1. Asthma and COPD Presented by Erin Frankenberger & Michelle Wisniewski
BIO 313E Pharmacology and Pathophysiology II

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. COPD
The two most common types of chronic obstructive pulmonary disease are chronic bronchitis and emphysema

9. 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

10. 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

11. 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)

12. 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

13. 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

14. Treatment of Stable COPD
Beta-agonists
Anticholinergics
Inhaled corticosteroids
Theophylline
Phosphodiesterase-4 inhibitors
Oxygen therapy

15. Treatment of Acute COPD Exacerbation
Oxygen supplementation
Bronchodilators
Corticosteroids
Antibiotics
Ventilator assistance

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Intrinsic Asthma Exacerbating Factors
Extreme emotions (crying)
Cigarette smoke
Cleaning agents
After exercising
Pollutants
Exposure to cold weather
Respiratory infections
Anxiety

25. 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

26. Extrinsic Asthma Exacerbating Factors
Dust and mold
Seasonal pollens
Smoke
Animal dander
Pollutants
Certain food (seafood, peanut butter, soy)

27. Treatment for Asthma Bronchodilators (inhalers) Glucocorticoids
Steroids
Nebulizer
Leukotriene inhibitor (Singulair)
Antibodies (Xolair)

28. 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

29. 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

30. Supportive Therapies for Asthma
Controlled breathing techniques
Walking and swimming strengthen chest muscles and overall cardiovascular fitness
Reduce factors that cause stress and anxiety

31. References
Gould, B. & Dyer, R. (2011). Pathophysiology for the health professions (4th ed.). St. Louis, MO: Saunders.

32. References
Asperheim, M.K. & Favaro, J. (2012). Introduction to Pharmacology (12th ed.). St Louis, MO: Saunders