Combination of asthma and chronic obstructive pulmonary disease: features of etiology, pathogenesis, diagnosis, pharmacotherapy

Abstract

Bronchial asthma and chronic obstructive pulmonary disease are the most common obstructive diseases of the respiratory system. 230 million people suffer from chronic obstructive pulmonary disease, from bronchial asthma - 300 million people worldwide. Annually 200-300 people in Europe and 2.74 million of world population die from chronic obstructive pulmonary disease, from asthma - 250 thousand people a year. The social and economic significance of these diseases determine the need for in-depth study of their combination in the same patient. Each disease has its own phenotypes, but in 10-20% of patients, there are symptoms of both chronic obstructive pulmonary disease and asthma. In spite of clear diagnostic criteria, in some cases it is difficult to distinguish these diseases. Morphological basis of these diseases is a chronic inflammation in the bronchial tree that causes damage to the epithelial continuity that initiates bronchoconstrictive reaction and leads to irreversible airway obstruction attributable for both severe bronchial obstruction and chronic obstructive pulmonary disease. However, the treatment strategy of bronchial asthma and chronic obstructive pulmonary disease has significant differences, it is important to have a clear diagnostic criteria to distinguish different phenotypes, including those of combined phenotype of asthma and chronic obstructive pulmonary disease. Rational starting therapy of asthma and chronic obstructive pulmonary disease overlap syndrome includes drugs acting on the pathogenic mechanisms of both diseases, and is a combination of inhaled corticosteroids with combined bronchodilator therapy - long-acting β2-agonists and long-acting anticholinergics.