Asthma and chronic obstructive pulmonary disease (COPD) are both health conditions involving the respiratory system and can lead to difficulty breathing. There is some overlap between the two conditions and it is estimated that approximately 40% of patients with COPD also suffer from asthma.
However, there are some distinct differences between the two conditions, in their pathophysiology, presentation of symptoms and the optimal management plans. The key differences to aid in diagnosis and treatment decisions are outlined below.
Characteristics of Asthma
Asthma is a chronic inflammatory disorder of the airways that leads recurrent episodes of symptoms such as wheezing, breathlessness, chest tightness and coughing, which commonly occur at night or in the early morning.
These flare up periods are associated with triggers that cause obstruction of the airways, which is usually reversible.
Diagnosis of asthma most commonly occurs during childhood, in individuals that have a history of dry cough in the night, although it can present at any age.
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Characteristics of COPD
COPD is a disease characterized by the progressive obstruction of the airways that leads to a reduction in airflow and respiratory function. These changes are not completely reversible and inhaled noxious particle or gases, such as cigarette smoke, are associated as risk factors for the condition.
Diagnosis of COPD usually occurs in older adults with a history of smoking or chronic exposure to other inhaled irritants.
View how chronic obstructive pulmonary disease (COPD) develops:
Key Differential Factors
Both asthma and COPD are chronic inflammatory diseases of the small airways involving mucus and bronchoconstriction that limit the airflow. However, the differences between the two conditions are important and affect the way we manage them.
The reversibility of the damage to the airways is a major difference between asthma and COPD. The airways obstruction in asthma is largely reversible in patients with asthma, whereas the obstruction in COPD is considered to be irreversible or less reversible.
The difference in reversibility is highlighted in the results from lung function tests, such as spirometry. Both show a reduction in airflow, but assessing the effect of bronchodilator administration can help to differentiate between the conditions. Asthma exhibits greater...Read more..
The debate about e-cigarettes and the relationship to tobacco products has moved up a notch following a new study about teen vapers in the U.S. The study shows a link to tobacco products.
Vaping (the use of electronic cigarettes) is seen by many, including those who market the products, as a safer alternative to smoking tobacco products (e-cigarettes contain the addictive chemical nicotine but no known carcinogens.) However, the arguments used by the main manufactures (many of them tobacco companies that have diversified) relates to how the product is used to wean people away from traditional tobacco product, as a step to giving up smoking anything at all. For this reason, in parts of the U.K., electronic cigarettes have medicinal status and can be prescribed by a medical doctor to a patient in a quest to give up smoking.
There is other evidence, such as from the U.S. Centers for Disease Control and Prevention (CDC), that suggests the marketing of e-cigarettes, especially the types infused with flavors like bubblegum, are designed to appeal to young people who have never smoked before.
This tendency has been picked up in a new study that suggests that vaping may encourage tobacco smoking by teens (traditional cigarettes or the use of a hookah) who would have seemed the least likely to take up the habit.
The concern here is that the e-cigarettes are a stepping stone to tobacco products. There are also concerns that the chemicals in e-cigarettes and the long-term effects on the human body is unknown (this is an issue raised by the World Health Organization.)
The new study comes from Dr. Thomas Wills, of the University of Hawaii Cancer Center in Honolulu. Wills told Science News: " All the information that’s come out in the past few months suggests that there is a risk associated with e-cigarette use."
The study was based on a review of 2,200 children (in the 9th and 10th grades.) Information was gathered about e-cigarette and traditional cigarette use. Those who vaped were three times more likely that those who had never vaped to take up the smoking of tobacco products.
The study also included a personality assessment. Those teens who considered themselves to be, or who displayed characteristics of, rebelliousness, were most likely to make the transition over from e-cigarettes to tobacco products.
The research is published in the journal Tobacco Control. The paper is headed "Longitudinal study of e-cigarette use and onset of...Read more..
