cough, expectoration , and wheezing, are they COPD or asthma ? What should patients with overlapping diseases pay attention to in their treatment? Last Wednesday, we were very honored to have Cai Shaoxi, director of the Department of Respiratory and Critical Care Medicine, Southern Hospital of Southern Medical University, as a guest in the popular science live broadcast room of "Happy Breathing - Let Life Be Beautiful" in our famous doctor interview-breathing series special program. Let’s talk about “When COPD meets Asthma” , and now part of the content is organized into text and sent out.
For more exciting interactive questions and answers, you can search Breathing to enter the live broadcast room and watch the full live broadcast replay.
also suffers from coughing up phlegm and asthma. What are the differences among patients with COPD and asthma?
Professor Cai said that both are chronic inflammatory diseases of the airways. People think they are both coughing and phlegm, followed by frequent wheezing. Therefore, everyone thinks that when the weather is cold, it is more likely to be COPD. Many friends, including some of our elderly people, will say that I am a patient with COPD. I have already taken medication, but in fact, when encountering certain sensitive environments, he will suddenly have asthma attacks, or have continuous coughing that cannot be controlled. At this time, we must be alert to whether asthma is combined, and our treatment principles will also be different.
Although both are chronic airway inflammatory diseases, their inflammatory backgrounds are different. If both conditions coexist in the same patient, we may ignore the problem of asthma because we focus on COPD. When encountering the possibility of allergies, a severe attack, or even a fatal attack, may occur.
As ordinary people, we need to realize that on the basis of COPD disease, if you have asthma, the treatment principles are different, and you need to do some daily management. While reducing the acute exacerbation of COPD, you must also reduce the acute attacks of asthma, because both attacks will affect lung function at the same time, affect the quality of life, and also increase a certain burden.
Therefore, I think everyone needs to know what COPD is like, whether I have asthma, and whether I have COPD combined with asthma or just COPD.
In addition to the phlegm and wheezing we mentioned, what are the other characteristics of asthma?
Professor Cai introduced that we can refer to the picture below to take a look.
The middle point is also the most typical, which is called recurrent asthma or irritating cough. We have just mentioned that for patients with COPD, coughing and wheezing are more common in winter. But what are the characteristics of asthma? It can come like the wind. For example, if you encounter a certain smell that is not right, or you have some allergies. It turns out that the most typical allergens in the past are like pollen. Then spring is coming and he encounters this kind of environment. It would be good, but if he encounters this kind of allergen that he is sensitive to, he can Some patients may have sudden asthma attacks, and some patients may not have a typical asthma attack. They may have a desperate and continuous cough, and may even have some of the characteristics of allergic rhinitis , such as sneezing, runny nose, etc.
Some of these patients were diagnosed with allergic rhinitis when they were young or children, so we say that the most typical symptoms should be recurring asthma, or recurring and continuous irritating coughs, which may be relieved after a while, or may require the use of some drugs.
In addition to this, you suddenly wake up at night with suffocation or wheezing, wheezing , and when are these symptoms most common? It is often in spring, when the climate suddenly changes, or the air is not well circulated and stuffy. There are also some patients who are allergic to certain types of contact. There are also some patients who will develop this kind of eczema even when they are exposed to cold wind. Some people are even stubborn and very difficult to control. This is actually a type of allergy.
I have coughing up phlegm and wheezing. How can we further determine whether we have asthma?
Professor Cai introduced that we just said that the clinical symptoms of COPD and asthma have some overlap, so we need to distinguish this overlap. First of all, we need to find out whether the direct relatives in the family, such as father, mother, grandfather, grandmother, grandma, and grandpa, have a history of asthma, because asthma has a certain genetic predisposition. That is to say, if there is a history of this kind of allergy in your immediate family members, your coughing and asthma may be related to a certain degree of allergy and inheritance. However, it does not necessarily mean that if your parents have it, you will have it, but you need to be vigilant.
Secondly, we can also get to know our brothers, sisters and parents, or recall whether we had any history of allergies when we were children. Because some allergies in childhood may be alleviated and improved as we grow up, but they will reappear when we are in our 40s, 50s, and 60s. If we don’t recall and understand them carefully, we may overlook the history of allergies in childhood. This is also very important.
In addition, we also need to tell our doctor what medicines we used for coughing and asthma, which medicines are absolutely effective, and which medicines seem to be ineffective. We can take photos and record them. This is very important for the doctor to understand your medical history.
