Paediatric Pulmonology and Allergology

2004 October, Vol. VII, No. 2 (2543-2554)

Chronic obstructive pulmonary disease and asthma: identity and difference

Remigijus Nargela

Ast­hma and chro­nic obst­ruc­ti­ve pul­mo­na­ry di­se­a­se (COPD) are chro­nic in­flam­ma­to­ry di­sor­ders cha­rac­te­ri­sed by air­flow li­mi­ta­tion. The diag­no­sis of ast­hma or COPD is ba­sed on cli­ni­cal his­to­ry and lung func­tion tests. Dif­fe­ren­tial diag­no­sis bet­we­en ast­hma and COPD may be­co­me mo­re dif­fi­cult in el­der­ly in­di­vi­du­als when the pa­tient de­ve­lops a po­or­ly re­ver­sib­le air­flow li­mi­ta­tion that res­ponds on­ly par­tial­ly to tre­at­ment. The re­la­tions­hips of in­flam­ma­tion and re­mo­de­ling to air­flow li­mi­ta­tion both in ast­hma and COPD is at pre­sent unc­le­ar. Ste­roids are the first-choi­ce con­trol­ler me­di­ca­tion in ast­hma but not in COPD. The pre­sent ar­tic­le will fo­cus on pat­ho­lo­gi­cal chan­ges pre­sent both in ast­hma and COPD, as well as on dif­fe­ren­tial diag­no­sis and the ma­na­ge­ment of the­se di­sor­ders. In­flu­en­ce of his­to­ne de­ca­ty­la­se (HDAC) ac­ti­vi­ty dec­re­a­se on re­sis­tan­ce of mac­rop­ha­ges to glu­co­cor­ti­cos­te­roids in pa­tients with COPD is no­ted. It is thought that we­ak ef­fect of glu­co­cor­ti­cos­te­roids is as­so­cia­ted with oxi­da­ti­ve stress.

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