Chapter 64 Asthma and chronic obstructive pulmonary disease
Asthma, which is experienced by almost 1 in 10 of the UK population, can occur from infancy to old age and is genetically based. Chronic obstructive pulmonary disease (COPD) is experienced by 8% of UK men and 3% of women and is an adult illness, in most cases the consequence of lung damage caused by smoking (less than 10% is due to occupational illness). Symptoms in asthma and COPD have many similarities, such as breathlessness, ranging from mild to severe, and a pattern of exacerbations that can be triggered by infections (for both) or allergens in the case of asthma. For moderate asthma the most important intervention is inhaled corticosteroid, an anti-inflammatory medication. Used daily, and continuously, inhaled steroids reduce lung inflammation and prevent symptoms in asthma. Higher-dose oral steroids are used in short courses to manage exacerbations. In severe asthma they may be taken daily for regular control.
Bronchodilating medication is the other main medical intervention. It relaxes airways and relieves symptoms, but does not reduce airway inflammation, the underlying mechanism that drives asthma. Patients use this medication when they feel mildly breathless or before exercise. It is usually given through a pocket-sized inhaler. In mild asthma, with only occasional breathlessness, this may be the only medication used. Medical interventions for COPD consists of bronchodilating medication to relieve symptoms, taken daily through a pocket-sized inhaler or an electrically powered nebulizer, and antibiotics for COPD exacerbations resulting from chest infections. Oral or inhaled corticosteroids are appropriate for some patients with COPD.
Quality of life in asthma and COPD
From the patient’s viewpoint, the main difference between asthma and COPD is that, for most people with asthma, lung obstruction is reversible. This means that breathlessness in asthma is relieved by regular use of inhaled or oral steroids, and occasional use of bronchodilators. With appropriate medication almost all people with asthma can lead a non-restricted life. In about 90% of patients with asthma, activities need not be limited, and exacerbations can be reduced to a very low level.
COPD has more significant effects on quality of life, because lung damage is non-reversible. A diagnostic criterion of COPD is lung function (FEV1) that is less than 60% of normal of comparable age. Constant moderate-to-severe breathlessness, cough and phlegm production with periods of acute symptoms triggered by infection are characteristic of COPD. About 15% of all hospital admissions are due to COPD. COPD is a disease of adulthood and old age.
In about 70% of patients with COPD, daily activities are limited by breathlessness, sleep is frequently disturbed and patients have severe attacks of breathlessness, which can lead to hospital admissions. In COPD, pulmonary rehabilitation can help patients cope with constant breathlessness and manage everyday activities.
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