The pathophysiology of airway dysfunction

被引:25
作者
Doherty, DE
机构
[1] Univ Kentucky, Albert B Chandler Med Ctr, Div Pulm & Crit Care Med, Lexington, KY 40536 USA
[2] Lexington Vet Adm, Med Ctr, Lexington, KY USA
关键词
D O I
10.1016/j.amjmed.2004.10.017
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Asthma and chronic obstructive pulmonary disease (COPD). are distinct inflammatory disorders with differing pathophysiologic mechanisms, different clinical courses, and, therefore, distinct treatment strategies. Whereas in asthma airflow limitation is typically episodic and reversible, airflow limitation in COPD is progressive and only partially reversible. In contrast to asthma, which is characterized by an elevated number of eosinophils in the blood and the accumulation of elevated numbers of activated eosinophils, mast cells, and CD4(+) T(H)2-lymphocytes in the lungs, the primary inflammatory cells,present in the lungs of patients with stable COPD are neutrophils, macrophages, and CD8(+) lymphocytes. Bronchoconstriction in COPD is largely regulated by cholinergically mediated vagal tone, and the pathologic processes of COPD further reduce airway patency., Bronchodilators, most notably anticholinergics, are recommended as first-line pharmacologic therapy for COPD. Proper use of inhaled anticholinergic medications has been shown to lead to significant reversibility of acetylcholine-mediated bronchoconstriction during both stable disease and exacerbations of COPD. For patients with asthma, current, guidelines recommend anti-inflammatory medications, specifically inhaled corticosteroids and leukotriene-modifiers, as first-line therapy, making these agents the mainstay of asthma therapy. In contrast, the current guidelines for COPD management recommend that inhaled anti-inflammatory agents be tried in patients with COPD only as second-line therapy for patients who have severe to very severe airflow obstruction with frequent exacerbations and who remain symptomatic despite maximized bronchodilation with multiple inhaled bronchodilators. Hence, it is extremely important to understand the differences between the underlying pathogenesis and pathophysiology of COPD and those of asthma, as these differences dictate the implementation of distinctly different treatment options for these 2 diseases.
引用
收藏
页码:11S / 23S
页数:13
相关论文
共 72 条
[1]   Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease [J].
Aaron, SD ;
Vandemheen, KL ;
Hebert, P ;
Dales, R ;
Stiell, IG ;
Ahuja, J ;
Dickinson, G ;
Brison, R ;
Rowe, BH ;
Dreyer, J ;
Yetisir, E ;
Cass, D ;
Wells, G .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 348 (26) :2618-2625
[2]   The effects of inhaled corticosteroids in chronic obstructive pulmonary disease: A systematic review of randomized placebo-controlled trials [J].
Alsaeedi, A ;
Sin, DD ;
McAlister, FA .
AMERICAN JOURNAL OF MEDICINE, 2002, 113 (01) :59-65
[3]  
Altose MD, 2000, NEW ENGL J MED, V343, P1902
[4]  
[Anonymous], STAND DIAGN MAN PAT
[5]   IDENTIFICATION OF ACTIVATED LYMPHOCYTES-T AND EOSINOPHILS IN BRONCHIAL BIOPSIES IN STABLE ATOPIC ASTHMA [J].
AZZAWI, M ;
BRADLEY, B ;
JEFFERY, PK ;
FREW, AJ ;
WARDLAW, AJ ;
KNOWLES, G ;
ASSOUFI, B ;
COLLINS, JV ;
DURHAM, S ;
KAY, AB .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1990, 142 (06) :1407-1413
[6]  
Barnes PJ, 2000, CHEST, V117, P10
[7]   Medical progress: Chronic obstructive pulmonary disease. [J].
Barnes, PJ .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 343 (04) :269-280
[8]   IDENTIFICATION OF LYMPHOCYTES-T, MACROPHAGES, AND ACTIVATED EOSINOPHILS IN THE BRONCHIAL-MUCOSA IN INTRINSIC ASTHMA - RELATIONSHIP TO SYMPTOMS AND BRONCHIAL RESPONSIVENESS [J].
BENTLEY, AM ;
MENZ, G ;
STORZ, C ;
ROBINSON, DS ;
BRADLEY, B ;
JEFFERY, PK ;
DURHAM, SR ;
KAY, AB .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1992, 146 (02) :500-506
[9]   EOSINOPHILS, T-LYMPHOCYTES, MAST-CELLS, NEUTROPHILS, AND MACROPHAGES IN BRONCHIAL BIOPSY SPECIMENS FROM ATOPIC SUBJECTS WITH ASTHMA - COMPARISON WITH BIOPSY SPECIMENS FROM ATOPIC SUBJECTS WITHOUT ASTHMA AND NORMAL CONTROL SUBJECTS AND RELATIONSHIP TO BRONCHIAL HYPERRESPONSIVENESS [J].
BRADLEY, BL ;
AZZAWI, M ;
JACOBSON, M ;
ASSOUFI, B ;
COLLINS, JV ;
IRANI, AMA ;
SCHWARTZ, LB ;
DURHAM, SR ;
JEFFERY, PK ;
KAY, AB .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, 1991, 88 (04) :661-674
[10]   Asthma in the elderly [J].
Braman, SS .
CLINICS IN GERIATRIC MEDICINE, 2003, 19 (01) :57-+