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Is Asthma Chronic Pulmonary Disease

Study Design And Cohort

Asthma and Chronic Airways Disease – Professor Chris Whitty

The Melbourne Asthma Cohort was recruited from a 1957 birth cohort at the age of 7 which has been previously described and comprehensively reviewed from the age of 7 to the current study at the age of 50. In brief, a modified random sampling strategy was used to select 401 subjects, following a survey of 30000 Grade 2 Melbourne primary school children in 19631964. The survey included a parent completed questionnaire which was followed by a parent interview and physical examination of the child by members of the research team. All those children with a history of asthma or wheezy bronchitis were included in the study and one in two with mild wheezy bronchitis and one in 20 controls were included. When the children were reviewed at the age of 10, it was realised that there were very few with severe asthma , and a further sampling of 21000 children was performed from the same birth cohort to establish an SA group which included 83 children.

What Is The Prognosis And Life Expectancy For A Person Copd Vs Asthma

The prognosis for COPD ranges from fair to poor and depends on how rapidly COPD advances over time. In general, individuals with COPD have a decrease in their lifespan according to research.

If you have asthma, the prognosis for most people ranges from fair to excellent, depending upon how well you can identify what triggers your attacks, and your response to medication.

Inflammatory Mediators Involved In Asthma

Chemokines are important in the recruitment of inflammatory cells into the airways and are mainly expressed in airway epithelial cells . Eotaxin is selective for eosinophils, whereas thymus and activationregulated chemokines and macrophage-derived chemokines recruit Th2 cells . Cysteinyl leukotrienes are potent bronchoconstrictors and proinflammatory mediators mainly derived from mast cells and eosinophils . Cytokines orchestrate the inflammatory response in asthma. Key cytokines include IL-1 and TNF, and GM-CSF. Th2-derived cytokines include IL-5, which is required for eosinophil differentiation and survival; IL-4, which is important for Th2 cell differentiation; and IL-13, needed for IgE formation . Histamine is released from mast cells and contributes to bronchoconstriction and inflammation . Nitric oxide , a potent vasodilator, is produced from syntheses in airway epithelial cells . Exhaled NO is increasingly being used to monitor the effectiveness of asthma treatment . Prostaglandin D2 is a bronchoconstrictor derived predominantly from mast cells and is involved in Th2 cell recruitment to the airways .

Airway structural cells involved in the pathogenesis of asthma are: airway epithelial cells, airway smooth muscle cells, endothelial cells, fibroblasts and myofibroblasts and airway nerves .

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When To Get Medical Advice

See a GP if you have persistent symptoms of COPD, particularly if you’re over 35 and smoke or used to smoke.

Do not ignore the symptoms. If they’re caused by COPD, it’s best to start treatment as soon as possible, before your lungs become significantly damaged.

The GP will;ask about your symptoms and whether you smoke or have smoked in the past. They can organise;a breathing test;to help diagnose COPD and rule out other lung conditions, such as asthma.

Find out more about how COPD is diagnosed.

Key Differences Between Asthma And Copd

Asthma2014.ppt

The following points will target on the fundamental differences between both kinds of reparatory diseases:

  • The long term medical condition of the respiratory tract, diagnosed in childhood but is manageable through the proper treatment by recognizing the main cause of the disease, and by taking proper precautions is termed as asthma. While the COPD or Chronic Obstructive Pulmonary Disease is the another kind of disease, diagnosed in the later stage of life which is usually after the age of 40 and the severity of the illness goes on increasing with the time.
  • Symptoms of the asthma are wheezing, shortness of breathing and dryness in a cough, which arise on exertion, while the symptoms of COPD include wheezing, a problem in breathing and cough is more mucus yielding with sputum especially in the morning
  • The cause of asthma can be genetic, environmental factors, allergens, etc. But in a case of COPD, the main cause is the continuous smoking for more than ten years by the patient or sometimes can be due to genetic or environmental factors also.
  • More intermittent or periodic airflow obstruction and eosinophilic airway inflammation are observed in asthma, whereas progressively worsening airflow obstruction and neutrophilic airway inflammation is observed in COPD.
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    Chronic Lung Disease And Asthma

    If you have asthma, you know the kind of effect it can have on your ability to exercise, perform strenuous activities, and even manage everyday tasks. What you may not be quite so familiar with is how this lung condition affects you on an internal level, and how asthma and similar lung diseases develop.

