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Differentiating Asthma from COPD Dr.R.Vijai Kumar Pulmonary & Critical Care

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Presentation on theme: "Differentiating Asthma from COPD Dr.R.Vijai Kumar Pulmonary & Critical Care"— Presentation transcript:

1 Differentiating Asthma from COPD Dr.R.Vijai Kumar Pulmonary & Critical Care

2 Cheetahs & Leopards

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6 Cheetah  Solid color polka dots  Fastest (120km an hour)on planet  (0 to 96 km in 3 seconds)  Drinks water once in 4 days  Hunts during day

7 Leopard  Uneven rosette spots  Not fast (55 km an hour)  Strong (can drag an animal on to a tree)  Hunts at night Cheetah  Solid color polka dots  Fastest (120km an hour)on planet  (0 to 96 km in 3 seconds)  Drinks water once in 4 days  Hunts during day

8 Asthma-definition (GINA-2011) “Asthma is a chronic inflammatory disorder of airways in which many cells and cellular elements play a role.

9 Asthma-definition (GINA-2011) “Asthma is a chronic inflammatory disorder of airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway responsiveness that leads to recurrent episodes of wheezing,breathlessnes,chest tightness and coughing particularly at night or early in the morning.

10 Asthma-definition (GINA-2011) “Asthma is a chronic inflammatory disorder of airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway responsiveness that leads to recurrent episodes of wheezing,breathlessnes,chest tightness and coughing particularly at night or early in the morning. These episodes are usually associated with widespread but variable air flow obstruction within the lung that is often reversible either spontaneously or with treatment”

11 COPD-definition (GOLD 2007) ‘‘A preventable and treatable disease with some significant extra-pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible.

12 COPD-definition (GOLD 2007) ‘‘A preventable and treatable disease with some significant extra-pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.’’

13 “Asthma is a chronic inflammatory disorder of airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway responsiveness that leads to recurrent episodes of wheezing,breathlessnes,chest tightness and coughing particularly at night or early in the morning. These episodes are usually associated with widespread but variable air flow obstruction within the lung that is often reversible either spontaneously or with treatment”

14 ‘‘A preventable and treatable disease with some significant extra-pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.’’ “Asthma is a chronic inflammatory disorder of airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway responsiveness that leads to recurrent episodes of wheezing,breathlessnes,chest tightness and coughing particularly at night or early in the morning. These episodes are usually associated with widespread but variable air flow obstruction within the lung that is often reversible either spontaneously or with treatment” Asthma COPD

15 ‘‘A preventable and treatable disease with some significant extra-pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.’’ “Asthma is a chronic inflammatory disorder of airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway responsiveness that leads to recurrent episodes of wheezing,breathlessnes,chest tightness and coughing particularly at night or early in the morning. These episodes are usually associated with widespread but variable air flow obstruction within the lung that is often reversible either spontaneously or with treatment” COPD Asthma

16 Overlap? Greyzone?

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18 Dutch Hypothesis (Orie etal 1961)

19  Various forms of OLD have overlapping cl features- different specific clinical phenotypes 1

20 Dutch Hypothesis (Orie etal 1961)  One form (Asthma) can evolve into another (COPD) 2

21 Dutch Hypothesis (Orie etal 1961)  Development of OLD is based on allergy (inflammation), influenced by endogenous (genes)and exogenous factors (environ). 3

22 Dutch Hypothesis (Orie etal 1961) 3 Controversial But, not disproven

23 Case (Mrs.K)  55 yr lady  Semiconscious (ER)  SpO2 (44%)  Fever, Cough 3 days  Known asthma  Sleepy at Home (always)

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25 Case (Mrs.K) Day 1 Ph7.30 paCO261.2 paO230 HCO329.8 After 8 Days of BiPAP Ph7.52 paCO249.5 paO255 HCO340.4

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29 Asthma missed Symptoms mild “allergy” Spirometry-Normal Normal in between

30 Asthma missed Symptoms mild “allergy” Spirometry-Normal Normal in between COPD missed Symptoms after 40 years “smoker’s cough” Spirometry-Not done Large lung reserve

31 Asthma missed Symptoms mild “allergy” Spirometry-Normal Normal in between NHNE survey pts >17 years 25% smokers had COPD 44% (FEV1/FVC 50%) never diagnosed earlier

32 What differentiates Asthma/COPD ? Neutrophil

33 Increased Eosinophils in COPD(EG 2 (+) cells/mm 2 Ref:Saetta AJRCCM 1994;150:

34 Asthma (with FEV 1 /FVC=<0.7) P<0.001

35 Increased Neutrophilic Inflammation in Asthma neutrophils

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44 46 patients of severe AWO COPD-27 Asthma-19 Detailed history Spirometry DLCO eNO Sputum BAL HRCT

45 Eosinophils Basement Mem

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47 Biomarkers EosinophilsEx Nitric Oxide

48  eosinophils,CD4/ CD8,BM,Diffusion, eNO,response to steroids  Neutrophils,RV,H RCT emphysema score,

49 Natural History  Asthma

50 Natural History  Asthma  COPD Cough Dyspnea Exacerbations Hospitalisations Systemic Effects Resp Failure Pulm Hyp DisabilityDeath

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52 Dynamic Hyperinflation

53 COPD (the big difference!)

54 Systemic Inflammation

55 Systemic inflammation rises with COPD severity  Franciosi LG,etal.Pulm Pharmcol Therapy.2006;19:

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61  Yin=female,negative,dar kness,softness,moisture, nighttime,even numbers,docile.  Yang=male,positive,brig ht,hard,dry,daytime,odd number,dominant.

62 COPD (the big difference!) Pulmonary Hypertension

63 Diffusing Capacity (DLCO) Asthma  Increased surface area=DLCO high COPD  Loss of surface area=DLCO low

64 COPD vs Asthma-Symptoms Asthma  Episodic,total remission Usually begins in childhood COPD  Progressive,asymptomatic until 35 years,worsens in middle age,dyspnea & exacerbations more common  Smoking History

65 COPD vs Asthma-Symptoms Asthma  FEV1 reversibility 12% with a SABA COPD  FEV1/FVC=<0.7 (with or without reversibility)

66 ATS/ERS Guidelines 2004 “ Some patients with Asthma cannot be distinguished from COPD with current diagnostic tests. The management of these patients should be similar to that of Asthma ”

67 That’s a Cheetah for sure!

68 Thanks for your Attention!


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