ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Asthma means an inflammation which is not microbic and develops in airway.

Result of this inflammation there are developments such as; contraction in muscles which cover airway, swelling of inner layer called mucosa and secretion which is dark and squamous. Because nose is a part of respiratory tract, it shows similar alterations for most patients. All in all syndromes appear as a result of narrowing and even closure at the airway.

Chronic Obstructive Pulmonary Disease (COPD) is a disease which also develops as a result of airway inflammatory. But the important difference of the disease is the development of permanent damages because of inflammation. The most important differences of Asthma are permanent damages in airway and it progresses slowly and continuously.

Asthma is a frequent disease. It is a complex of diseases which have similar symptoms. When symptoms and characteristic of symptoms are well examined, diagnose of the disease is easy but also difficult. This has 2 reasons. First one is that there is no laboratory method which can be direct evidence of asthma diagnosis and the second is that in the examination there are important differences from patient to patient with the number of symptoms and prognostic.

Although symptoms and findings are very important, they are not specific for asthma. The disease progresses not only from patient to patient but also progresses with different symptoms for same patient in time. There are important clues except progress of symptoms and examination about asthma diagnosis. Allergy is a common characteristic for many asthmatic patients although it is not necessarily for all. It is not the reason of disease but its initiator. Touch allergens which are liable to patient initiates the attacks.  House dust mite, pollen and pets are the examples of the most frequent allergens. Except allergens, asthma attacks can be initiated by unspecific reasons such as; cleaning materials, cold effort and cigarette smoke. Many patients have hypersensitivity of touching because of these allergens and unspecific reasons. The link between asthma and genetic has not been lightened. The most important criteria which makes genetic link able to be thought is being same and similar table in the members of families which have blood relations. Diseases such as eczema, urticarial and migraine can progress with asthma. These features are helpful for diagnosis. But all of these are not observed in all the patients and are not specific. There are asthma patients who have different features and types. The different typed diseases may progress with different health table. Similar but different tables can make it to be thought of the roles of many genes, not only one.

The disease heavily progresses by less than 10% of asthma patients. When asthma is said, many people thought that it is a type which has heavy progress. Adjudging about disease by considering only the patients whose disease progresses heavy is wrong. Another problem about diagnosis is that there are some other diseases which progresses with same symptoms. The most important one of them is Chronic Obstructive Pulmonary Disease (COPD). Separating these two diseases from each other is sometimes very difficult. The patients of COPD are smokers or get diagnosed after smoking for many years. Among asthmatics there can be some patients who smoke. These types of patients can smoke comfortably except the asthma exacerbations periods. Although COPD progresses at the early stage after smoking, it is accepted as an advanced age disease incorrectly because permanent damage and function loss of airway progress slowly and symptoms occur within 20 years or more. In other words the diagnosis of COPD can be got after 50-60 years.

Asthma and COPD are the most frequent diseases. While rate of asthma varies from society to society, approximately 3-6 people out of 100 have asthma. Many asthmatics do not consult a doctor because symptoms do not disturb much. And some asthmatics may receive unnecessary treatment with the diagnosis of respiratory tract infection.

COPD is in the first 5 of causes of death all around the world. It is estimated that COPD will take 3th place in causes of death around the world in 2020. Cigarette which is number one reason for COPD causes COPD by contributing the damage of lung tissue. Damaged lung tissue causes function loss of respiratory system. Even though education, increase of smoking consciousness, indoor smoking ban cause a decrease in the rate of smoking, rate is still high. 15-20 smokers out of 100 have COPD. %90 of patients with diagnosis of COPD is smoker. Although COPD starts in the first years of smoking, COPD symptoms occur after the %50 loss of function of respiratory tract. Approximately 20 years or more time is needed for %50 loss. Slow function loss is the most important mistake of smokers. When the symptoms of disease occur, function loss will be at high levels. At every stage of disease, the most important and evidence-based treatment is quitting smoking. Quitting smoking slows down the progression of disease. There is no other treatment which slows down the progression of disease as much as quitting smoking.

Consequently, above shortly mentioned COPD and asthma are one of the chronic diseases which are frequently seen in society. Judgment where there is no definitive treatment is common in society. This judgment is absolutely wrong. Biological structure of a person cannot be changed in recent conditions indeed. COPD and asthma may progress as a consequent of biological structure and/or external mechanisms. Early stage diagnosis is important to prevent and slow down the progression of disease. For prevention, some changes about living and environmental conditions can be done. It is possible to turn back asthma inflammation with treatment. There are treatment options which affect the mechanisms of these diseases. Adjustments of living and environmental conditions and regular practicing at the right time and adaptation of appropriate treatment modalities are important criteria for a successful treatment.



Pulmonology
Ahmet Altay ŞAHİN, M.D. PROF.