I don't know. No one knows. And I bet the theory is not without many critics. However, if true it would certainly make sense. Consider the following:
- Both diseases are caused by abnormal immune responses to substances in the air. With asthma its harmless substances like allergens. With COPD it's harmful substances such as chemicals released from burning biomass (tobacco smoke, wood smoke).
- Exposure to certain substances causes oxidative stress. This stress causes cells to release substances like Reactive Oxygen Species. This triggers an immune response.
- In response, immune cells release pro-inflammatory markers. These are your prostaglandins, cytokines, and chemokines and the like. These cause your airway inflammation.
- If you're always exposed to these substances, the inflammation becomes chronic over time. And here you get your eosinophilic inflammation in asthma and neutrophilic inflammation in COPD.
- Although there is some overlap. There are some asthmatics with neutrophilic inflammation and some COPDers with eosinophilic inflammation.
- Eosinophilic inflammation responds best to beta adrenergics and corticosteroids. But, neutrophilic inflammation responds poorly to these treatments. It responds best to muscarinics. Other than that, there is not effective treatment for neutrophilic inflammation.
- So, because it's treatable, those with eosinophilic inflammation can obtain good control of their disease (mostly asthma, but sometimes COPD). Since it is less treatable, those with neutrophilic inflammation often experience some degree of shortness of breath every day (mostly COPD, but sometimes asthma).
- Some people with severe asthma have presentations similar to COPD. They may even have something now sometimes called Asthma/ COPD Overlap Syndrome (ACOS). However, some cases of severe asthma are not ACOS yet still present similar to COPD.
- There are 100 plus known asthma genes. Each asthmatic has a random assortment of these genes. This causes each asthmatic to present somewhat differently. There is only one known COPD gene. Still, less than 50% of people who smoke develop COPD. So, is it possible that all COPD is genetic just like asthma? And, is it possible that asthma genes are also those genes that cause COPD (it just has a unique presentation)?
- Asthma genes are all immune genes that have mutations on them. These mutations cause a change in the recipe how that gene makes a specific protein. So, it seems it would make sense that the same genes might also cause COPD, another disease caused by abnormal or overactive immune response.
- Some asthma genes are active when we are born. But, most are only activated when exposed to certain environmental factors (allergens, cigarette smoke, increases or decreases in female and male hormones, etc.). COPD is known to be caused by an immune response to harmful substances that are inhaled. So, is it possible that different "keys" unlock different asthma/ COPD genes? And this causes the uniqueness of the presentation.
So, this is an interesting subject. I'm just giving you my extemporaneous thoughts on the subject. It's education guided by common sense. In the future I'm going to investigate this further and report my findings.
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