Pathophysiology of Asthma &

COPD
Tri Adi Kurniawan

Asthma & COPD

Admission exacerbations
Dyspnoe
Cough
Sputum
Wheezing
Crackles
....... ???

OVERLAP BETWEEN ASTHMA AND COPD

Definition of asthma
A chronic inflammatory disorder of the airways in which
many cells and cellular elements play a role, in particular,
mast cells, eosinophils, T lymphocytes, neutrophils, and
epithelial cells.
The inflammation also causes an associated increase in
the existing bronchial hyperresponsiveness that leads to
recurrent episodes of wheezing, breathlessness, chest
tightness, and cough, particularly at night and in the early
morning.
These episodes are usually associated with widespread
but variable airflow obstruction that is often reversible
either spontaneously or with treatment.
GINA 2011

Definition of COPD

COPD, a common preventable and

treatable disease, is characterized by
persistent airflow limitation that is usually
progressive and associated with an
enhanced chronic inflammatory response
in the airways and the lung to noxious
particles or gases

REVISED 2011

Exacerbations and comorbidities

contribute to the overall severity in
individual patients
GOLD. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary
Disease. Revised 2011. Available from: http://www.goldcopd.org

Clinical features of asthma and COPD

Differences between asthma and COPD

Schematic of the genesis of airflow obstruction in asthma and COPD

Asthma Pathophysiology
Smooth Muscle
Dysfunction

Inflammatory mediator release

Bronchial hyperreactivity

Airway
Inflammation

Inflammatory cell infiltration/

activation

Hypertrophy/hyperplasia

Cellular proliferation

Bronchoconstriction

Epithelial proliferation
Mucosal edema

Symptoms/Exacerbations

AIRWAY ASHTMA
Normal airway
No thickening below
basement membrane

Inflammed
airway
Eosinophil infiltration

Shedding of
epithelial cells

Blood vessels
Formation of
mucus plugs

Vasodilatation increased
vascular permeability
with oedema

Collagen thickening

Inflammatory and immune cells involved in asthma

antigen

Nave T-lymphocyte

IL-12 [-]

Th-O
Th-O
dendritic cell

IL-12 [+]

Th-1
Th-1response
response

Th-2 response

[-]
IL-4
IL-13

Ig E

IL-9
IL-4

Mast Cell

IL-3

Basophils

IL-3, IL-5
GM-CSF

Eosinophil

IFN, lymphotoxin, IL-2

Mediators of inflammation
Cell
Cellmediated
mediatedimmunity
immunity
And
And
Neutrophilic
Neutrophilicinflammation
inflammation

Asthma
AsthmaSymptoms
Symptoms

Histamine,
Histamine,prostaglandins,
prostaglandins,
Leukotrienes,
Leukotrienes,enzymes
enzymes

Bronchial
Bronchial Hyperresponsiveness
Hyperresponsiveness
Airway
Airway Obstruction
Obstruction

Mechanisms Underlying Airflow

Limitation in COPD

Small Airways Disease

Airway inflammation
Airway fibrosis, luminal plugs
Increased airway resistance

Parenchymal
Destruction
Loss of alveolar attachments
Decrease of elastic recoil

AIR FLOW LIMITATION

GOLD Revision 2011

Mechanisms of Airflow Limitation in COPD

(Peripheral Airways)

Adapted from: Barnes P. NEJM 2000; 343; 269

Inflammatory and immune cells involved in chronic obstructive

pulmonary disease (COPD)

Barnes PJ, 2008

Contrasting histopathology of asthma and chronic obstructive pulmonary

disease (COPD).

Airway remodelling
Asthma develope progressive airway
limitation that is not fully reversible with
currently therapies.
Reflect the changes in airway structure as a
consequence of persistent inflammation
Hypertrophy of bronchial smooth muscle,
transformation of fibroblasts to myofibroblasts, and deposition of subepithel
collagen.

Faktor risiko
FAKTOR LINGKUNGAN
Alergen
Infeksi pernapasan
Asap rokok/polusi udara
Diet
Hewan peliharaan

FAKTOR PEJAMU:
Genetik
Atopi-alergi
Hipereaktivitas bronkus
Ras/etnik

TIDAK ADA GEJALA

MANIFESTASI KLINIS

Alergen lingkungan

DUST MITE

JAMUR KAYU

TEPUNG SARI

POLUSI UDARA

KECOA

ASAP ROKOK

Faktor pencetus
ALERGEN
POLUSI UDARA
INFEKSI PERNAPASAN
MAKANAN
ASAP ROKOK
EXERCISE

IRITAN

EMOSI YANG BERLEBIHAN

Chest X-Ray

Bronchoscopy

Normal

Bronchoconstriction

OBSTRUCTION

REVERSIBILITY

VARIABILITY

Obstruction
FEV 1
FVC

75%

Reversibility: pre & post bronchodilator test

(BD Test)
Ashtma: FEV1 12% and > 200ml post BD