Distinguishing

COPD from Asthma

 Asthma
• Penyakit sistem pernafasan yang melibatkan
inflamasi saluran nafas dan gejala bronkospasme
yang reversibel
• Characteristics: inflamasi, obstruksi saluran nafas,
hipersekresi mukus, dan hiperresponsiivitas jalan
nafas terhadap berbagai stimulus
• Terapi dapat meningkatkan parameter FEV1 > 15 %
 COPD
• Terdiri dari 2 komponen: emphysema dan chronic bronchitis
Emphysema: dikarakterisis dengan adanya pembesaran
yang abnormal dan permanen kantong udara (alveolus) dari ujung
bronkiole sampai ke bagian distal , disertai dengan kerusakan
dinding alveolus, dengan atau tanpa fibrosis
Chronic bronchitis : adanya batuk produktif yang kronis,
sedikitnya 3 bulan dalam setahun dalam dua tahun berturut-
turut
• Disertai airflow obstruction yang irreversible atau sebagian saja
yang reversible, di mana perbaikan FEV1 umumnya < 15%
dengan adanya terapi
 Pasien dengan severe chronic asthma:
mirip COPD dalam hal reversibilitas airway obstruction
karena adanya airway remodelling and destruction

Sebaliknya,
Banyak pasien COPD secara tidak tepat dianggap
menderita asma, dan mungkin mendapatkan terapi asma

Tidak tepat
 Medical History Differences
History Asthma COPD
Childhood Common Irrelevant
problems
Atopic features Common Irrelevant
Smoking Irrelevant Very common
Night symptoms Common Less common
Cough & sputum Intermittent/rare Daily/common
Age of onset Any > 40 years old
Variability lots little
 Examinations and tests for COPD and Asthma

Asthma COPD

Peak flow berkurang Berkurang atau

normal
FEV1 Berkurang atau Berkurang
normal
Bronchodilator > 15 % < 15%
response
Corticosteroid Baik Kurang
response
Inflammatory cells Eosinophils, mast Neutrophils,
cells, CD4+ T cells macrophages, CD8+
T cells
 Tests conducted for asthma and COPD
Condition Peak flow FEV1
Normal / well-controlled normal normal
asthma
Less well-controlled asthma low Normal/low
COPD Normal/low low
Post-bronchodilatation
Asthma > 15% > 15%
COPD < 15% < 15%
Prognosis ASMA COPD
Mungkin akan memburuk. Hampir pasti memburuk.
Tetapi dapat dihambat Kecepatan pemburukan tidak
dengan kontrol asma tergantung pada terapi, tp tgt
yang baik pada nilai FEV1 awal dan
perilaku merokok
FIG. 5. COPD versus asthma. The pattern of inflammation in COPD and asthma are markedly
different, and this underlies the different symptoms, clinical presentation, and response to treatment
of these diseases. In COPD the predominant inflammatory cells are neutrophils, macrophages, and
CD8 (Tc1) lymphocytes, whereas eosinophils, mast cells, and CD4 (T helper 2 cell) lymphocytes
predominate in asthma. In COPD this inflammatory pattern leads to slowly progressive airflow
limitation, whereas in asthma the inflammation results in variable bronchoconstriction and airway
hyperresponsiveness. Alv, alveolar; Th2, T helper 2 cell; ep, epithelial.
 Pathophysiologic differences between COPD
(chronic bronchitis and emphysema) and Asthma
COPD ASTHMA

Chronic Bronchitis Emphysema

Lung Diagram

Main cause of Mucus Destruction of alveolar Inflammation

airflow hypersecretion walls, reducing elastic Airway hyper-
limitation Fibrosis recoil and capillaries for responsiveness
Inflammation gas exchange
Narrowing of
bronchi and
bronchioles
Reversibility Minimal to no reversibility(1) Mostly reversible
selesai
 Molecular mechanism of COPD

CD8+
lymphocyte Alveolar macrophages
?
MCP-1
Chemokines (IL-8, GRO-)
Perforins, Lipid mediators (LTB4)
MMPs
granzymes
Neutrophil
Neutrophil elastase
Cathepsins
Matrix metalloproteinases
Protease
inhibitor
- Proteases
1-At
SLPI Mucus
TIMPs emphysema hypersecretion