    The best way to treat your asthma is by making an effort to better understand it. The more you learn about pulmonary diseases, the better equipped you will be to manage their presence in your life.

    Get to know the symptoms, causes, and methods of diagnosis for asthma so you can take better care of yourself.

    Inflammatory Cells In Asthmatic Airways

    Mast cells -activated mucosal mast cells release bronchoconstrictor mediatorshistamine, cysteinyl leukotriens, prostaglandin D2. They are activated by allergens through IgE receptors or by osmotic stimuli . Eosinophils are in increased number in airways, release basic proteins that may damage epithelial cells, and have a role in releasing a growth factors and airway remodeling , T lymphocytes are in increased number and release specific cytokines, including IL-4, IL-5, IL-9, IL-13 that orchestrate eosinophilic inflammation and IgE production by B lymphocytes . There may also be an increase in inKT cells which release large amounts of T helper: Th1 and Th2 cytokines . Dendritic cells,Macrophages are in increased number, and release inflammatory mediators and cytokines that amplify the inflammatory response . Nutrophils are in increased number in airways and sputum of patients with severe asthma and in smoking asthmatics, but the role of these cells is uncertain and their increase may even be due to steroid therapy .

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    Similarities And Differences In Regular Standard Treatment Of Asthma And Copd

    • In both diseases the adequate treatment may reduce symptoms and number of exacerbations and improve the quality of life.

    • Treatment of asthma is characterized by suppression of inflammation.

    • Treatment of COPD is characterized by decreasing of symptoms.

    The GOAL of treatment in ASTHMA is to: reduce inflammation and to achieve¸total control . The GOAL of treatment in COPD is to: reduce symptoms, prevent exacerbations and decrease mortality . In both asthma and COPD almost the same drugs are used, but not in the same order and the same efficiency in treatment.

    Definition Of Chronic Obstructive Pulmonary Disease

    Treating COPD, Asthma & Other Chronic Lung Disease – HealthCasts Episode 8

    This disease is diagnosed at the later stage of life, which is after the age of 40. COPD refers to the two types of lung infections emphysema and bronchitis and often occur together. In this disease, the airways or the tubes which carry air in and out of the lungs get partially blocked and results in the problem in breathing.

    Normally the tiny air sacs which are present at the end of the airways, inflate or deflate during the breathing process. But with COPD, these tiny air sacs become less flexible, and the problem arises in breathing.

    Emphysema plays the major role in causing a destruction of the air sacs and thus creating the problem in the outward flow of air. While bronchitis causes the narrowing of the bronchial tubes, due to inflammation and resulting in the formation of mucus.

    The condition of the patient gets progressively severe, as in the beginning, the symptoms may be mild with shortness of breath and coughing. But in later stage the difficulty increases with increasing problem of breathing, chest tightening, wheezing,

    Smoking is the cause of this disease, whether the patient has smoked in the past, exposed to secondhand smoke, lung irritants, or suffered from asthma, air pollution, dust, or chemical fumes. Although there is no cure. Treatments like oxygen therapy, medicines, the lung transplant may provide relief. Most important step for the treatment is to quit smoking.

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    Comorbid Diseases Or Conditions

    Comorbidity is the simultaneous existence of two or more diseases or conditions in an individual. Comorbidity for the purpose of respiratory disease in the CCDSS was defined as the co-existence in an individual of one of either asthma or COPD with diabetes, hypertension, mood and/or anxiety disorders, asthma or COPD .

    For asthma, the prevalence of four comorbid diseases or conditions was calculated among those with and without asthma. For diabetes and mood and/or anxiety disorders, the prevalence was calculated for those age one and older; for hypertension, it was calculated for those aged 20 years and older and for COPD, for those aged 35 years and older.

    For COPD, the prevalence of COPD was reported among those with and without each of the comorbid conditions. Therefore the prevalence of COPD was calculated among those with and without diabetes, mood and/or anxiety disorders, hypertension and asthma. The prevalence was calculated among those aged 35 years and older among all four comorbid diseases or conditions, corresponding to the reporting age for COPD.

