Are Asthma And COPD The Same Disease

I have read this in a few research articles. There are actually several theories attempting to explain asthma and COPD. One is that asthma and COPD are the same disease with different presentations. So, is it possible this theory is true?

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. 

Study links premature birth to respiratory symptoms

A new study reported on at RT magazine suggests that deliveries at 37 or 38 weeks gestation are linked to an increased risk for respiratory symptoms in childhood.  This might be evidence enough to encourage physicians to delay inductions and c-sections as long as possible.

As a matter of fact, the results were rather significant. It shows that children born prematurely had a 70 percent increased risk of having respiratory symptoms by the age of ten, and up to a 50 percent greater risk of needing to use rescue inhalers.

They also had an increased risk of respiratory infections and antibiotic use beginning at the age of five when compared to those children born closer to term (40 weeks).

This is more evidence how it is important for delivering physicians to keep in mind the best interest of the unborn child and not their own convenience, and potential profits, when delivering a child.

Aerosols no longer indicated for airway clearance

We respiratory therapists seem to grumble and gripe a lot about useless breathing treatments, and usually to no avail.  However, it seems the good people working for American Association For Respiratory Care (AARC) have heeded some of the criticism and performed some of their own research into the matter.

RT Magazine reports the following:

A new evidence-based Clinical Practice Guideline (CPG) published in Respiratory Care found that evidence is lacking that proves pharmacologic agents routinely administered for airway clearance are effective in improving oxygenation and respiratory mechanics, reducing ventilator time and ICU stay, or resolving atelectasis.

The CPG is based on the work of an American Association for Respiratory Care (AARC) task force and Vanderbilt University researchers.

The following are the new recommendations regarding use of aerosols for

• The routine use of aerosolized acetylcysteine (Mucomyst) to improve airway clearance is not recommended in hospitalized adult and pediatric patients. 
• Aerosolized agents to change mucus biophysical properties or promote airway clearance are not recommended for adult or pediatric patients with neuromuscular disease, respiratory muscle weakness, or impaired cough.
• Mucolytics are not recommended to treat atelectasis in postoperative adult or pediatric patients, and the routine administration of bronchodilators to postoperative patients is not recommended. 
• There is no high-level evidence related to the use of bronchodilators, mucolytics, mucokinetics, and novel therapy to promote airway clearance in the studied populations. 

This is vindication, of sorts, to all of us RTs who have complained for years that this type of therapy rarely results in the desired benefits.  We'll have to wait and see if the medical profession eventually catches on to this new wisdom.  Using history as our guide, this will probably occur in the year 2035.

Further reading:

• RT Magazine: New CPG Questions Value of Aerosols for Airway Clearance
• RT Cave: Hypoxic Drive Theory: Reality or Hoax

New study shows outdoor wood stoves unhealthy

When I was a kid my parents decided to take the cheapest route home heating and had a wood furnace installed in our basement. This decision might have been good for their pocket books, yet it wreaked havoc on my lungs and therefore my life.

Not only do wood stoves give off smoke that can irritate lungs, but all the wood stacked in the basement was filled with molds and fungus that are known allergens for me and many other chronic lungers. The smoke outside meant I couldn't play out there, and the mold and fungus inside made indoor life equally miserable.

My parents ultimately were told this was bad for me, and there response was to shut off the wood heating ducts to my room and turn on the gas just to heat my room. Yet little did they realize that while this effort was a good gesture, it was frivolous at best.

A new study reported by the Environment and Human Health Inc. as reported here reveals the following about outdoor wood furnaces (OWF):

"Wood smoke contains many of the same toxic compounds that are found in cigarette smoke. Just a few of them include benzene, formaldehyde, and 1,3-butadiene, all three of which are carcinogenic."

In fact, while indoor wood furnaces are a bad enough asthma trigger, "The Northeast States for Coordinated Air Use Management (NESCAUM) found that the average fine particle emissions from one OWF are equivalent to the emissions from 22 EPA-certified indoor wood stoves, 205 oil furnaces or as many as 8,000 natural gas furnaces."

The study also reported the following (PM stands for particulate matter, which is the particle size of the smoke measured):

• A house 100 feet from an OWF had 14 times the levels of PM 2.5 as houses not near an outdoor wood furnace and 9 times the levels of the EPA air standards
• A house 120 feet from an OWF had over 8 times the levels of PM 2.5 as the houses not near an outdoor wood furnace, and 6 times the levels of the EPA air standards.
• A house 240 feet from OWF had 12 times the levels of PM 2.5 as the houses not near an outdoor wood furnace and 8 times the levels of the EPA air standards
• A house as far away as 850 feet from OWF had 6 times the levels of PM 2.5 as the houses not near an outdoor wood furnace and 4 times the levels of the EPA air standards.
• High levels were present in every 24-hour period tested inside homes neighboring outdoor wood furnaces
• All houses tested had particulate exposures well above the EPA ambient air quality standard.
• Levels of PM 2.5 that exceed the EPA standards are associated with asthma or chronic obstructive pulmonary disease (COPD) attacks and hospitalizations, and are also associated with increased risk of cardiac attacks.
• Particles of wood smoke are so small that windows and doors cannot keep smoke out
• A study by the University of Washington, Seattle, showed that 50 to 70 percent of outdoor wood smoke entered homes that were not burning wood.
• Because wood smoke particles are so small, they are not filtered out by the nose or the upper respiratory system. Instead, these small particles end up deep in the lungs where they can cause structural damage and chemical changes.
• Carcinogenic chemicals and wood smoke irritants adhere to the small particles and enter the deep, sensitive regions of the lungs where toxic injury is high.