Pre-existing asthma may be a strong predictor of future chronic migraine attacks in individuals experiencing occasional migraine headaches, according to researchers from the University of Cincinnati (UC), Montefiore Headache Center and Albert Einstein College of Medicine, and Vedanta Research. The findings were published online in November in the journal Headache, a publication of the American Headache Society.
"If you have asthma along with episodic or occasional migraine, then your headaches are more likely to evolve into a more disabling form known as chronic migraine," said Vincent Martin, M.D., professor of medicine in UC's division of general internal medicine, co-director of the Headache and Facial Pain Program at the UC Neuroscience Institute, and lead author of the study.
Dr. Martin teamed with Richard Lipton, M.D., and Dawn Buse, Ph.D., both of Montefiore Headache Center and Albert Einstein College of Medicine; and Kristina Fanning, Ph.D.; Daniel Serrano, Ph.D.; and Michael Reed, Ph.D., all from Vedanta Research, to study about 4,500 individuals who experienced episodic migraine or fewer than 15 headaches per month in 2008.
"Migraine and asthma are disorders that involve inflammation and activation of smooth muscle either in blood vessels of in the airways," said Richard Lipton, M.D., director of Montefiore Headache Center and vice chair of neurology, and the Edwin S. Lowe Chair in Neurology, Albert Einstein College of Medicine, and founder of the American Migraine Prevalence and Prevention Study. "Therefore, asthma-related inflammation may lead to migraine progression."
About 12 percent of the U.S. population experiences migraine, according to the American Migraine Prevalence and Prevention (AMPP) Study. This condition is three times more common in women than men, including 18 percent of American women and 6 percent of American men. Individuals with chronic migraine have headaches occurring 15 or more days per month; this condition affects one percent of the U.S. population and takes a severe toll on sufferers who often miss work and social events. The World Health Organization (WHO) rates migraine as the world's seventh most disabling medical condition.
The researchers analyzed data from the AMPP Study. Study participants completed written questionnaires both in 2008 and 2009. Based on responses to the 2008 questionnaire, they were divided into two groups—one with episodic migraine and coexisting asthma and another with...Read more..
In a recent study published in Respiratory Magazine, patients with COPD and other chronic respiratory disorders who received music therapy in conjunction with standard rehabilitation saw an improvement in symptoms, quality of life, and psychological well-being when compared to patients who received only rehabilitation. The results of the study, conducted by researchers at The Louis Armstrong Center of Music and Medicine at Mount Sinai Beth Israel, suggest that music therapy may be an effective addition to traditional treatment. A total of 68 participants diagnosed with chronic respiratory diseases were included in the study.
A randomized group of the patients attended weekly music therapy sessions over the course of 6 weeks that included live music, visualizations, singing that incorporated breath control techniques, and wind instrument playing. Certified music therapists provided active music-psychotherapy. The music therapy sessions integrated the preferred music of patients, which encouraged self-expression, increased engagement in therapeutic activities, and provided an opportunity to cope with the challenges of a chronic disease, according to a Mount Sinai School of Medicine news release.
“The care of chronic illness is purposefully shifting away from strict traditional assessments that once focused primarily on diagnosis, morbidity, and mortality rates,” says Joanne Loewy, DA, director of the Louis Armstrong Center for Music and Medicine at MSBI, where the study was conducted. “Instead, the care of the chronically ill is moving toward methods that aim to preserve and enhance quality of life of our patients and activities of daily living through identification of their culture, motivation, caregiver/home trends and perceptions of daily wellness routines.”
Jonathan Raskin, MD, co-author of the study and director of the Alice Lawrence Center for Health and Rehabilitation at MSBI, states, “Music therapy has emerged as an essential component to an integrated approach in the management of chronic respiratory disease. The results of this study provide a comprehensive foundation for the establishment of music therapy intervention as part of pulmonary rehabilitation care.”
The researchers found that the patients who received music therapy in conjunction with standard rehabilitation saw an improvement in symptoms, as well as their psychological well-being and quality of life, according to the study which appears in Respiratory...Read more..
