The reversible one vs the one that gave up trying
A 55-year-old with 30 pack-years presents with chronic dyspnea and wheezing. PFTs show FEV1/FVC < 0.7. After albuterol, FEV1 improves by 8%.
Asthma or COPD?
These two diseases both cause airflow obstruction and wheezing. That's where the similarity ends. Flip between tabs — notice how different the stories are.
Young. Often childhood onset. Atopic history — eczema, allergic rhinitis, food allergies. Family history of asthma. The kid who couldn't run the mile in gym class.
Eosinophilic inflammation → bronchial hyperreactivity → airway smooth muscle spasm → reversible obstruction. The airways are twitchy, not destroyed.
REVERSIBLE. Give albuterol → FEV1 jumps β₯12% AND β₯200mL. The airways open back up because the walls are still intact. They're just spasming.
Inhaled corticosteroids (ICS) are the controller. SABA for rescue. Step up with LABA + ICS combo. The goal is no symptoms — and that's actually achievable.
Older smoker. Usually 40+ with significant smoking history. The guy who smoked a pack a day for 30 years and now can't climb stairs.
Neutrophilic inflammation → protease-antiprotease imbalance → alveolar wall destruction (emphysema) + mucus gland hypertrophy (chronic bronchitis). The architecture is permanently damaged.
IRREVERSIBLE. Give albuterol → FEV1 improves <12% or <200mL. The obstruction is structural. You can't relax a wall that's been demolished.
LAMA (tiotropium) is the first-line controller. Add LABA. ICS only added for frequent exacerbations (β₯2/year). Smoking cessation is the ONLY thing proven to slow decline. O2 if PaO2 β€55.
One screen. All the differences. Lead with what's DIFFERENT, not what's shared.
Board vignette drops. Patient is wheezing. Walk through it.
Five patients walk in wheezing. Don't give them the wrong inhaler.
Random selection from the pool. Reload for different questions.