Asthma is a common chronic disease affecting lives of millions of people worldwide demonstrating an increasing incidence rate and varying prevalence. In Europe, almost 10 million people <45 years of age have asthma. The prevalence of asthma in the European Union (EU) is 8.2% in adults and 9.4% in children.
In terms of pathophysiology, asthma is an inflammatory disease of lungs, leading to an extended limitation of airflow. Asthma is thought to be caused by a combination of genetic and environmental factors that can contribute to asthma or airway hyperactivity and may include any of the following:
Environmental allergens, exercise and hyperventilation, Gastroesophageal Reflux Disease, Chronic Sinusitis or Rhinitis, Obesity, occupational exposure in factors that cause asthma, environmental pollutants, irritants (household sprays etc.), emotion factors or stress etc.
Diagnosis is typically based on the pattern of symptoms and response to therapy over time. Asthma may be suspected if there is a history of recurrent wheezing, coughing or difficulty breathing and these symptoms occur or worsen due to exercise, viral infections, allergens or air pollution. Spirometry is then used to confirm the diagnosis. The clinical signs and symptoms of asthma differ among patients. Symptoms are worsening usually at night and early in the morning or after exercise or with cold air.
Symptoms are worsening usually at night and early in the morning or after exercise or with cold air. Symptoms might be dyspnea, intolerance, wheezing, coughing, shortness of breath, chest tightness and pain, anxiety, or panic and often. Other nonspecific symptoms in infants or young children may be a history of recurrent bronchitis, bronchiolitis, or pneumonia; a persistent cough with colds; and/or recurrent croup or chest rattling.
Pathophysiology of asthma is complex and involves the following components:
Airway inflammation, intermittent airflow obstruction and bronchial hyperresponsiveness. Allergic asthma is usually related to increased levels of total and specific IgE in blood circulation. Increased levels of eosinophiles are detected in blood, in airways mucous and in bronchovesicular secretion. Symptoms increase after allergen inhalation and might insist even in absence of allergic stimuli. Medications that can cause problems in asthmatics are angiotensin-converting enzyme inhibitors administered in cardiovascular diseases such as Hypertension, aspirin, and NSAIDs. In addition, asthma might be caused by food such as dairy products, eggs, seafood etc.
Medical approach of asthma includes treatment of acute asthmatic episodes and control of chronic symptoms including nocturnal and exercise-induced asthmatic symptoms. Medicines used for asthma treatment are inhaled corticosteroids, long-acting bronchodilators, theophylline, leukotriene modifiers and more recent strategies such as the use of anti-immunoglobin E (IgE) antibodies, anti-IL5 antibodies and anti-IL4/IL13 antibodies in selected patients. Relief medications include short-acting bronchodilators, systemic corticosteroids etc.
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease which is characterized by long-term respiratory symptoms and airflow limitation. In accordance with WHO’s estimations, 65 million people suffer from moderate to severe COPD. Approximately 3 million people die from COPD annually, a disease that is the 4rth cause of death in the USA.
In Greece where more than 50% of adults are smokers, a study showed that 800.000 Greeks suffer from this disease, with half of them not knowing it.
The most common cause of COPD is smoking. Risk factors causing COPD include indoor and outdoor pollution, such as air pollution in the atmosphere, exposure to occupational irritant substances such as dust from grains, and cadmium dust or fumes, and genetics.
Patients typically demonstrate a combination of signs and symptoms of chronic bronchitis, emphysema, and reactive airway disease including the following:
- Cough, usually worse in the mornings and productive of a small amount of colorless sputum
- Breathlessness: The most significant symptom, but usually does not occur until the sixth decade of life
- Wheezing: May occur in some patients, particularly during exertion and exacerbations
The formal diagnosis of COPD is made with spirometry, a simple and painless examination that measures the amount of airflow obstruction present and is generally carried out after the use of a bronchodilator, a medication to “open up” the airways.
COPD is not curable, but the symptoms are treatable, and its progression can be delayed, particularly by stopping smoking. The goal of COPD management is to improve a patient’s functional status and quality of life by preserving optimal lung function, improving symptoms, and preventing the recurrence of exacerbations.
One of the most important things that a patient must do is to stop smoking. Medical treatment includes bronchodilators, corticosteroids, antibiotics, combination inhalers (steroids with a bronchodilator). Vaccination against flew or pneumonia reduces risk of these illnesses. Pneumonic rehabilitation and oxygen therapy (when appropriate) help patient either to stay healthy and active as possible or to reduce shortness of breath, protect organs and enhance quality of life. Surgery is recommended in severe cases.
Once the diagnosis of COPD is established, it is important to educate the patient about the disease and to encourage his or her active participation in therapy.
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