Treating Asthma and Chronic Obstructive Lung Disease - Coursework Example

Project Log

Abstract

Airway inflammation is measured to be significantin asthma but is comparatively unreachable to study. Fewer insidioustechniques of obtaining sputum from patients not capable of creating it impulsively should offer a useful investigational toolin asthma.

Asthma and chronic obstructive lung disease (COPD) are lung inflammatory conditions linked with structural"remodeling" unfortunate to protect normal lung function.The clinically pragmatic distinctions between asthma and COPD arereflected by divergence in the remodeling progression, the prototypeof inflammatory cells and cytokines. In case of asthma theepithelium appears to be more delicate than that of COPD. In case of COPD, the epithelialreticular basement membrane (RBM) is extensively thicker, and depicts an enlargement of the mass of bronchial smooth muscle. Emphysema is not reported in asthmatic nonsmoker.

COPD depicts epithelial mucous metaplasia, airway wall fibrosis, andinflammation associated with thrashing of nearby alveolar attachmentsto the external wall of small airways: bronchiolar smooth muscleis amplified.

Emphysema is a feature of severe COPD: the vicious process, alveolar wall thickening and focalfibrosis may be distinguished. The hypertrophy of submucosal mucus-secretingglands is similar in extent in asthma and COPD. The number ofbronchial vessels and the area of the wall engaged by them increasein severe corticosteroid-dependent asthma: it is likely that theseincreases also occur in severe COPD.Pulmonary vasculature is remodeled in COPD. In asthma numerousof these structural modifications begin early in the disease process,even in the child. In COPD the changes instigate later in life andthe associated inflammatory reaction differs from that in asthma.The following study defines and compares the key remodelingprocesses.

Method of Project Log

Day 1

Searched Library to collect the information regarding the relationship between Asthma and COPD

Day 2

Assimilated the information and formulated the hypothesis to compare the key remodeling processes for COPD and Asthma

Day 3

Prepared the protocol to carry out the study

Day 4

Fixed the appointment with the hospital authorities, patients of COPD and Asthma and normal volunteers and take their consent for sputum examination for eosinophils and neutrophils.

Day 5

Performed the first round of study with all the four categories of subjects’ viz. COPD patients, Asthma patients, Smokers and Normal subjects.

Day 6

Performed the second round of study with all the four categories of subjects.

Day 7

Results were calculated, studied and concluded.

Result

Plenty ofsamples (76% of first attempts) obtained from lower respiratory tract were obtained. A fall is reported as low as 5.3% and maximum of 20% in the forced expiratory volume(FEV1) during inhalation of saline. There was a reliability coefficient of 0.8 for Eosinophil and 0.7 for metachromatic cell counts respectively. This data was reproducible. A comparative data was estimated betweensputum from normal subjects, sputum from asthmaticpatients contained a significantly higher proportion of eosinophils(mean 18.5% (SE 3.8%) v 1.9% (0.6%)) and metachromatic cells(0.50% (0.18%) v 0.039% (0.014%)) (Pin et al, 1992).

The results obtained by Jacob et al show that in the span of 15 months, 175 patients went for 537 consultations. In 57% patients’ impairment in their quality of life was reported. The given data is associated with subsequent GP interventions and patients’ education and counseling. A multivariate logistic regression analysis was performed based on physical complaints and a change in medication prescription was done along with education about control regimen.

Various studies are being performed to understand and also discriminate COPD and asthma in one of the studies direct and indirect costs associated with asthma and chronic obstructive pulmonary disease (COPD) in Sweden in 1980 and 1991, was performed to classify trends in the use of outpatient concern, drugs and inpatient concern, and the development of momentary morbidity, permanent disability and mortality for asthma and COPD (Jacobson, 2000).

It is reported that Asthma and COPD jointly account for approximately 2% of the economic cost of all diseases. The total costs associated with each disease were alike, the allocation of the different cost mechanisms and changes differ with time. As reported (Jacobson, 2000), during 1980s, the cost of drugs and out-patient care increased for both diseases on the contrary, the cost of inpatient concern for asthma decreased, but for COPD increased. (Jacobson, 2000).

