2. Definition Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation and a range of pathological changes in the lung. Obstructive bronchiolitis emphysema

3. Diagnosis Spirometry is the gold standard - the most reproducible, standardized, and objective way of measuring airflow limitation. FEV1/FVC < 0.70 (postbronchodilator) FEV1 <80% predicted => confirms the presence of airflow limitation that is not fully reversible.

4. Stages I: At this stage, the individual is usually unaware that his or her lung function is abnormal. II: This is the stage at which patients typically seek medical attention because of chronic respiratory symptoms or an exacerbation of their disease. III: greater shortness of breath, reduced exercise capacity, fatigue, and repeated exacerbations that almost always have an impact on patients’ quality of life. IV: At this stage, quality of life is very appreciably impaired and exacerbations may be life threatening.

5. Treatment at each stage

6. GINA

7. Definition Asthma is a chronic inflammatory disorder which 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.

8. Clinical Diagnosis Spirometry The degree of reversibility in FEV1 accepted as ≥ 12% and 200 ml from the pre-bronchodilator value. Peak expiratory flow measurements are made using a peak flow meter and can be an important aid in both diagnosis and monitoring of asthma. To confirm the diagnosis of asthma. Although spirometry is the preferred method of documenting airflow limitation, a 60 L/min (or 20% or more of rebronchodilator PEF) improvement after inhalation of a bronchodilator, or diurnal variation in PEF of more than 20% suggests a diagnosis of asthma. To improve control of asthma, particularly in patients with poor perception of symptoms. Asthma management plans which include self- monitoring of symptoms or PEF for treatment of exacerbations have been shown to improve asthma outcomes.

9. Clinical Diagnosis Measurement of airway responsiveness. For patients with symptoms consistent with asthma, but normal lung function - methacholine, histamine, mannitol, or exercise challenge Measurements of airway responsiveness reflect the “sensitivity” of the airways to factors that can cause asthma symptoms, sometimes called “triggers,” and the test results are usually expressed as the provocative concentration (or dose) of the agonist causing a given fall (often 20%) in FEV1.

10. Classification Controller medications –Inhaled glucocorticosteroids –Leukotriene modifiers. –Long-acting inhaled 2-agonists –Theophylline –Cromones: sodium cromoglycate and nedocromil sodium Reliever Medications –Rapid-acting inhaled 2-agonists. –Systemic glucocorticosteroids –Anticholinergics. –Theophylline(short acting)

12. Levels of asthma control