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Monday, November 9, 2009

The link between asthma and COPD

A doctor told me once that if you have childhood asthma that doesn't go away when you grow up you are said to have COPD. As a former child asthmatic. He also said once, "If you ever smoke I might as well just kill you."

I think about what he said often. Recently I decided to do some research.

I've learned that most of the time when we refer to COPD (Chronic Obstructive Pulmonary Disease) (COPD) we are referring to people who smoke. This is rightly so because, according to, 94% of those with COPD are people who smoked cigarettes.

That said, there are still 5% of COPD patients that often go unaccounted for. Almost 1% of these get COPD "by genetic-based deficiencies in an enzyme called alpha-1 antitrypsin," according to National Jewish.

The other 5% get COPD either get the disease from "exposure to various types of dust such as coal, grain, or wood or by recurrent or significant lung infections in infancy and early childhood."

People with asthma are among those most likely to be hospitalized with lung infections, and therefore asthmatics fall into this 5% too.

So now we see where the slight overlap of Asthma and COPD comes into play (see picture). A small percent of asthmatics, if their asthma is not controlled appropriately, can develop lung scarring over time that results in permanent lung damage that can cause them to have chronic persistent asthma/ COPD.

It is these asthmatics who are your hardluck asthmatics (I think). It is these asthmatics who are staged to become your bronchodilatoraholics, and who require the use of rescue medicine on a daily basis.

I have written here before how I have a need for my rescue medicine on a daily basis for relatively mild symptoms, and have to constantly be vigilant for my asthma triggers because my lungs are "more sensitive" than the lungs of most asthmatics.
I also learned that asthma is often misdiagnosed as bronchitis. From my medical records I've learned I had frequent bouts of "bronchitis" before I was 2. Chances are I was misdiagnosed, because I was diagnosed with asthma when I was 2-years old. Plus there were lots of asthma attacks. All of this, I bet, caused my asthma to get as bad as it did.

Keep in mind here I'm just speculating, but it makes sense to me. To be honest, I don't think even the worlds formost asthma experts would know exactly why asthma sometimes gets so bad. Although there are many theories.

There is a small area where the circles of asthma and COPD overlap (again, see picture). I would guess that less than 10% of asthmatics fall into the COPD category. Yet I've read in "Egans Fundamentals of Respiratory Care," that anywhere from 15-70% of those with COPD have the asthma gene.

From my own asthma history and from my recent research I've learned two things I would like to share with my asthmatic readers.

1. Childhood asthma is better diagnosed and better treated today as compared to when we were kids. So chances are our asthmatic kids won't get as bad as we are, and won't push their asthma into the COPD category.

2. If you had asthma as a kid you better never touch a cigarette. If you do you're playing with fire (literally), as you are risking pushing your asthma into the COPD category, as I would imagine the Recovered Asthmatic is doing.


Steve said...

Great post Rick .I'm definitely in that COPD overlap group.

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Unknown said...

Hi Rick: Good posting. I wonder where I fit into this entire asthma/copd continuum. Lifelong NON-smoker (though secondhand smoke exposure from different situations). Adult-onset asthma during bronchitis age 38. Two years later flu set it off again and I was mild intermittent asthmatic for many years. In Jan. 03 had severe bacterial bronchitis infection (may have been pneumonia) which set off last six years of severe exacerbations typically featuring bacterial bronchitis (one of them was definitely pneumonia). My doctors classify me as having chronic peristent moderate to severe asthma, likely some chronic bronchitis at this point. Oh, to make thing even more murky, I am NON-allergic to most typical asthma allergens. I am, however, hyper-sensitive to irritants, fumes, smoke. Was on Advair a number of years and this year on Symbicort..and this year only had bacterial bronchitis twice : ) !
What are your thoughts on where I fit in? I am 57 now and very educated on my conditions and compliant with my meds. Oh, and I tested NEGATIVE for alpha 1.

Rick Frea said...

I think if you are a Hardluck asthmatic then you probably fall in the COPD range to some degree, although it's hard to know for sure. If you have some degree of constant shortness of breath you are dealing with, then you probably fall into the COPD range.

Unknown said...

Hi Rick...thanks for your feedback. Since I wrote that comment, I have entered into another flare-up...this time some minor URI triggered the asthma and I'm now on a pred taper, and with the deep, wet coughs it's starting to feel like a bronchitis again. Ugh. Anyhow, have a good Thanksgiving.

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My mother is also having this problem even during summer season she feeling uneasy to survive, what would be the reason