    The following case definitions were used for the comorbid diseases and conditions:

    Diabetes

    Hypertension

    Mood and/or Anxiety Disorder

    Individuals aged one and older with at least one physician billing claim listing a mood and/or anxiety diagnostic code in the first field, or one hospital discharge abstract listing a mood and/or anxiety diagnostic code in the most responsible diagnosis field in a one-year period.

    Why Does Overlap Happen

    Having already analyzed all the potentially important common risk factors for overlapping asthma and COPD, such as increasing age, smoking, BHR, inflammation, remodeling and exacerbations, the big question is why does overlap happen. Dutch hypothesis tries to answer the question, stating that asthma and BHR predispose to COPD later in life and that asthma, COPD, chronic bronchitis, and emphysema are different expressions of a single airway disease. Furthermore, the presence of these expressions is influenced by host and environmental factors . Epidemiological studies, on the other hand, proved a correlation between respiratory illnesses during childhood and impaired adult lung function . Knowing that airway growth starts in utero, fetal or childhood exposures may contribute to adult asthma or COPD .

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    Staging And Treatment Of Chronic Obstructive Pulmonary Disease

    The stages of COPD are defined primarily by lung function . This emphasises the important clinical message that the diagnosis of COPD requires the measurement of lung function. The stages of COPD suggested in the GOLD Guidelines are as follows. Stage 0: At risk, cough or sputum present but lung function normal. Stage 1: Mild COPD, FEV1/forced vital capacity <70%, with an FEV1 â¥80% predicted, with or without chronic symptoms. Stage 2: Moderate COPD, FEV1/FVC <70% and FEV1 % pred>30% and <80%. Stage 2 is split at an FEV1 of 50% pred since the existing data support the value of inhaled corticosteroids below an FEV1 of 50% pred but not above. Stage 3: Severe COPD, FEV1<30% pred and FEV1/FVC <70%.

    In the GOLD guidelines, Stage 0 is a newly defined stage that was included to give a strong public health message that symptoms of chronic cough and sputum production should alert the clinician to the presence ofan ongoing pathophysiological process even when lung function is normal. This may progress to clinically significant COPD in a proportion of those exposed . The analogy that is perhaps most relevant is that mild hypertension in some but not all , with mild elevation of blood pressure will progress to clinically significant hypertension.

    Inflammation: Neutrophils And Eosinophils

    FRE

    There are three common clinical characteristics in obstructive pulmonary diseases: airway inflammation, airway obstruction and bronchial hyperresponsiveness . Chronic inflammation is considered to be mainly eosinophilic and driven by CD4 cells in asthma, while it is neutrophilic and driven by CD8 cells in COPD . Nonetheless, noneosinophilic and neutrophilic asthma has been reported too, which displayed resistance in steroids . Smokers asthmatics have elevated neutrophils in their airways, similar to COPD. Smoking promotes neutrophilic inflammation which in turn causes increased corticosteroid resistance . On the contrary, eosinophilic inflammation has been observed in some COPD patients and is correlated with greater reversibility of obstruction when steroids are given . When randomly selected asthmatics with incomplete reversibility are studied, we can notice elevated neutrophils in their airways and additionally the intensity of neutrophilia is related with the FEV1 decline . Furthermore, it has been already proven from histopathological and other studies that inflammation concerns all airways, large and small distal , even the lung tissue, in both COPD and asthma patients .

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    Managing Asthma And Other Lung Conditions

    Asthma can be a restrictive condition, but its far from impossible to manage. Get to know your individual triggers and avoid them so you can avoid any asthma attacks that may follow.

    Pay attention to your breathing so you can pick up on the signs of an asthma attack as early as possible and react accordingly. Speak to your doctor about getting an emergency inhaler or other medications.

    You can also manage your asthma in small ways every day by taking good care of your lungs. Avoid unnecessary exposure to toxins, practice routine exercise, and maintain good physical fitness. These will all help limit the harmful effects of asthma.

