendations can be made.
Pathophysiology
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