Asthma and COPD
“Asthma is a chronic inflammatory disorder characterized by increased responsiveness of the airways to multiple stimuli. In susceptible individuals, the inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning.”1
“The goal of treatment of acute asthma in the ED is to reverse airflow obstruction rapidly by repetitive or continuous administration of inhaled B2-agonists, provide adequate oxygenation, and relieve inflammation.”1
Note: see Pediatrics section for Pediatric Asthma.
Chronic Obstructive Pulmonary Disease (COPD)
“COPD is characterized by airflow limitation this is NOT fully reversible. The airflow obstruction is generally progressive and associated with an abnormal inflammatory response to noxious particles or gases.”2
“COPD has two dominant forms:
- Pulmonary Emphysema, characterized by abnormal, permanent enlargement and destruction of the airspace distal to the terminal bronchioles; and
- Chronic Bronchitis, a condition of excess mucus secretion in the bronchial tree, with a chronic productive cough occurring on most days for at least 3 months in the year for at least 3 consecutive years.
- Note: Elements of both forms are often present, although one predominates.”3
“Acute exacerbations of COPD are usually triggered by an infection or respiratory irritant. Classically, patients with exacerbations of asthma or COPD presents with complaints of dyspnea (use of supplemental O2 in COPD), chest tightness, wheezing, and cough. Physical exam shows wheezing and prolonged expiration.”3 An approach to COPD exacerbations includes having a knowledge of the possible triggers/pathogens, recognition of the the symptoms, and early initiation of treatment with inhaled medications, steroids, and/or antibiotics.
The decision of when to treat the patient with an exacerbation of their COPD with antibiotics is an important one. Here are two resources highlighting the indications and choices for antibiotic use (COPD Exacerbations by EMCases & CoreEM).
Click HERE for a list of all mentioned FOAM resources.
- Cydulka, R. Chapter 72, “Acute Asthma in Adults”. Tintinalli’s Emergency Medicine – A Comprehensive Study Guide. J Tintinalli. 7th ed. McGraw-Hill Education, 2010. 361. Print.
- Cydulka, R., Bates, C. Chapter 70, “Chronic Obstructive Pulmonary Disease”. Tintinalli’s Emergency Medicine – A Comprehensive Study Guide. J Tintinalli. 8th ed. McGraw-Hill Education, 2016. Print.
- Genteges, J., Chapter 34, “Chronic Obstructive Pulmonary Disease.” Tintinalli’s Emergency Medicine Manual. Cline et al. McGraw-Hill Medical, 2012. 353. Print.
Prepared by Alex Mungham PGY1 FM – University of Ottawa