Asthma and COPD

Presented by Erin Frankenberger & Michelle Wisniewski

BIO 313E Pharmacology and Pathophysiology II

Objectives
Differentiate between the clinical
manifestations of Asthma and COPD
Identify the various subtypes of COPD,
including emphysema and chronic
bronchitis
Compare and contrast the treatment of
Asthma and COPD

COPD
COPD, or chronic obstructive pulmonary
disease, is a group of similar chronic
respiratory diseases in which there is
progressive tissue degeneration and
obstruction within the airways of the lungs
The destruction of the alveolar walls and
septae leads to large, permanently inflated
alveolar air spaces
The resultant airway obstruction is not fully
reversible

COPD Fast Facts

COPD typically has an adult-onset and a
slow development and progression
A typical COPD patient has a history of
smoking having smoked >20 cigarettes
per day for more than 20 years
Less typically occurs in young adults
with alpha-antitripsin deficiency

COPD Fast Facts

The first sign of COPD is a productive
cough followed by progressive and
persistent dyspnea that is made worse
with exertion or respiratory infection
As the disease progresses, a morning
headache becomes a sign of nocturnal
hypercapnia or hypoxemia

COPD Signs and Symptoms

Symptoms are constant and progressive
Include shortness of breath, cough,
wheezing, increased expiratory phase,
cyanosis, and barrel chest
Symptoms of advanced COPD include
weight loss and muscle wasting, which is
attributed to immobility, hypoxia, or the
release of systemic inflammatory
mediators, such as TNF-a

COPD Signs and Symptoms

Clinical signs of COPD include pursed-lip
breathing, use of accessory muscles,
Hoover sign, hypoxia, cyanosis,
peripheral edema and cor pulmonale
Signs of cor pulmonale include neck vein
distension, splitting of the 2nd heart sound,
tricuspid insufficiency murmer and
peripheral edema
Spontaneous pneumothorax may also occur

COPD

The two most common types of

chronic obstructive pulmonary
disease are chronic bronchitis and
emphysema

Chronic Bronchitis
Chronic bronchitis results in inflammation in
the airways of the lungs
Thick mucus, a chronic cough, airway
obstruction, and frequent infections are
typical of this disease
Chronic cough is accompanied by shortness
of breath and tachypnea
This disorder is differentiated from acute
bronchitis in that the disease course is
continuous and the duration is at least a year

Chronic Bronchitis
The excessive build up of thick mucus
in the lungs results in narrowing of the
bronchi
The resultant narrowing of the airways
leads to hypoxia, cyanosis and
hypercapnia

Emphysema
Emphysema results in destruction of
the alveolar sacs in the lungs
The alveoli lose their elasticity and
result in air trapping, or permanent
alveolar air spaces
Damage to the alveoli results in
difficulty expelling oxygen poor air from
the lungs, thus resulting in shortness
of breath (SOB)

Emphysema
Initially, dyspnea occurs with activity and
exertion, but as the disease progresses,
occurs at rest
Typical manifestations of emphysema
include hyperventilation, barrel chest,
and a forward-leaning posture to increase
ease of breathing
Other signs and symptoms include anorexia,
fatigue, clubbed fingers and secondary
polycythemia

COPD Exacerbating Factors

Smoking and inhalation of toxins or other
respiratory irritants
Alpha1-antitrypsin deficiency (A1AD)
Viral upper respiratory infections
Acute bacterial bronchitis
Heart disease

Treatment of Stable COPD

Beta-agonists
Anticholinergics
Inhaled corticosteroids
Theophylline
Phosphodiesterase-4 inhibitors
Oxygen therapy

Treatment of Acute COPD

Exacerbation

Oxygen supplementation
Bronchodilators
Corticosteroids
Antibiotics
Ventilator assistance

Supportive Therapies for COPD

Smoking cessation
Avoidance of air pollution
Pulmonary rehabilitation, including education,
exercise training, nutrition and social support
Exercise, such as walking, swimming or bicycling
and weight training for weight normalization and to
decrease muscle wasting
Vaccinations
Surgery, such as lung transplant or lung volume
reduction surgery

Asthma
Asthma is a respiratory disease
involving episodes of bronchial
obstruction in those with
hypersensitive airways
This obstruction is reversible, however
frequent repeated episodes may cause
irreversible damage to the lungs

