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Difference between asthma and emphysema

Asthma before and after

Asthma vs emphysema

Asthma is defined as an inflammatory disease of the airways of lungs producing a reversible obstruction due to spasmodic constriction of the airways. Emphysema is a disease of the lung tissue, to be precise the lung alveoli (air sacs) present at the end of the bronchial tubes. Emphysema results from the destruction of these alveoli and thus, presents as an irreversible pathology.

Asthma is a condition characterized by cough, wheezing and breathlessness. Exacerbations and remissions are the rule. A transient spasmodic obstruction is produced due to an exciting/triggering agent that either presents from the external environment or is present in the body like an infection. Asthma is thus, an allergic response, an exaggerated response of the body to a seemingly harmless foreign agent. Emphysema is a chronic lung disease resulting from the destruction of the alveolar sacs due to smoking for long periods of time or due to alpha-1 antitrypsin enzyme deficiency. It causes a slow and gradual reduction in the alveoli. Alveoli are the terminal air sacs enabling exchange of oxygen and carbon dioxide.

The first symptom of asthma will be wheezing caused due to a sudden narrowing of the bronchial tubes and the whistling sound produced by the gush of air passing through the narrow tubes. In emphysema, the first symptom will be breathlessness on heavy exertion which will slowly progress to breathlessness on slightest exertion. This symptom is the hallmark of emphysema as the air exchange which could have been possible is reduced as the alveoli number has reduced. Other symptoms of emphysema are persistent cough with production of phlegm, wheezing or crepitations, chest pain and all symptoms get worse with age. Signs to be noticed in a person with emphysema are clubbing of finger nails, polycythemia (excessive red blood cells) to compensate for the lack of oxygen in the body and cyanosis (blue nails and lips) in extreme cases.

Asthma patients have breathlessness on account of wheezing, raised eosinophil counts as there is an allergic component. The symptoms are instantly relieved by using bronchodilators which dilate the narrow lumen of the tubes. On X-ray, an asthmatic person will not have any abnormality but a person with emphysema will have dark shadows of a hyper inflated lung with a narrowed heart region between the two lung fields. The emphysematous lungs tend to enlarge the chest of the patient as they do not deflate completely even after deep exhalation. The patients are commonly referred to as having a ‘barrel chest’. The breathing is labored and use of accessory muscles is visible as the accessory respiratory muscles get fatigued.

Blood tests for asthma will show raised eosinophils whereas blood tests for emphysema will show leucocytosis (both are forms of elevated white blood cells).

Treatment of asthma includes avoiding exposure to allergic agents, used of bronchodilators and nebulization in cases of a severe acute episode. Treatment of emphysema includes quitting smoking immediately which will drastically reduce the pace of damage, use of acute or long term bronchodilators, steroids for reducing exacerbations and antibiotics to prevent infection. Mucolytic agents are used to reduce cough. Nasal oxygen in times of acute distress will relieve the patient as there is persistent hypoxia in these patients.

Asthmatic episodes will reduce over time with proper medications but emphysema will deteriorate with age and time.

Summary: Asthma is called as a reversible obstructive lung disease whereas emphysema is called as a restrictive lung disease as air inflow and outflow are limited. Asthma manifests as episodic, intermittent cough with phlegm, wheezing and breathing difficulties. Emphysema is characterized by progressive alveolar destruction leading to worsening cough, phlegm production and breathlessness.


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