What changes have occurred in our lungs after COPD was combined with asthma?
Director Cai introduced that we can understand it together with a picture.
As we grow older, our lung function may gradually decrease, but we can see that the trachea on the left side of the diagram is wide in diameter. In other words, what we people say is that the air is smooth, so there is no problem in breathing. But the narrow lumen on the right is actually caused by COPD. Due to factors including air pollution, smoking, and infections from some toxic and harmful pollutants, the airway becomes narrowed and the lumen becomes less open.
On this narrow basis, if you encounter allergens, and this patient has asthma, for example, if you encounter certain viruses , certain allergens, these allergens will further spasm on the basis of the original narrow COPD airway, causing further edema of the mucosa, and further contraction of the airway smooth muscle.
If the original stenosis is further narrowed, it is conceivable that children will have problems breathing, which will lead to an increase in wheezing, chest tightness, coughing, and yellow sputum when COPD itself is acutely exacerbated. So when we treat, if we have both COPD and asthma, we will take two factors into consideration when treating this. This is very important.
What are the specialties of the treatment of COPD combined with asthma?
Professor Cai introduced that we know that the current treatment of both COPD and asthma is based on inhaled drugs, but the ingredients are very different. COPD mainly uses the bronchodilator . After inhalation, for patients with COPD, their airways can have better space for movement, and there will be a greater increase in activity strength, which can reduce the decline in lung function. These are actually necessary for COPD, but in turn, this bronchodilator is good for simple asthma. People, the next problem arises when applying it, because the inflammation of asthmatic airways cannot be controlled with this simple bronchodilator. So when it is used repeatedly, it may cause asthma patients to become tolerant to inhaled bronchodilators.
Just now we mentioned that inhaled medication is very good for the treatment of chronic airway diseases, so inhaled medication for asthma patients mostly includes surface hormones. Surface hormones can very well treat the underlying inflammation problem of asthma.Compared with systemic oral hormones, inhaled hormones are very low. I often use a simple way of describing it. An acute asthma attack requires intravenous medication or oral medication. If it is converted to an inhaled dose and reaches a local level, that one dose is enough for our asthma to be inhaled for more than half a year. Therefore, for COPD and asthma, more emphasis is placed on persisting in the use of inhaled drugs during the stable period. We can effectively maintain the disease without acute exacerbation, and the decline in lung function and quality of life will be alleviated.
So I want to say that for both COPD and asthma, it is very important to manage them well in the stable period and reduce their acute exacerbation. As for the corresponding medication, you can decide with the corresponding doctor after evaluating the lung function what level and how to use the medication. This is worth discussing and selecting treatment on an individualized basis according to the patient's characteristics.
How to reduce the number of acute exacerbations? Any suggestions?
Professor Cai said that the first step is to tell the doctor your past medication history. As we just said, this is very important for letting the doctor understand your medical history and treatment status, and whether you need to adjust your medication or continue it. The second is to encourage our patients with COPD and asthma to keep a simple diary. Record your medication, exacerbation, environmental factors, etc. Sometimes patients report that they are breathing terribly, but in fact sometimes it is not just medication problems, but also environmental problems. This is also very important for asthma patients to avoid acute exacerbations. Because of the acute exacerbation of COPD, patients may need to be hospitalized when they are severe. Acute exacerbations of asthma are often sudden, and a severe exacerbation may be fatal. At this time, it is necessary to understand what medicines are best to use and whether there are environmental factors that can be prevented, so as to facilitate subsequent adjustments.
Another is that patients need to understand their asthma control situation, which means that we patients also need to understand their own control situation, so that we can communicate with our doctors, not only know the medication, but also know how well the medication is being controlled, because through this understanding and adjustment, we can achieve the overall purpose of truly individualized treatment and avoid some adverse factors caused by a sudden acute exacerbation.
We can refer to the Asthma Control Test to compare our own situation. It evaluates the past month, that is, the past 4 weeks, how much time we spent at work, study or at home because of asthma that caused you to stop and stop doing things. There are 5 questions in total. According to the score of each question, the scores of each question are finally added to get your total score.
If the score is lower than 19, it is called uncontrolled, and you need to communicate with your doctor to see if the method of use is wrong or the treatment needs to be adjusted. If an acute exacerbation occurs during this period and it cannot be relieved after the use of emergency drugs, emergency medical treatment is required.
