Asthma and COPD: Differences, similarities and controversies
Overlapping Disorders or Distinct Processes?
Asthma and chronic obstructive pulmonary disease (COPD) are two major health problems whose incidence is increasing. Both are recognized as major causes of morbidity and mortality worldwide. Never as now is better known the pathophysiology of both, as well as their inflammatory, cellular and immunological profiles. It has powerful diagnostic, image, gasometric, functional, cellular, and immunological tools, as well as abundant basic, clinical, genetic and therapeutic research. However, despite having international guidelines based on evidence, the responses to the treatments are sub-optimal in both. In BA the incidence of uncontrolled patients is high and in COPD, treatment with inhaled bronchodilators and glucocorticoids (IGCs) improves symptoms and quality of life but does not impact the deterioration in lung function or improve life expectancy.
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For a long time, it has been accepted that BA and COPD are distinct diseases that have different pathophysiological mechanisms as well as unique epidemiological features. BA is recognized as an allergic disease, usually starting in childhood and characterized by airway hyperreactivity leads to a variable airflow obstruction . In contrast, COPD is usually caused by the consumption of tobacco or biomass / fuels, develops after the fourth decade of life and is characterized by a progressive and persistent airflow obstruction.
Why is overlap between asthma and COPD important?
In a 15 year longitudinal study of individuals with asthma, Lange and colleagues concluded that some asthmatics progress to fixed airways obstruction suggesting that this asthmatic subgroup may exhibit non-normalizing lung function and be more similar to COPD. GOLD guidelines, NHLBI guidelines , and GINA guidelines state that asthma and COPD are underdiagnosed and misdiagnosed.In addition, these guidelines attempt to distinguish asthma and COPD obviating recognition of potential overlap. Simply put, there are often times where guideline-driven therapy for COPD and asthma may preclude some patients from getting more tailored therapy.
Personalizing Asthma and COPD Management With Therapies
Our understanding of the underlying pathophysiology of asthma and COPD has evolved significantly over the past decade. We have come to appreciate how heterogeneous these entities are, how many different cellular elements are involved, how many different cytokines and mediators are implicated, and how dynamic these diseases may be from one point in time to another.
Clinical – COPD
Not all COPD patients are alike. Some require oxygen and some do not. Some require one maintenance inhaler whereas others require three. Some have 2 or more exacerbations per year and some have few or no exacerbations. How can one account for these distinct differences in patient presentation or phenotype?
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