00:01
Let's begin with some of these areas.
00:03
Take a look at where area 9 is. Next, asthma.
Interesting. Where is this area 9? It’s
outside of the shaded green region. What does
that mean? Well, in our topic as we further
get into or dive into asthma, I will then
walk you through what it means for an asthma
patient to be outside of the box or inside
or should I say the shaded green? Either
outside the shaded green or inside the shaded
green. Inside the shaded green would be a patient
who has asthma who then shares with other
COPD's, the symptoms of COPD. So, area 9 demonstrates
asthma whose airflow obstruction is completely
reversible and therefore, not considered to
be COPD. Is that clear? Current day practice,
make sure that you are clear about your definition
of COPD and as to how if asthma was completely
reversible and it stays out of the definition
of COPD. Thus, may be virtually impossible
to differentiate these asthmatics from chronic
bronchitis and emphysema patients who partially
have reversible airflow obstruction with airway
hyperactivity. Now, what this referring to
is take a look at emphysema and chronic bronchitis
here. I want you to pay attention to real
quick, number 1 and number 2, not truly highlighted
yet, but you can see that you are outside
of the green shaded box or area. So therefore,
it is quite possible that those patients that
are asthmatics in which are completely reversible
might also be sharing and could actually be
experiencing issues of chronic bronchitis
or emphysema being outside that box. Is that
clear? So therefore, to differentiate between
the three diseases of COPD or non-COPD tends
to be impossible or incredibly difficult.
02:08
Areas 6, 7 and 8, take a look at where you
are. You are in the green shaded area. By
definition, this is COPD. You are going to
have severe airflow limitation, especially
with exhalation. In addition to that, you
are looking for a patient who is now progressing
into something more severe. These are unremitting
asthmatics. What does that mean? It means
that there isn’t complete reversibility
of the disease. In addition, you will find
that the asthma here, which is the big circle
is now sharing symptoms with whom?
I want you to focus more upon number 6. Area
6 is chronic bronchitis. And often times,
those are asthmatics, often times will have
a history of chronic bronchitis as well. Now,
the area 8 could overlap the diagnosis of
chronic bronchitis and emphysema in a patient
who is asthmatic. So, you are seeing here
that overall these three very much share
overlapping signs and symptoms. Ultimately,
airflow obstruction. Your FEV1 to FVC ratio,
depressed. Your loop spirometry, upon exhalation,
the second half will show you what? A scalloped
portion.
03:31
Take a look at area 6. So, this is what I
was referring to and this is what you are
paying attention to. Represents the diagnosis
of asthmatic bronchitis. So, in the US, often
times, in clinical practice, your
patients that are walking in will have asthmatic
bronchitis. Now, well, that should make perfect
sense because are you not having a plug formation
in asthma? What is that plug made up of?
Mucous. Is it a possibility that a patient
with asthma with this mucous plug is having
productive cough over a three month period
consecutively over a period of two years?
Sure. So, asthmatic form of COPD who are exposed
to chronic smoke irritants.
04:17
Move on. What about area 5? Area 5 is chronic
bronchitis and emphysema. So now, take a
look, please. You are outside of the circle
of asthma. That is not a diagnosis. Area 5,
often times this is what you are going to
find in your clinical practice, beware of
this when you read clinical vignettes and
questions. Many of your patients will be sharing
both of the symptoms and signs of chronic
bronchitis and emphysema. Say they might have
the cough like chronic bronchitis and at the
same time, they were having emphysematic type
of disease process taking place in the parenchyma.
04:53
Area 1, 2 and 11. Identify these. Good. Now, you're
once again, you are outside the shaded box
and so, therefore, these individuals are reversible.
Patients with chronic bronchitis or emphysema
without airflow obstruction, not classified
as having COPD. Now, at some point, could
they result in it? Sure. I would spend a little
bit of time making sure that you are comfortable
with the signs and symptoms. Your priority
should be COPD in the green shaded box. Your
priority should be the common diagnosis that
you find in the US.
05:28
Number 5 is what you are paying attention
to that we walked through. Number 6 is something
that you are paying attention to. Number 9
you do want to pay attention to because when
we dive into asthma further, from a pathologic
point of view, then maybe your patient is
completely reversible. By definition, would
not be in the shade of COPD and would be really
an asthmatic who is, well, easily treated
with something like a beta-2 agonist.