Asthma and COPDPresented 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 will cause irreversible damage in 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

Ashtma Signs and Symptoms

• Mucus is coughed up and can 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

Ashtma 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 onset in adulthood• 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• After 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• Smoke• Animal dander• Pollutants• Certain food (seafood, peanut butter,

soy)

Treatment for Asthma

• Bronchodilators (inhalers)• Glucocorticoids• Steroids• Nebulizer• Leukotriene inhibitor (Singulair)• Antibodies (Xolair)

Treatment for Asthma

• Treatment methods depend on the severity of asthma

• The bronchodilators are used more to control asthma attacks

• Leukotriene inhibitors and antibodies are more so 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

• Stepwise therapy• Environmental control (elimination of

irritants such as smoke and dust)• Avoidance of foods that provoke

attacks• Skin tests to determine specific stimuli• Proper ventilation

Supportive Therapies for Asthma

• Controlled breathing techniques • Walking and swimming strengthen

chest muscles and overall cardiovascular fitness

• Reduce factors that cause stress and anxiety

References

• http://www.merckmanuals.com/professional/pulmonary_disorders/chronic_obstructive_pulmonary_disease_and_related_disorders/chronic_obstructive_pulmonary_disease_copd.html#v8575447

• http://www.merckmanuals.com/professional/pulmonary_disorders/asthma_and_related_disorders/asthma.html?qt=asthma&alt=sh

• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654706/• 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/Extrinsic-Asthma-VS-Intrinsic-Asthma.html

• http://www.onhealth.com/asthma/page6.htm• http://www.aafa.org/display.cfm?id=8&sub=16