1. ASTHMA AND COPD By Jess Laidlaw

2. Overview 1)Asthma 2)COPD 3)Comparison

3. ASTHMA

4. How does asthma present? Symptoms CoughWheeze Chest tightness Shortness of breath Worse at night

5. What can trigger an asthma attack? Extrinsic Pollen Pollution Dust mites Animal dander Cold air Exercise Emotion Occupational sensitizers Intrinsic No definite external cause

6. What co-morbidities are asthma patients likely to have? Atopy – Asthma – Eczema – Hayfever This tends to run in families

7. What is the pathophysiology of asthma? (3 key components) Airway obstruction (reversible) – Smooth muscle contraction Airway hyper-responsiveness – Caused by histamine, prostaglandins, leukotrienes Airway inflammation – Caused by T lymphocytes, mast cells, eosinophils, oedema, smooth muscle hypertrophy, epithelial damage, mucus plugging IgE mediated hypersensitivity reaction Remodelling occurs over time

8. COPD

9. Which conditions comprise COPD? Chronic bronchitis – Productive cough for 3 months of the year, for 2 consecutive years Emphysema – Abnormal, permanent enlargement of air spaces (distal to terminal bronchiole)

10. How does COPD present? Symptoms Productive cough (clear/white sputum) Wheeze Shortness of breath If severe: Tachypnoea Use of accessory muscles Intercostal recession Pursed lips

11. How does COPD present? Responsive to CO2 Pink puffer Tachypnoeic Pink Insensitive to CO2 Blue bloater Cyanosis Oedema

12. What can cause COPD/ trigger an exacerbation? Caused by… Smoking Alpha-1 antitrypsin deficiency Triggered by… Infection Cold weather Atmospheric/occupatio nal pollution

13. Which co-morbidities are COPD patients likely to have? Ischaemic heart disease Hypertension Diabetes Heart failure Cancer

14. What is the pathophysiology of COPD? Chronic bronchitis Hypertrophy and hyperplasia of goblet cells (mucus) Columnar  squamous epithelium due to chronic inflammation Airway thickening and narrowing. Airflow limitation. Emphysema Dilation and destruction of lung tissue Loss of elastic recoil Expiratory airflow limitation and air trapping Caused by long term exposure to toxic particles and gases e.g. smoking

15. What is the difference between asthma and COPD? Asthma is a reversible and transient obstruction of the airways. COPD is an irreversible and progressive obstruction of the airways. (They are both examples of obstructive airway disease)

16. COPDASTHMA Smoker or ex-smokerMostPossibly Symptoms under age 35RareCommon AtopyUncommonCommon Cellular infiltrateMacrophages Neutrophils CD8+ T cells Eosinophils CD4+ T cells Cough and sputumDaily/commonIntermittent BreathlessnessPersistent/progressiveVariable Night time symptomsUncommonCommon Significant diurnal variability of symptoms UncommonCommon Bronchodilator response (FEV1, PEFR) <15%>20% Corticosteroid responsePoorGood What is the difference between asthma and COPD?

17. Thank you, and good luck in your exams!