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Asthma

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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Discuss the economic and health burden caused by asthma.

  2. Explain the pathophysiology of asthma.

  3. Describe the clinical presentation of acute and chronic asthma.

  4. Identify factors that affect asthma severity.

  5. Identify the goals of asthma management.

  6. Classify asthma severity based on impairment due to asthma and future risk for negative outcomes due to asthma.

  7. Recommend environmental control strategies for patients with identified allergies.

  8. Educate patients on the use of inhaled drug delivery devices, peak flow meters, and asthma education plans.

  9. Develop a therapeutic plan for patients with chronic asthma that maximizes patient response while minimizing adverse drug events and other drug-related problems.

  10. Evaluate current asthma control and make therapeutic changes when necessary.

  11. Develop a therapeutic plan for treating patients with acute asthma.

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KEY CONCEPTS

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  • Image not available. Asthma is a complex disease that presents in a heterogeneous manner.

  • Image not available. Asthma is the most prevalent chronic disease of childhood, and it causes significant morbidity and mortality in both adults and children.

  • Image not available. Asthma is characterized by inflammation, airway hyperresponsiveness (AHR), and airway obstruction.

  • Image not available. In chronic asthma, initial classification of asthma severity is based on current disease impairment and future risk.

  • Image not available. Direct airway administration of asthma medications through inhalation is the most efficient route, and it minimizes systemic adverse effects.

  • Image not available. Short-acting-inhaled β2-agonists are the most effective agents for reversing acute airway obstruction caused by bronchoconstriction and are the drugs of choice for treating acute asthma and symptoms of chronic asthma.

  • Image not available. Inhaled corticosteroids (ICS) are the preferred therapy for all forms of persistent asthma in all age groups.

  • Image not available. The intensity of pharmacotherapy for chronic asthma is based on disease severity for initial therapy and level of control for subsequent therapies.

  • Image not available. In acute asthma, early and appropriate intensification of therapy is important to resolve the exacerbation and prevent relapse and future severe airflow obstruction.

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INTRODUCTION

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In 2011, the Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) defines asthma as "a chronic inflammatory disorder of the air-ways, involving airway hyperresponsiveness that leads to widespread and variable episodes of reversible airway obstruction." This airway obstruction results in wheezing, breathlessness, chest tightness, and coughing, particularly at night or early in the morning.1

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Image not available. Asthma is a complex disease that presents in a heterogeneous manner. Severity of chronic disease ranges from mild intermittent symptoms to a severe and disabling disease if left untreated. Despite variances in the underlying severity of chronic asthma, all patients with asthma are at risk of acute severe disease. The National Heart, Lung, and Blood Institute (NHLBI) National Asthma Education and Prevention Program (NAEPP) Expert Panel Report-3 (EPR-3) Guidelines for the Diagnosis and Management of Asthma2 and GINA emphasize the importance of treating underlying airway inflammation to control asthma and reduce asthma-associated risks.

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EPIDEMIOLOGY AND ...

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