Cell count(% total) for all the four categories Normal (n=16), Smokers (n= 12), COPD (n=14), Asthma (n=12)

Conclusion

It can be concluded that induced sputum is capable of detecting differencesin cell counts between normal and asthmatic subjects and virtuesfurther development of drugs and therapies as a potential means of assessing airwayinflammation in asthma. It is clear from these studies that there are populations of patients with COPD and asthma that can be readily distinguished from one another based on their physiology, natural history, and/or disease pathogenesis. It is also clear from these studies that there are many patients who appear to have features of both these disorders (Figure 1).

The study conclude that different lines of therapy must be followed by the physicians for both COPD and Asthma once the cell count report is confirmed. It will be a definite help to the physician treating COPD and Asthma patients and will help to combat COPD which is proving to be the fourth leading causes of mortality in US (Confronting COPD in America: Executive Summary).

Recommendation:

In asthma episodic coughing, wheezing, and shortness of breath has been recognized since ancient times. In concurrence with the medical importance of asthma, the study was performed diligently to define and characterize asthma and COPD. As a result of these efforts, our concept of asthma pathogenesis has evolved from the prior supposition that asthma is caused by an essential irregularity in airway smooth muscle to our present conceptualization that asthma is a chronic inflammatory disorder of the airway.

COPD is a complex term that is used to explain a variety of diseases including chronic bronchitis and emphysema. Like asthma, COPD is characterized by a variable airflow obstruction, can be seen with AHR, and evident as episodic shortness of breath, dyspnea, and wheezing. The airways obstruction in COPD is characteristically irreversible or partly reversible, and the mucous metaplasia of chronic bronchitis and the alveolar destruction of emphysema cause a chronic, progressive loss of lung function. The protease-antiprotease hypothesis has dominated our thoughts about COPD over the past 40 years. It proposes that there is a balance between proteases such as matrix metalloproteases (MMPs), cathepsins and serine proteases, and antiproteases, such as tissue inhibitors of metalloproteases, leukocyte proteinase inhibitor.

As compared to healthy lung, an antiprotease shield is believed to predominate, preventing proteolytic parenchymal injury. Emphysema is proposed to occur when there is amplification in proteases or a decrease in antiproteases, a process that can be initiated by oxidant lung injury and/or lung inflammation. The affiliation between asthma and COPD has been contemplated on and investigated. The British hypothesis has held scientific and clinical influence in recent years. It proposes that asthma and COPD are distinct entities that are generated by distinct mechanisms. A variety of lines of evidence have been cited to support this idea (British Thoracic Society, 1997). A constant effort and awareness is desired to overcome the mortality caused by COPD and asthma. Drugs targeting COPD must be designed explicitly to combat the disease.

It is recommended that patient must practice breathing exercises by means of relaxation, leaning forward while exercising and belly breathing are much help to the patients with pulmonary problems and especially with the cases of COPD and asthma. Supplemental oxygen also help the patients with severe COPD (Lung- Treatment of COPD and Asthma).

Summary:

Asthma is characterized by eosinophilic and mononuclear cell infiltration, mucous metaplasia, airway remodeling, reversible airflow obstruction, and airway hyper-responsiveness. COPD is typified by nonreversible or incompletely reversible airway obstruction, often accompanied by mucous metaplasia and alveolar destruction. There is considerable overlap in pathogenesis and clinical features between both these conditions. However, asthma and COPD may be distinguished by their respective cytokine profiles. COPD and asthma may represent disease states along a continuum, with varying degrees of each disease often present in the same patient.

It is clear from the conducted study, that there are populations of patients with COPD and asthma that can be readily distinguished from one another based on their physiology, natural history, and/or disease pathogenesis. It is also clear that there are many patients who appear to have features of both disorders. As a result of these findings, it is reasonable to hypothesize that in these patients there is a continuum between COPD/emphysema and asthma. At the asthmatic extreme are patients with normal alveoli, normal pulmonary compliance, and minimal tissue proteolysis and injury. As one moves toward COPD and emphysema, there is a progressive increase in alveolar destruction, compliance, and parenchymal injury and remodeling. Using this concept, it is easy to see how varying degrees of asthma and COPD may overlap in the same individual.