Asthma, COPD - what is this?

9/9/2016
Atemschule in der Therme Wien Med 1

Asthma and COPD are the most common lung diseases worldwide; in Austria alone, hundreds of thousands of people are affected. In recent years, the range of therapeutic options has evolved so much that, in addition to pharmacotherapy in the form of sprays and tablets, non-drug therapy has moved into the focus of holistic individualized treatment.

When do I have to consider asthma or COPD?

To physicians, the symptoms of coughing, dyspnea, and expectoration (C-D-E) immediately suggest asthma or COPD. In this case, you should consult a pulmonologist – an expert in respiratory medicine –, who will, in addition to taking the medical case history (aka. anamnesis), conduct a physical examination and possibly an X-ray examination and a pulmonary function test. The pulmonary function test allows on the one hand differentiation of the two conditions, and on the other hand assessment of the degree of restriction.

What are the differences between asthma and COPD?

Asthma and COPD are chronic lung diseases that differ strongly in origin and consequently also in terms of symptoms and treatment (see Tab. 1).

The origin of asthma is often an allergy that has begun back in childhood. It leads to chronic eosinophilic airway inflammation, on the one hand resulting in smooth muscle contraction; additionally, remodeling processes take place in the bronchi, leading to further narrowing. Asthma beginning in adulthood is rarer. In addition, there are uncommon forms such as exercise-induced or infection-related asthma.

COPD, by contrast, originates from tobacco consumption or passive smoking, less frequently from environmental factors. The condition is based on a neutrophilic inflammation that progresses slowly and in addition to narrowing of the bronchi also leads to destruction of the alveoli, which is called emphysema.

Condition

The first symptoms of asthma can be allergic rhinitis, conjunctivitis changes or dermal lesions; pulmonally, it is usually a dry cough, which typically also occurs at night. Upon allergen contact, bout-like narrowing of the bronchi by smooth muscle contraction occurs.

COPD progresses slowly! Patients imperceptibly restrict their movement radius; activity and endurance decrease. Only then will increased mucus production, which is distressing particularly in the morning hours, and shortness of breath upon exertion follow.

Manifestations

The classification of asthma is based on complaints (number of asthma attacks / need for rescue medication / restriction of activity); the lung function test is also used to grade the severity. The focus is on asthma control, i.e. achieving a steady state in which ideally no rescue medication is necessary. Then an asthma patient is physically as fit as a healthy person is.

Since COPD progresses slowly, these patients usually see the pulmonologist only at an advanced stage of the disease. Since destruction of the bronchi and emphysema are irreversible, here the primary medical objective is to prevent progression of the disease.

Pharmacotherapy methods

The most important objective in allergic asthma is avoidance of inhalation of the allergen. Then the inhaled corticosteroid – ICS – forms the basic therapy; subsequently bronchodilator substances (long-acting β2 receptor antagonists – LABAs – and muscarinic receptor antagonists – LAMAs) can be used. Additionally, anti-histamines and leukotriene receptor antagonists are used. Only when this armamentarium is ineffective, oral administration of corticosteroids is indicated; in specific cases of severe asthma, IgE receptor antagonists and IL-5 receptor antagonists are beneficial.

The most important treatment for COPD is permanent cessation of smoking. Then we start with inhalation therapy with LAMAs, followed by the combination of LAMAs and LABAs, with ICSs being only the treatment of last resort.

Non-drug therapies with special view to the VAMED facilities

Pulmonological rehabilitation allows patients with asthma and COPD to make a big leap in terms of dyspnea, activity, and endurance. The base is medical training therapy with emphasis on respiratory muscle training. In hundreds of lung patients, we were able to demonstrate that after rehab they have less dyspnea, lose weight, are physically fitter and smoke less or stop smoking altogether, enabling them to live their daily lives again as this would not be made possible by medical treatment alone.

Our advantage is: We take our time!

This is possible only in a large team, where not only physicians but also physiotherapists, training therapists and occupational therapists tackle the main problem, namely the dyspnea. In addition, there are nutritional counseling, psychological care, and support to give up smoking. Unlike an acute care hospital or a surgery, we can take weeks of our time for you! In special education sessions, you will learn all the details of your condition, the effects and side effects of your treatment, and how to act in case of dyspnea. This provides security and alleviates the fear.

Pulmonological rehabilitation is possible in the VAMED facilities both in inpatient (Rehabilitation Hospital Enns) and in outpatient form (Therme Wien Med). The advantage of inpatient rehab is that you have a contact person available 24/7. The advantage of outpatient rehabilitation is that this can be done extra-occupationally and in a family-friendly manner. This therapy thus comes very close to the ideal of holistic, individualized care and is free of side effects.

 

Asthma

COPD

Dyspnea

suddenly occurring

slowly progressive

Coughing

dry cough, nocturnally

productive cough, matutinally

Onset of disease

often in childhood

> 40th year of life

Smoking

can trigger bout

most common cause

lung function

often inconspicuous in period free of bouts

FEV1 / FVC < 70 %

Peak flow

variable

constant

Hypersensitivity of the bronchi

yes

rare

Effect of cortisone

pronounced

low

Origin

eosinophilic inflammation

neutrophilic inflammation

Radiography

usually normal

signs of pulmonary emphysema

 

These articles might also interest you:

+ "Pulmonological rehabilitation in Austria" - from Dr. Ralf Harun Zwick
+ "Sports & respiratory training in pulmonological Rehabilitation" - from Dr. Ralf Harun Zwick
+  Part 1 "What is Gender Medicine? - The Genders" - from Univ. Prof. Dr. Alexandra Kautzky-Willer
+ "Personalized Rehabilitation"- from Prim. PD. Dr. Michael Fischer

 

 

AUTOR

Dr. Ralf Harun Zwick Therme Wien Med - Ambulante Pneumologische Rehabilitation

Kurbadstraße 14 1100 Vienna
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