Differences of Asthma and COPD Similarities and differences between asthma and chronic obstructive pulmonary disease: treatment

and early outcomes - A.S. Buist European Repiratory Journal published By European Respiratory Society

oral or inhaled corticosteroid. This makes the diagnosis of asthma sometimes challenging in older adults and it requires the adjustment of the goals of treatment with respect to the patient's age, as maintenance of normal lung function can no longer be a realistic goal. It is also not often acknowledged that both diseases often co-exist in an individual, so it is not uncommon to see the characteristics of both diseases. It is therefore often challenging for the clinician to know which disease a patient has or what mix of diseases, since COPD is not one disease but rather a spectrum of diseases involving both the airways and parenchyma 2, 23. Because of the differences in the cells involved in asthma and COPD, and the relative lack of efficacy of pharmaceutical agents that can alter the progression of COPD (disease-modifying), the approach to the treatment of asthma and COPD is different. The essential difference is that the treatment of asthma is driven by the need to suppress the chronic inflammation, whereas in COPD, treatment is driven by the need to reduce symptoms. Asthma and Ige The immune system produces at least five kinds of immunoglobulins (Ig) or antibodies (IgA, IgD, IgE, IgG and IgM), but the principal one that participates in allergic reactions is immunoglobulin E, or IgE.
Immunoglobulin E, or IgE, is a natural substance in your body that plays an important role in the development of allergic asthma. Increased levels of IgE may result when you are exposed to triggers, such as:

Asthma and COPD have important similarities and differences 3. Both are chronic inflammatory diseases that involve the small airways and cause airflow limitation49, both result from gene-environment interactions and both are usually characterised by mucus and bronchoconstriction. The similarities are striking, but the differences are also striking. For example, different anatomical sites are involved 8; COPD affects both the airways and the parenchyma, whilst asthma affects only the airways. Both asthma and COPD involve the small airways and the structural changes in the small airways are responsible for much of the impairment that occurs in these diseases 1012. physiological

Perhaps the most important difference between asthma and COPD is the nature of inflammation, which is primarily eosinophilic and CD4driven in asthma, and neutrophilic and CD8-driven in COPD 1, 2, 13 15. This is a very important distinction because the nature of the inflammation affects the response to pharmacological agents. There is now ample evidence that inhaled corticosteroids are effective against the eosinophilic inflammation in asthma but largely ineffective against the primarily neutrophilic inflammation seen in COPD 1618. One fact not acknowledged in the definitions is that airway remodelling can occur in long-standing asthma 13, 1922 and results in partially reversible airflow obstruction. Therefore, in many (but not all) patients with long-standing asthma there is a component of chronic irreversible airflow obstruction with reduced lung function and incomplete response to a short-acting bronchodilator or to an
Increased levels of IgE may contribute to the following symptoms:

Animal dander Cockroaches Dust mites Molds

Wheezing Chest tightness Shortness of breath Chronic cough

Inhalation of substances such as dander, pollen or dust mites where the substances bind to membranes in your lung Ingestion of foods or medicines where the initial immune system reactions occur in the stomach Physical contact of skin with substances such as poison ivy

How IgE Affects Your Asthma When you're exposed to certain allergens, your body releases IgE, which then binds with several types of cells:

Immunologically, your body senses the allergen as foreign and sets off a cascade of events stimulating several different types of immune cells (see diagram): T cells rapidly stimulate B cells B cells transform into plasma cells Plasma cells produce IgE antibodies specific to the allergen IgE antibodies bind to mast cells

Basophils Lymphocytes

Mast cells When IgE binds with any of these cells, it canstimulate your immune system, cause your airways to become narrow and inflamed, and make your asthma symptoms worse.

At this point, the allergen has triggered the allergy cascade, but you will not develop any symptoms or even realize that anything has happened. During subsequent exposures to the allergen, you may develop asthma symptoms as part of the early-phase response. Early Phase Response- Re-exposure With re-exposure to the allergen your immune system senses the allergen as foreign leading to: The mast cell/ IgE complexes produced in the sensitization phase, binding to the allergen thinking that it is a foreign invader Mast cells then release inflammatory cells called mediators (e.g. histamine) that quickly travel throughout your body with the purpose of fighting off the foreign invaders such as bacteria and viruses. You begin to experience symptoms of your bodys overreaction to the allergen.

Pathophysio Many asthmatics are atopic (an inherited a predisposition towards allergy) where your immune system develops an exaggerated response to certain foreign substances or allergens. Your body's immune system senses these allergens, perceives them as foreign, and begins to prepare to fight off them off as a foreign intruder. The process that takes place is often referred to as the allergic cascade, which generally occurs in 3 steps: 1. 2. 3. Sensitization Early phase response Late Phase response

Sensitization- Allergen Exposure The first time you are exposed to an allergen, sensitization, you will not usually have symptoms. You may be exposed to allergens that stimulate the allergic cascade through:

The mediators react in different parts of your body causing your allergy symptoms. You may begin wheezing, coughing or feeling short of breath as the immunologic response causes swelling and

narrowing of the airways in your lung. You may only experience runny nose or watery, itchy eyes. The immunologic response begins nearly immediately with symptoms occurring very shortly after re-exposure lasting 3-4 hours. Late Phase Response Beginning at the same time as the early phase response, but not causing symptoms for several hours, is the late phase response. Mediators released by the re-exposure to an allergen also stimulate other kinds of immune cells called eosinophils. Eosinophils contain substances that when released normally fight off infections, but in asthma, the cells damage the lung causing more inflammation and worsening symptoms. In the late phase, symptoms will not develop for at least 4 hours, but may last as long as 24 hours. Increased inflammation and obstruction of airflow may be more severe than what is seen during the early phase.