Study suggests willpower isn't the only player
In this New Year, it is time to get smoking stopped! And perhaps our genes can help us understand how. In a recent study, it has been found that some smokers have much more difficulty kicking the habit than others. Now, a new review of prior research identifies a potential culprit: genes.
Researchers analyzed genetic differences cited in 22 studies involving nearly 9,500 white smokers. Of particular interest were variations in genes involved in processing dopamine, a neurotransmitter that helps to regulate the brain's reward and pleasure centers.
Experts believe that the nicotine found in tobacco boosts dopamine in the brain, leading to addiction.
The researchers wondered if variants in genes that regulate dopamine might be associated with the ability to put out the butts for good.
In the end, the scientists focused on a DNA sequence called Taq1A. They found that smokers who carried a variation of that sequence -- called A2/A2 -- appeared to have an easier time quitting smoking than those who carried other variations of the Taq1A sequence.
"This variant has been studied for years, but this study provided more convincing evidence on the role of this genetic variant in smoking cessation by analyzing a significant large number of smoke samples," said study co-author Ming Li, a professor in the department of psychiatry and neurobehavioral sciences at the University of Virginia.
The findings were published Dec. 1 online in Translational Psychiatry.
Li, working with researchers from Zhejiang University School of Medicine in Hangzhou, China, noted that roughly 6 million people die worldwide every year because of smoking.
The studies included in the current analysis were conducted between 1994 and 2014, and numbered from fewer than 100 participants to more than 2,000.
Quitting success varied widely, ranging from less than 10 percent to nearly 67 percent, the researchers reported.
Ultimately, the team found there was a "significant association" -- but no definitive proof -- between having the A2/A2 DNA variant and an increased ability to successfully quit.
The authors said the finding should encourage more research into the genetics behind efforts to quit smoking. Such research could eventually lead to the development of personalized treatments that target each smoker's inherited predispositions, they suggested.
However, Li's team cautioned that "research on this problem remains...Read more..
Children who are raised in households with dogs or farm animals during their first year of life may have a lower risk of asthma a few years later, a new study suggests.
In the study, the researchers looked at early exposure to dogs and farm animals and the rate of asthma among about 377,000 preschool-age and 276,000 school-age children in Sweden.
Among the school-age kids in the study, those who had been exposed to dogs during their first year of life were 13 percent less likely to have asthma at age 6, compared with the school-age kids who had not been exposed to dogs in their first year of life, the researchers found.
Based on the new findings, researchers can confidently "say that Swedish children with dogs in their homes are at lower risk of asthma at age 6, and that this risk reduction is seen also in children to parents with asthma," said study author Tove Fall, an associate professor of Uppsala University in Sweden.
The researchers also found that, the school-age kids who were exposed to farm animals during their first year of life were 52 percent less likely to have asthma at age 6 than those who had not been exposed to farm animals during their first year of life.
Among the preschool-age children, those who were exposed to farm animals during their first year were 31 percent less likely to have asthma when they were between 1 and 5 years old, compared with the kids who were not exposed to farm animals during their first year of life, according to the study, published on November 2, 2015 in the Journal JAMA Pediatrics.
In the study, the researchers looked at diagnoses of asthma obtained from the National Patient Register in Sweden. They also examined data on prescribed asthma drugs dispensed at pharmacies in Sweden. The researchers also looked at whether the kids' parents were registered as dog owners during the child's entire first year of life, and whether the parents reported that they worked with farm animals. The data in the study were analyzed from January 2007, through September 2012.
The researchers said they don't know for sure what exactly may explain the link between early exposure to animals and a reduced risk of asthma.
"It might be due to a single factor, or more likely, a combination of several factors related to a dog ownership lifestyle or dog-owners' attitudes, such as kids' exposure to household dirt and pet dust, time spent outdoors or being physically active," Fall told Live Science. "As a parent in...Read more..
