Similarities and discrepancies between exacerbations of asthma and chronic obstructive pulmonary disease

Asthma is a chronic inflammatory disorder of the airways which causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough, symptoms which are usually associated with reversible airflow limitation.1 2 This definition includes the recurrence of respiratory symptoms which might be otherwise classified as asthma exacerbations. However, the term asthma exacerbation is usually reserved for more severe and/or more persistent respiratory symptoms requiring a prolonged increase of current antiasthma medication.1 2 Chronic obstructive pulmonary disease (COPD) is defined as a progressive airflow limitation, mostly irreversible.3 4 The term COPD includes patients with obstructive chronic bronchitis and/or pulmonary emphysema.3 4 Patients with moderate or severe persistent asthma may also have an irreversible component of airflow limitation, and thus they may also be included in the definition of COPD.3 The definition of COPD does not include exacerbations,3-5 even if exacerbations are the main cause of medical intervention and admission to hospital in these patients. Recent guidelines provide classifications of exacerbations of asthma and COPD based on clinical parameters.1-4 6Although these classifications may provide a useful tool for clinical studies, they are not standardised and they are rather cumbersome and difficult to use in clinical practice. The definitions derived from the literature are operational and vary with investigators.7-14 In this article we will try to provide some definitions to be subsequently used to discuss the pathogenesis and treatment of the two diseases. Mild exacerbations of asthma may be defined as increased intensity or frequency of symptoms and/or worsened lung function—that is, decreased forced expiratory flows or increased variability of peak expiratory flow—that force the patient either to change prescribed treatment and/or to seek medical attention.13 14 The borderline between ongoing symptoms with frequent use of rescue medication and mild exacerbations may be difficult …

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