The short term, or "irritable" side effects of inhaling smoke from outdoor wood heaters include:

• Night time coughing
• Headaches
• Inability to catch breath (dyspnea)
• Burning throat
• Burning eyes
• Bronchitis
• Pneumonia
• Colds
• Increased respiratory infections (particularly in children)
• Missed days of work or school
• Emergency room visits

The long term side effects of inhaling from outdoor wood heaters include:

• Increased risk for lung cancer
• Asthma
• COPD
• Cardiovascular problems
• Carbon monoxide poisoning

In fact experts note that "Even episodes of short-term exposures to extreme levels of fine particulates from wood smoke and other sources, for periods as short as two hours, can produce significant adverse health effects."

The particulates breathed in are not only linked with chronic lung disease but to lung cancer, as evidence shows the smoke inhaled also contains known carcinogens. So short-term exposure may result in either asthma, COPD, and long term exposure to those plus lung cancer.

So smoke from indoor and outdoor wood furnaces have the same known harmful chemicals as cigarette smoke, smoke from outdoor wood stoves is thicker and more prevalent in the air, and is more "pervasive for those who live near them," said Dawn Mays-Hardy of the American Lung Association, New England.

Likewise, "Resident of Environment and Human Health, Inc. Nancy Alderman says, "EHHI has now shown that wood smoke from outdoor wood furnaces enters neighboring houses in high enough amounts to cause serious health impacts to these families. States can no longer ignore this science and should ban outdoor wood furnaces until safer technologies are found."

Flutiform to compete with Advair & Symbicort?

In my perusal of the health news world today I found this article about a New asthma drug that is probably going to hit the market soon. It's a medicine that will compete with Advair and Symbicort. This is good news, I think, for chronic lungers.

This new medicine is called Futiform. Like Advair and Symbicort, it's a combination dry powder inhaler with both a long acting bronchodilator and a corticosteroid. It seems to be a copy cat medicine with the intent on profiting on the latest craze in asthma medicines that aim to treat both the major components of asthma: bronchospasm and chronic inflammation.

I should mention here that the FDA recommends that if a long-acting bronchodilator is prescribed for asthma an inhaled corticosteroid should also be prescribed to treat the underlying chronic inflammation of the air passages in the lungs.

In this sense, combination inhalers such as Advair and Symbicort are a recommended and common treatment for asthma. And, perhaps soon, we can even add Futiform to this list.

The interesting thing here is that while Futiform is a new medicine per se, neither of the medicines it is composed of are new. The corticosteroid in Futiform is Flovent, the same corticosteroid that is in Advair. The long-acting bronchodilator is Formoterol, the same that is in Symbicort.

In my lifelong experimentation with corticosteroids, I have found that none works better than Flovent. My pharmacist insists it's not any better than the other such steroids on the market, but I beg to differ. I have many asthmatic friends who feel the same way.

Serevent, the long acting bronchodilator in Advair, is a medicine I have often wondered about. While I've been using my Advair compliantly for over 2 years, I still have to use my rescue inhaler a few times a day. Of course that's not bad, but it could be better.

Serevent does not provide quick relief for asthmatics, however I have learned that formoterol does. Therefore, and I'm just speculating here, I'm wondering if perhaps formoterol is a better medicine than Serevent.

Thus, I'm wondering if this new medicine combines the best corticosteroid (Flovent) with the best long-acting bronchodilator (formoterol). If that's the case, this product should do pretty well in the world market at least until a better medicine is invented.

Of course, like you, my job as a gallant asthmatic is to always be thinking along these positive lines. We are constantly on the look out for that new asthma medicine that might help us get that much better control of our asthma. If nothing else, this "probable" new medicine may provide another option for us chronic lungers to try.

On a side note here, I don't like to be a Guinea pig for new medicines, but both Flovent and Formoterol have been on the market long enough to know they are safe if they are used only as prescribed.

Oh, and one more thing, the article referred to above mentioned something about generic forms of Advair and Symbicort perhaps hitting the market soon. It'll be interesting to see how this option benefits us asthmatics.

Whether or not the generic forms will be as efficatious as the original may always be up to debate, but a lesser expensive Advair and Symbicort might be the best thing to happen to us asthmatics during an economic downturn.

Well, we'll see.

c-sections increase risk of asthma by 80%

You heard right. According to a study referred to here, children born by c-section are 80% more likely to develop asthma.

Scientists are unclear of the reason, but there are theories. First off, one must be aware that asthma is an auto-immune disorder that only those who have the asthma gene will have a chance to acquire. In most cases it is caused in infancy when the immune system is forming.

One great theory is the hygeine theory, in which scientists believe we as humans have worked so hard to clean up the way we live to prevent the spread of disease that we have literally cleaned ourselves into some new diseases, and one of them is asthma.

Your immune system ideally is supposed to attack bad parasites and bacteria. It is believed that the immune system has to constantly be stimulated. Absent bad bacteria and bad parasites, the immune systems of some people get bored and start to attack good things, like harmless dust mites, molds, animal dander, cockroach urine and stuff like that (common allergens).

One such theory, according to MedicineNet.com, has scientists thinking, "babies born via C-section have impaired immune cell function because of suppression of regulatory T cells, which regulate the development and function of the immune system."

Basically, children born by c-sections have immature immune systems. The same thing is believed to be true of babies born pre-maturely.

The study, presented at the American Thoracic Society's 2008 Conference in Toronto, "suggests that the stress and process of labor itself or exposure to specific microbes through the birth canal in vaginal rather than C-section delivery may influence neonatal immune responses."

This study significantly impact the decision by many people to have elective c-sections, especially by parents who have a history of allergies and asthma (and probably have the asthma gene).

Stay tuned, because in a future post here at the RT Cave I will explore other possible causes of asthma, or things that might turn the asthma gene to the on position. Stay tuned.