asthma vs COPD

1. What is asthma and COPD?

Asthma - chronic inflammatory condition that characterised by reversible airway limitation (obstruction),  hyperresponsiveness to wide range of stimuli and inflammation of bronchi cause smooth muscle hyperthrophy, mucus plugging and epithelial damage.

COPD - chonic inflammatroy progressive irrevesible airway limitation. Related to ephysema and chronic bronchitis. 

2. Cx and examination.

SOB, cough,fever (+-)

COAD: smoking hx, hyperinflated lung

asthma: 

• symptops: SOB, cough, fever (+,-)
• history of asthma
• duration 
• elimination of other DDX
• precipitating factor (emotion, cold, dusk, exercise, URTI, chemical) and  occupation
• assess current severity
• assess severity of asthma ( freq, noctunal, daytime sym, use of B-agonist inhaler, PEFM)
• QOL
• Mhx: eczema, asthma, urticaria, allergic rhinitis.
• family history of asthma
• social : smoking
  
  

4. Differential diagnosis for SOB

• MI
• pneumotorax
• pulmonary embolism
• respiratory infection
• anxiety
• COPD
• metabolic acidosis

3. Complication 

COPD:  Respiratory failure and cor pulmonale (heart dz secodary to respiratory dz)

4. Investigation

diagnostic:  CXR (to exclude pneumotorax), ECG , FBC

assess severity: Peak flow meter, lung spirometry, ABG

5. Management 

ASTHMA

aim:

Management: 
  
Aims of treatment:

Management: 
  
Aims of treatment:

Abolish symptoms
Restore normal and best possible lung function
Reduce the risk of severe attacks
Enable normal growth to occur in children
Minimize absence from school employment

This involves:
Patient and family education about asthma
Patient and family participation in treatment
Avoidance of identified causes where possible
Use of the lowest effective doses of convenient medication to minimize short-term and long-term side effects

Control of extrinsic factors

• Avoid causative allergens: house dust mite, pets, moulds
• Active and passive smoking
• Avoid Beta blockers in tablet or eye drop form 
• Avoid NSAIDS
• Avoid exposed to materials at works

DRUG.

Asthma self-management: Peak flow meters, treatment plans discussed with each patient
 
-An inflammatory disease + Anti-inflammatory 
 controller therapy started even in mild cases
 
-Inhaled oral steroids
 
-Short-acting relievers: Salbutamol, Terbutaline
 
-Long-acting relief/ disease controllers
 *Long-acting β2 agonists: Salmeterol, Formoterol
 *Sodium Cromoglycate
 *Leukotriene Modifiers: Montelukast, Zafirlukast
 
-Other agent with bronchodilator activity
 *Antimuscarinic agents: Ipratratropium, Oxitropium
 *Theophylline preparations
 
-Steroid sparing agents: Methotrexate, Ciclosporin, 
 Gold, IV Ig, Anti-IgE monoclonal antibody  
 omalizumab.


 

Acute Mx:

specific treatment:

COPD

Acute Mx:

specific treatment:

1) Counseling 
 2) Reduce risk factors
 3) Manage stable COPD
 4) Manage exacerbations
 5) Manage complications

6.THERAPUTIC

to be continued