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LEARNING OBJECTIVES

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  1. Identify appropriate standards for the diagnosis of asthma and COPD.

  2. Use available parameters to measure and monitor target goals for patients being treated for asthma and COPD.

  3. Conduct a comprehensive follow-up visit for a patient with asthma or COPD using appropriate history-taking techniques, physical examination, and laboratory tests. The visit includes assessment of disease control, plus assessment and support of compliance with lifestyle modifications and medication regimens.

  4. Evaluate patients for complications from asthma, COPD, and the medication regimen used to treat them.

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INTRODUCTION

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Roughly 12% of the population of the United States suffers from either asthma or COPD, at an economic cost of over $100 billion annually. COPD is the third leading cause of death in the United States. As with other chronic diseases, pharmacists can play an important role in assisting patients to optimize the benefits from their medication regimen. The pharmacist, either as part of a health care delivery team or in pharmacist-run asthma or COPD disease management programs, has been shown to have a positive clinical and economic benefit on patient outcomes. Since medication is the primary therapeutic modality, pharmacists need to understand the diagnosis, pathophysiology, and treatment of these diseases since patients may attempt self-care of these disorders, require education for proper medication use, or may rely on the pharmacist to help them manage their disease.

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ETIOLOGY/PATHOPHYSIOLOGY/EPIDEMIOLOGY

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While both asthma and COPD have major small airway disease components with inflammation and increased airway resistance, they have different etiologies, characteristics, and outcomes (see Table 21.1).

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Asthma

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Asthma affects patients of all ages. Over 25% of the 25.9 million patients with asthma are children. Asthma is a chronic inflammatory disease of the airways. The inflammation causes airway hyperresponsiveness to various stimuli, leading to bronchospasm, which manifests itself as coughing in the early morning hours, wheezing, breathlessness, and chest tightness. The inflammation also causes airway obstruction that limits airflow that can be reversed with treatment. Long-term untreated disease can lead to airway remodeling that may not be completely reversible. Initially, the pathogenesis was thought to be exclusively due to IgE-mediated reactions involving eosinophils. However, while eosinophilis and IgE are still important elements in the pathogenesis of asthma, over the last several years evidence has shown asthma to be a heterogeneous disease. Different patterns of inflammatory processes that involve multiple cellular mechanisms, result in different disease intensity and varying response to guideline-based treatments. Currently, the development of asthma is thought to be due to an interaction among innate immunity, a complex genetic component, and environmental factors, including respiratory syncytial virus, rhinovirus, and airborne allergens. Recent evidence also shows that this process impedes the normal epithelial cell barrier (like atopic dermatitis), which allows antigens to pass into local tissue to create the interaction between the three major pathogenic components. In patients with stable, well-controlled asthma, exacerbations are mostly due to ...

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