Q: How is COPD different from asthma?

Asthma and COPD both cause airway obstruction, but with crucial differences: Asthma: typically reversible airflow obstruction; onset any age; allergic/eosinophilic inflammation; responds well to ICS; normal lung function between attacks in early disease. COPD: largely irreversible; onset typically >40 years; neutrophilic and emphysematous pathology; responds to bronchodilators but not ICS alone; progressive even with treatment. Some patients have both (Asthma-COPD Overlap, ACO) — these typically benefit from ICS. In practice, the two are often confused — spirometry is essential for diagnosis.

Question 1

What is COPD?

Accepted Answer

Chronic obstructive pulmonary disease (COPD) is a progressive, largely irreversible disease of the airways and lung parenchyma, characterised by persistent respiratory symptoms and airflow limitation. Two main pathological components: emphysema — destruction of alveolar walls, reducing gas exchange surface area; chronic bronchitis — chronic airway inflammation with mucus hypersecretion and airway wall thickening. The diagnosis requires spirometry: FEV1/FVC ratio <0.70 after bronchodilator (indicating fixed airflow obstruction). COPD is the third leading cause of death globally, killing 3.2 million per year.

Question 2

How is COPD different from asthma?

Accepted Answer

Asthma and COPD both cause airway obstruction, but with crucial differences: Asthma: typically reversible airflow obstruction; onset any age; allergic/eosinophilic inflammation; responds well to ICS; normal lung function between attacks in early disease. COPD: largely irreversible; onset typically >40 years; neutrophilic and emphysematous pathology; responds to bronchodilators but not ICS alone; progressive even with treatment. Some patients have both (Asthma-COPD Overlap, ACO) — these typically benefit from ICS. In practice, the two are often confused — spirometry is essential for diagnosis.

Question 3

What causes COPD?

Accepted Answer

Primary causes: Tobacco smoking (80% of COPD in HICs): the dose-response relationship is clear — heavier and longer smoking = more COPD. Biomass fuel smoke (3 billion people exposed globally): the dominant cause in LMIC women — cooking over open fires with wood, dung or crop residues in unventilated homes. Secondary causes: occupational dust and chemical fumes (coal mining, grain dust, isocyanates, silica, cadmium); outdoor air pollution; recurrent childhood respiratory infections; low birthweight; genetic factors (alpha-1 antitrypsin deficiency — 1-2% of COPD).

Question 4

How is COPD treated?

Accepted Answer

Smoking cessation: the ONLY intervention proven to slow FEV1 decline — must be offered at every visit. Bronchodilators: LAMA (tiotropium, umeclidinium) and/or LABA (salmeterol, indacaterol) — first-line maintenance; dual LAMA+LABA for most symptomatic patients. Triple therapy (LAMA+LABA+ICS): for patients with frequent exacerbations, especially eosinophilic phenotype (blood eos ≥100). Dupilumab (2024 — biologic for eosinophilic COPD with eos ≥300). Oxygen therapy: for severe resting hypoxaemia (SpO2 ≤88%); long-term oxygen therapy (LTOT) — 15+ hours/day — reduces mortality. Pulmonary rehabilitation: most cost-effective quality-of-life intervention.

Question 5

What happens during a COPD exacerbation?

Accepted Answer

An acute exacerbation of COPD (AECOPD) is a sudden worsening of breathlessness, cough and sputum, requiring additional treatment beyond usual medications. Most AECODs are triggered by respiratory viruses (rhinovirus, influenza, RSV) or bacteria. Management: increased frequency of SABA; systemic corticosteroids (prednisolone 40mg × 5 days — reduces exacerbation severity); antibiotics if purulent sputum or severe (amoxicillin, doxycycline or clarithromycin first-line); controlled oxygen therapy (target SpO2 88-92% — avoiding hypercapnia); NIV (bilevel positive airway pressure, BiPAP) for hypercapnic respiratory failure. Each severe exacerbation permanently reduces lung function.

Question 6

How does GMJ News cover COPD?

Accepted Answer

GMJ News covers WHO COPD burden, GOLD staging, smoking cessation, LAMA/LABA/ICS treatment, pulmonary rehabilitation, dupilumab for eosinophilic COPD, alpha-1 antitrypsin deficiency, biomass fuel as an LMIC cause, and exacerbation management. COPD — the third leading cause of death — is directly relevant to PHIG's NCD programme and tobacco control advocacy in Georgia.

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