RESPIRATORY


Table 2: Clinical features differentiating COPD and asthma COPD


Smoker or ex-smoker Symptoms under age 35 chronic productive cough Breathlessness


Night time waking with breathlessness and/or wheeze


Significant diurnal or day-to-day variability of symptoms


Nearly all Rare


common Persistent and progressive Uncommon Uncommon


> obstruction, inflammation and bronchial hyper-responsiveness. When an allergen is inhaled, it triggers a reaction within the cells of the bronchus. through a process of events, there is inflammation and an increase in mucus production which causes bronchoconstriction, leading to a difficulty in breathing. Asthma can be atopic (most common) or non- atopic (uncommon). Symptoms of asthma would include: dyspnoea, wheeze, chest tightness and a dry, irritating cough 7


.


Pneumonia is an infection of one or both lungs, and can be caused by either a bacterium, virus or fungi. In pneumonia, there is inflammation and fluid build-up in the lung which makes it hard to breathe. there are many different types of pneumonia; however, community acquired


RISK fActoRS tobacco smoking is the biggest risk factor in the development of respiratory conditions 6


Asthma Possibly often


Uncommon variable


common common


pneumonia (cAP) is the most common. Signs and symptoms include: malaise, confusion, fever and chills, rigor, tachycardia, dyspnoea and a productive cough. the most common causative agents are: Strep. pneumoniae, influenza and the respiratory syncytial virus (RSv). fungal pneumonia is uncommon and is mainly seen in patients who are immunocompromised. People with existing respiratory conditions are more likely to suffer from pneumonia.


. About 90 per


cent of coPd cases are caused by cigarette smoke. Inhalation of oxidative toxins from occupational exposure (exposure to dust, chemicals and particles), air pollution and from


Table 3: Respiratory diseases and differential diagnosis 6 Disease


Characteristics coPd


• onset in mid-life. • Symptoms slowly progressive. • history of tobacco smoking or exposure to other types of smoke.


Asthma


• onset early in life (often childhood). • Symptoms vary widely from day to day. • Symptoms worse at night/early morning. • Allergy, rhinitis, and/or eczema also present. family history of asthma.


congestive heart failure


• chest x-ray shows dilated heart


• Pulmonary edema. • Breathlessness when lying flat • fine lung crepitations • Pulmonary function tests indicate volume restriction, not airflow limitation


tuberculosis


• onset all ages. • chest x-ray shows lung infiltrate. • microbiological confirmation. • high local prevalence of tuberculosis.


Bronchiectasis


• large volumes of purulent sputum; commonly associated with bacterial infection. • frequent chest infections • history of childhood pneumonia • coarse lung crepitations • chest x-ray/ct shows bronchial dilation,


54 - PhARmAcY IN focUS


second hand smoke are all risk factors for developing coPd, asthma and pneumonia. Some other risk factors for developing pneumonia are: being immunocompromised, older than 65 years, malnourishment and taking certain medications (such as amiodarone and methotrexate). other risk factors for asthma include: being overweight and genetics (having a blood relative with asthma or having another allergic condition such as eczema or hay fever). genetic risk factors for would include people who have an alpha-1 antitrypsin deficiency.


dIAgNoSIS there are a range of investigations that can be used to diagnose various respiratory conditions; however, spirometry is the first-line diagnostic test that will need to be performed on a patient that presents with either asthma or coPd 6, 7


. Since the symptoms of asthma and coPd are


similar, when differentiate between the two, the doctor will look at: the age of onset of the symptoms, characteristics of the cough and the symptom variability 8


. According to


NIcE guidelines, a diagnosis of coPd should be considered in patients over 35 years that have exposure to a risk factor and presents with one or more of the following 4


:


• exertional breathlessness • chronic cough • regular sputum production • recurrent chest infections or frequent winter 'bronchitis' • wheeze


Pneumonia is mainly diagnosed by the doctor performing a physical exam and a chest x-ray. other investigations would include a blood test to check white blood cell count and identify the pathogen, and also sputum culture, again to identify the infecting organism. however, when a patient presents with pneumonia,


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