If post-bronchodilator spirometry is required for the diagnosis of chronic obstructive pulmonary disease (COPD), why doesn’t every single primary care physician do it?
A University-based Primary Care Clinic (PCC) analysis revealed that only 19% of patients with COPD had undergone spirometry testing, which determines how well the lungs work by measuring oxygen flow. With COPD being the third leading cause of death in United States, this is certainly a startling statistic. Sandra Adams, MD, from The University of Texas Health Science Center at San Antonio (UTHSCSA) in Texas, presented a way to combat the lack of testing at the CHEST 2015 meeting in Montréal, Canada.
“This is what it’s really all about… the patients,” Adams began the presentation. Between 2012 and 2013, only 64% of the participants reported having spirometry testing within the last 16 years in order to confirm the condition.
Most people would probably say to look at the physicians and institutions where spirometry rates were the lowest. “I actually took a different approach and went to the ones with the highest rates,” Adams expounded. After gathering information on why the high raters used spirometry, as they should, the researchers moved on to those failing to use it. Some of the physicians with low rates voiced the ‘if it quacks like a duck’ viewpoint when it comes to COPD. So the team didn’t hesitate to show them instances where COPD was actually not the correct diagnosis in cases following the mantra.
Improving confidence and knowledge when it comes to spirometry testing were important endpoints, but Adams explained that they “actually wanted to change behavior.”
The team implemented the WipeCOPD program which was designed so that it’s easy and “the clinician doesn’t have to think about.” The interactive program consists of 60 to 90 minutes of continuing education modules per month along with 30 minutes of “live” training sessions on how to perform spirometry moderated by a COPD expert. “The hardest part was getting them in the first module,” Adams said. But after clinicians started the first module, the amount continuing was high.
The rate of spirometry rates increased following the WipeCOPD interventions. It went from the initial 19% (14 out of 75 clinicians) to 56% (176 to 312 clinicians) in just five months. The third-quarter of the study is still in the process, however, rates are clocking in around 82%.
While smoking is linked to an increased risk of developing diabetes, this risk appears to drop over the long term once cigarette use stops, a review of evidence suggests.
Researchers analyzed data on almost 5.9 million people in 88 previous studies examining the connection between smoking, second-hand smoke exposure and diabetes. They estimated that roughly 28 million type 2 diabetes cases worldwide – or about 11.7 percent of cases in men and 2.4 percent in women – could be attributed to active smoking.
The more cigarettes smokers consumed, the more their odds of getting diabetes increased.
If they quit, ex-smokers initially faced an even higher risk of diabetes, but as more years pass without cigarette use their odds of getting the disease gradually diminished, the analysis found.
“The diabetes risk remains high in the recent quitters,” said lead study author An Pan, of Huazhong University of Science and Technology in China. Weight gain linked to smoking cessation may be at least partly to blame for the heightened diabetes risk in those first months after giving up cigarettes, Pan added.
“However, the diabetes risk is reduced substantially after five years,” Pan said by email. “The long-term benefits – including benefits for other diseases like cancer and heart disease – clearly outweigh the short-term higher risk.”
Worldwide, nearly one in 10 adults had diabetes in 2014, and the disease will be the seventh leading cause of death by 2030, according to the World Health Organization.
Most of these people have type 2 diabetes, which is associated with obesity and aging and happens when the body can't properly use or make enough of the hormone insulin to convert blood sugar into energy. Left untreated, diabetes can lead to nerve damage, amputations, blindness, heart disease and strokes.
Plenty of research has established a connection between smoking and diabetes, although the reason is still unclear.
For the current analysis, Pan and colleges focused on exploring the link between the amount and type of smoke exposure and diabetes risk, as well as the potential for this risk to diminish with smoking cessation.
Overall, the pooled data from all the studies showed the risk of diabetes was 37 percent higher for smokers than non-smokers, the study team reports in The Lancet Diabetes and Endocrinology.
Exactly how smoking might lead to diabetes isn’t firmly established, but it’s possible smoking might cause...Read more..