Asthma Fast Facts

Can be acute or chronic
Two types, extrinsic or intrinsic
15,000,000 children between the ages
of 5 to 17 have been diagnosed with
asthma in the U.S.
Attacks are often triggered by
allergens or irritants
Both types of asthma illustrate the
same pathophysiologic changes
involving inflammation

Asthma Fast Facts

Some exhibit asthma signs as a
constant, where as some only
experience marked episodes of
asthma attacks
Acute attacks are more common and
are usually resolved fairly easily
Severe attacks require immediate
medical attention
These severe attacks are called status
asthmaticus

Asthma Signs and Symptoms

Typical signs and symptoms include
cough, dyspnea, a feeling of pressure
in the chest
Signs of a cold including sneezing,
runny nose, congestion, sore throat,
and headache
The individual will often not be able to
talk
Wheezing is also common, due to air
trying to pass through restricted
bronchioles

Asthma Signs and Symptoms

Mucus is coughed up and may partially
or totally obstruct the airway
Tachycardia along with changes in
pulse rate on inspiration and expiration
Rapid and labored breathing
Hypoxia
Fatigue and trouble sleeping
Feelings of irritability

Asthma Signs and Symptoms

Hyperventilation can occur followed
by respiratory alkalosis
If hypoventilation occurs, hypoxemia
will increase leading to respitatory
acidosis
If attack is not controlled, the result can
involve respiratory failure

Intrinsic Asthma
Often has an adult onset
Irritants and other factors are the cause
of asthma attacks rather than allergens
Causative agent is unknown
The immune system is not involved in
this type of allergic reaction

Intrinsic Asthma Exacerbating Factors

Extreme emotions (crying)

Cigarette smoke
Cleaning agents
Exercising
Pollutants
Exposure to cold weather
Respiratory infections
Anxiety

Extrinsic Asthma
Acute episodes triggered by an
allergen
Commonly has family history
Onset is more commonly found in
children
Antigen reacts with immunoglobulin
E which releases chemicals including
histamine and causes inflammation,
bronchospasm, and an increase in
mucous secretion

Extrinsic Asthma Exacerbating Factors

Dust and mold

Seasonal pollens
Cigarette smoke
Animal dander
Pollutants

Treatment of Asthma
Stepwise therapy aims to gain and
maintain control of a patients asthma.
Asthma therapy is stepped up, or
increased, during times when a
patients symptoms are not controlled
or become more severe, and stepped
down when a patients asthma is
thought to be well-managed.

Treatment of Asthma
Long-term control medications:
Inhaled corticosteroids
Theophylline
Long-acting beta agonists Discus
Leukotriene modifiers
Mast cell stabilizers
Anticholinergics

Treatment of Asthma
Quick relief medications:
Short-acting beta agonists
Inhaled corticosteroids
Oral Corticosteroids

Anti-IgE therapy

Treatment of Asthma
Treatment methods depend on the severity
of asthma
Bronchodilators are used more to control
asthma attacks
Leukotriene inhibitors and antibodies are
indicated for chronic asthma
Medications like Singulair should be taken
daily, even when there are no symptoms to
prevent asthma attacks; it does not reverse
bronchospasms

Supportive Therapies for Asthma

Environmental control (avoidance of
triggers such as pollution and allergens)
Skin tests to for allergic reactions
Proper ventilation
Smoking cessation
Vaccinations
Patient education

Supportive Therapies for Asthma

Controlled breathing techniques
Exercise, such as Walking and
swimming strengthen chest muscles
and overall cardiovascular fitness
Stress and anxiety reduction

References
http://www.merckmanuals.com/professional/pulmona
ry_disorders/chronic_obstructive_pulmonary_diseas
e_and_related_disorders/chronic_obstructive_pulmo
nary_disease_copd.html#v8575447
http://www.merckmanuals.com/professional/pulmona
ry_disorders/asthma_and_related_disorders/asthma.
html?qt=asthma&alt=sh
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC26547
06/
Gould, B. & Dyer, R. (2011). Pathophysiology for the
health professions (4th ed.). St. Louis, MO:
Saunders.

References
Asperheim, M.K. & Favaro, J. (2012). Introduction to
Pharmacology (12th ed.). St Louis, MO: Saunders
http://www.healthguidance.org/entry/10909/1/Extrinsi
c-Asthma-VS-Intrinsic-Asthma.html
http://www.onhealth.com/asthma/page6.htm
http://www.aafa.org/display.cfm?id=8&sub=16