Inflammation and Treatment in Asthma and COPD

By James F. Donohue, MD, FCCP; and Jill A. Ohar, MD, FCCP

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Asthma

Disease Pathology in Asthma and COPD

While both diseases have components of variable airflow obstruction, asthmatics respond more frequently and to a greater extent to bronchodilators than do patients with COPD. COPD, as defined in the National Heart, Lung, and Blood Institute Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines⁴ as "progressive obstruction that is partially reversible." Both conditions are characterized by lung inflammation, although the magnitude of inflammation is greater in asthma (Table 1). COPD is associated with greater mucus hypersecretion and there are more epithelial changes, specifically more goblet cells, and squamous metaplasia. Asthma is more closely associated with airways epithelial shedding and thickening of the basement membrane. COPD has a greater component of alveolar destruction. Smooth muscle hypertrophy, while seen in both, is more often a feature of asthma, while submucosal gland proliferation is more typical of COPD. In chronic stable COPD, the cells active in the inflammatory process include macrophages, monocytes, CD8 lymphocytes, and neutrophils. In contrast, in asthma, the predominant cells are lymphocytes, mast cells, and eosinophils (Figure1). However, in acute exacerbations of COPD, eosinophils and lymphocytes take on a more prominent role.

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