1) Bronchial Asthma: Symptoms, Signs, Pathology

2) COPD: Symptoms, Signs, Pathology

3) Combined Disease…..From Smoking; From Recurrent Infections.

4) What Obstructive Airway Disease Is Not: Parenchymal , Interstitial, “lung tissue disease”; but this may also be present secondary to many other diseases.

5) Upper Airway Disease (Nasal Membranes, Paranasal Sinuses): a) from allergies; b) chronic rhinitis/sinusitis, with or without nasal polyps.

6) Inflammation: Healing…and Scarring (“remodeling”).  Over-reaction can produce other diseases: septic shock, severe influenzal pneumonia, autoimmune diseases, possibly coronary artery disease, etc.
 
7) TREATMENT:

a) Requires Comprehensive Diagnosis, involving the upper and lower airways.   Always look for underlying or accompanying allergic/asthmatic aspect for all obstructive airway diseases…may be the only reversible part of the disease processes left.
b) Environmental Control: Starts with cessation of smoking, completely and permanently; also involves home and work environment, etc.
c) “Good Bronchial Toilet”, adequate cleansing of the bronchial tubes: bronchodilators (three types), mucolytic agents, ciliary stimulants, barrier agents.
d) Anti-inflammatory agents: steroids, singulair, antihistamines, non-steroidal anti-inflammatory agents.
e) Treat the underlying cause, where identifiable…allergy immunotherapy, antibiotics, immunizations…
f) Identify the type of patient being treated: sensitive vs. oblivious.
g) Oxygen
h) Physical Therapy
i) Identify and treat co-morbid conditions: GERD; Hypertension, essential or pulmonary; Obesity; Obstructive Sleep Apnea.

Incomplete Diagnosis;
Too much compromise with a recalcitrant patient: Physicians and patients can discharge each other!
Overuse of Smpathomimetics;
Under-use of Parasympatholytics;
Under-use of anti-inflammatory agents;
Under-and improper use of antibiotics;
Inadequate use of immunizations;
Inadequate or ineffective use of Allergy Immunotherapy;
Inadequate patient responsibility…do things with the patient, not for the patient.
These are common, serious diseases, for which a great deal of help is available.

GS