    Glucocorticoid Treatment In Asthma And Copd

    Glucocorticoids are the most potent anti-inflammatory medications available for the treatment of asthma and COPD. When indicated, ICSs remain the mainstay of glucocorticoid therapy for stable disease because of their proven effectiveness and, in recommended doses, few systemic adverse effects. Their slow onset of action compared with systemic steroids, however, makes the latter the preferred treatment for acute exacerbations.

    Systemic Glucocorticoids in the Treatment of Acute Exacerbations of Asthma and COPD

    The primary therapeutic goals for acute asthma or COPD exacerbations are the rapid reversal of airflow obstruction and the correction, if necessary, of severe hypercapnia or hypoxemia. Hence early and aggressive treatment of acute exacerbations is critical. The major pharmacologic classes available to manage acute exacerbations include inhaled short-acting bronchodilators, systemic glucocorticoids, and, in the case of COPD, antibiotics.,

    When added to the bronchodilator therapies described below, systemic glucocorticoids improve symptoms and lung function and decrease the length of hospital stay., Patients with continued dyspnea and wheezing despite intensive bronchodilator therapy most likely have persistent airflow obstruction secondary to airway edema, inflammation, and intraluminal mucus plugging. The latter pathologic changes usually respond to glucocorticoid therapy and typically resolve at a pace far slower than smooth muscle constriction.

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    What Does This Paper Contribute To The Wider Global Community

    • This study purposively explores the preferences of people with asthma/chronic obstructive pulmonary disease regarding support in managing their illnesses to shed further light on support priorities from the patient perspective.
    • People with asthma/COPD value timely advice on managing symptoms of exacerbation as well as support for self-management on a routine basis.
    • People with asthma/COPD value when healthcare professionals listen to and acknowledge their concerns and know them over time.

    Limitations Of The Ccdss

    Overview of chronic obstructive pulmonary disease (COPD)

    The CCDSS may underestimate the burden of asthma and COPD as it relies partly on the physician billing claims database to identify cases. One of the limitations of this database is that physicians not paid on a fee-for-service basis are not always required to submit medical claims. Other payment schemes include salary, contract, capitation and partial fee-for-service. Alternative payment of physicians is more frequent for some specialties, in remote areas and for some primary health care centres. However, in some jurisdictions, physicians under alternative payment schemes are still expected to remit service information, otherwise known as “shadow billing”. Both fee-for-service claims and shadow billing were included where available. Services for non-fee-for-service physicians who do not shadow bill are not captured. Currently, it is not possible to establish the magnitude of this impact at the national scale; further studies are required.

    On the contrary, using the CCDSS, there is the potential for the accumulation of false positive cases of asthma. In other words, once someone is identified as a case, the person is always included in the database as a case, even if the person’s symptoms resolve. However, the current case definition was adopted in order minimize the number of false positives as much as possible in order to reduce their impact on the data.

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    Asthma And Copd: What’s The Difference And Is There A Link

    Asthma and chronic obstructive pulmonary disease are lung diseases. Both cause swelling in your airways that makes it hard to breathe.

    With asthma, the swelling is often triggered by something youâre allergic to, like pollen or mold, or by physical activity. COPD is the name given to a group of lung diseases that include emphysema and chronic bronchitis.

    Emphysema happens when the tiny sacs in your lungs are damaged. Chronic bronchitis is when the tubes that carry air to your lungs get inflamed. Smoking is the most common cause of those conditions .

    Asthma gets better. Symptoms can come and go, and you may be symptom-free for a long time. With COPD, symptoms are constant and get worse over time, even with treatment.

    When To Seek Medical Help

    Since COPD usually does not cause signs and symptoms until there is notable lung damage, many people only attribute mild concerns into getting older or not being the way they were before.;

    However, there are some symptoms you must never ignore.;

    For example, if the previously mild symptoms become worse, you should strongly consider setting an appointment with the doctor as its indicative of progressing lung damage.;

    Likewise, seek emergency treatment for the following concerns:

    • Trouble in catching breath during simple physical activity and talking.;
    • Cyanosis;
    • Fast heartbeat or pulse rate. Normal range is 60 to 100 per minute, but this range may increase with physical activity, injury, illness, or strong emotions.;
    • Problems in focusing, or hearing comments from loved ones that youre not mentally alert.;
    • The symptoms dont get better despite home remedies or doctor-approved treatment.;

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