“Chronic Obstructive Pulmonary Disease”, “C.O.P.D.”, “chronic bronchitis”, “emphysema”,  “chronic lung disease”....  Why is it important for patient and physician to distinguish between this category of disease and “bronchial asthma”?  And can these diseases co-exist in the same individual?

     Admittedly, the definitions of these  conditions are somewhat imprecise, and there is overlap between them, both in terms of diagnosis and treatment.  But the distinction is important, mainly because it affects prognosis - the future of the patient and the expectations of physician and patient.

      Bronchial Asthma is a disease process affecting lung airways in a reversible fashion, most commonly allergic in origin and treated with the prospect of “cure”. Chronic Bronchitis is a disease process affecting lung airways in a  more severe inflammatory and most often progressive fashion.  It is most commonly secondary to smoking, recurrent respiratory tract infections and occasionally a genetic predisposition.  Bronchial Asthma poorly treated may develop  to include Chronic Bronchitis and then may become progressive.  Chronic Bronchitis  in about 30% of cases develops from asthma and continues to carry an active - and reversible  - asthmatic component, if it is looked for through a comprehensive medical and allergy evaluation.

      Bronchial Asthma can present as wheezing, shortness of breath and / or persistent hacky cough.  Chronic Bronchitis usually presents as a productive cough, mainly in the morning, and is defined as this type of cough occurring over three or four months for two consecutive years.

      The main cause of Bronchial Asthma is allergies.  The main cause of Chronic Bronchitis is smoking, with the inevitable increased susceptibility to respiratory tract infections and the damage they cause.  The worst combination is a smoking asthmatic, a prescription for becoming a respiratory cripple in short order.

      Both diseases are treated with similar medications.  But medications are not enough in Bronchial Asthma, and also are not enough in Chronic Bronchitis with an allergic asthmatic component.  In asthma we go for “cure” by treating the underlying allergic cause with a complete diagnosis, environmental control, and allergy immunotherapy.    In Chronic Bronchitis we go for stabilization and management, if cessation of smoking has not occurred soon enough to avoid “airway remodeling”, a process of scarification.

      Bottom Line:  Any patient with a persistent cough (moist or dry), and / or wheezing, and /or shortness of breath (labored breathing, awareness of breathing) needs a complete medical and allergy evaluation.  This should be performed by a certified allergist.   It may also be performed by an enlightened pulmonologist who has made himself aware of the central importance of allergic mechanisms in these conditions - usually in cooperation with an allergist.  Anything less is poor treatment of a serious medical condition, resulting in too many respiratory cripples, often at a young age.    And above all:  STOP SMOKING!  A “cigarette cough” is chronic bronchitis, with all its implications.  Furthermore, discontinuation of smoking begins the healing process immediately, with resolution often within one year if caught early enough.

GS