Differentiating COPD from Asthma | Jindal Chest Clinic

Presentation on "Difference between COPD and Asthma". For more information, please contact us: 9779030507.

1. DIFFERENTIATING COPD
FROM ASTHMA
Dr. S. K. Jindal
www.jindalchest.com

2. What is COPD?
1.Chronic bronchitis and emphysema
2.Bronchial asthma
3.Asthmatic bronchitis
4.Nonspecific airway obstruction

3. Burden of COPD in Various Indian
Studies Population Prevalence (%) M:F ratio Smoker :
nonsmoker
ratio
Men Women
Wig (1964) Rural, Delhi 3.36 2.54 1.3 2.0
Viswanathan (1966) Patna 2.12 1.33 1.6
Sikand (1966) Delhi 7.0 4.3 1.6 2.5
Bhattacharya (1975) Rural, U.P. 6.67 4.48 1.6
Viswanathan (1977) Delhi Rural 4.7 3.5 1.3 9.6
Urban 8.0 4.3 1.9 4.0
Thiruvengadam (1977) Madras 1.9 1.2 1.6 10.2
Charan (1977) Rural Punjab 2.28 1.63 1.4
Radha (1977) New Delhi 8.1 4.6 1.8 1.8
Malik (1986) N. India Rural 9.4 4.9 1.9 5.5
Urban 3.7 1.6 2.3 7.0
Jindal (1993) N. India Rural 6.2 3.9 1.6
Urban 4.2 1.6 2.6 9.6
Ray (1995) South India 4.08 2.55 1.6 1.6
Jindal (2006) Multicentric 5.0 3.2 1.6 2.65

Jindal et al. IJCDAS 2001,IJCDAS 2006

4. Risk factors for COPD
Adjusted OR (95% CI)
Gender Men 1.000
Women 1.056 (0.897-1.224)
Age 35-44 years 1.000
45-54 years 1.552 (1.325-1.816)
55-64 years 2.174 (1.839-2.570)
65-74 years 4.102 (3.464-4.858)
>=75 years 4.899 (3.953-6.070)
Usual residence Rural 1.000
Urban 1.224 (1.083-1.384)
Mixed 1.563 (1.139-2.143)
Socioeconomic status Low 1.000
Middle 0.717 (0.632-0.814)
High 0.675 (0.536-0.850)
Smoking habit Nonsmoker 1.000
Cigarette smoker 1.952 (1.578-2.416)
Bidi smoker 2.654 (2.292-3.074)
Hookah smoker 2.897 (2.044-4.106)
Cooking fuel No self cooking 1.000
Cooking with LPG 0.781 (0.629-0.968)
Cooking with kerosene 1.252 (0.889-1.763)
Cooking with solid fuels 0.995 (0.787-1.258)
Jindal et al. IJCDAS 2006

5. Misdiagnosis is Frequent !
Manytimespatientsareincorrectlylabeled
Genuinedifficultyindiagnosis,duetooverlapofsymptomsofCOPDand
asthma
Lackofawarenessofdifferencesbetweenthesetwodiseaseconditions
Moreoften,patientswithCOPDarelabeled
ashavingasthma

6. Remember …
All that wheezes is not asthma
All smokers with respiratory symptoms do not have COPD
Asthma & COPD are not the same disease
No single rule of thumb to differentiate

7. COPD is not Asthma
Different causes
Different inflammatory cells
Different mediators
Different inflammatory consequences
Different sites
Different response to treatment

8. Question 1:
HowisairwayinflammationinCOPDdifferentfromthatin
asthma?
1.Predominantmacrophages
2.IL-4andIL-5involvement
3.Epithelialshedding
4.Mucosalfibrosis

9. Inflammation
Asthma COPD
Inflammatory cells Mast cell, Eosinophil Neutrophil
CD4+ cells CD8+ cells
Macrophages + Macrophages ++
Inflammatory LTB4, histamine LTB4
mediators IL-4, IL-5, IL-13 TNF-a
Oxidative stress + Oxidative stress +++
Inflammatory effect All airways Peripheral airways
AHR +++ AHR ±
Epithelial shedding Epithelial metaplasia
Fibrosis + Fibrosis ++
No parenchymal
involvement
Parenchymaldestruction
Mucus secretion + Mucus secretion +++
Response to steroid +++ ±

10. Inflammation
Butclinicianshavenomeanstoassessthesedifferencesin
inflammation
Forproperdiagnosis,theymustrelyon
History
Physicalexamination
Simpleinvestigations

11. Question 2:
Howdoesagoodhistoryandathorough
physicalexaminationhelptodistinguish
COPDfromasthma?
1.Identificationoftriggers
2.Progressivecourse
3.Episodicnature
4.Audiblewheezes

12. History
Asthma COPD
Onset Variable; more often Usually later in life
in childhood / early (4
th
to 5
th
decade)
adulthood
Course Episodic Progressive
Smoking Uncommon Common
Nasal symptoms Common Rare
Atopy Common Rare
Family history Often Uncommon
Triggers Often identified None
Wheeze Prominent & almost May or may not be
universal present

13. Physical Examination
Restinghyperinflationisahallmarkofemphysema,and
conventionallyseeninasthmaonlyduringacuteattacks
Complicationssuchascorpulmonale,chronicrespiratory
failure,etc.areseeninadvancedCOPD,andvirtuallynever
inbronchialasthma

14. Question 3:
Whichisthebestlaboratoryinvestigationindifferentiating
COPDfromasthma?
1.Haemogram–Eosinophils
2.CXR
3.PEF
4.Spirometry

15. Investigations
Asthma COPD
Chest radiograph Normal Suggestive
Spirometry Obstructive defect Obstructive defect
Good reversibility Poor reversibility
AHR Very common May be present
DLCO Normal / Increased Decreased
Lung elastic recoil Normal Increased
Thoracic CT scan Airway wall thickeningAirway wall thickening
Mucus plugs (ABPA) Emphysema
Air trapping ± Air trapping
In general, investigations are poor discriminators

16. Question 4:
Basedonhistory,physicalexamination,andcommon
investigations,howwellcanonedistinguishCOPDfrom
asthma?

17. The Diagnosis !
Basedonthecompleteclinicalprofile,itiseasyundermost
circumstancestocommentwhetheragivenpatientismore
likelytohaveCOPDorasthma
Somepatientsmaybereallydifficulttodiagnosedueto
overlapofclinicalandpathophysiologicalfeatures

18. The Overlap !

19. Take Home Message
Importantforcliniciansto:
understandthatasthmaandCOPDaretwoentirelydifferent
disorders
appreciatethatclinicaljudgementhasafargreaterrolethan
investigationsindifferentiatingCOPDfromasthma

20. THANK YOU