Medical management of asthma

Asthma is a chronic inflammatory disorder of the airways characterized by bronchial hyperresponsiveness (BHR) to a variety of stimuli and widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. Patients with asthma frequently have symptoms which can lead to limitations of daily activities, interrupted sleep, hospitalizations, and emergency department (ED) visits, and in small but significant group of patients, asthma can cause death. The goal of asthma treatment is to enable patients with asthma to lead a normal life with minimal or no symptoms or exacerbations. Asthma has been traditionally classified based on frequency of symptoms and degree of airway obstruction into the following categories: mild intermittent, mildpersistent, moderate persistent and severe persistent (Table 6.1) (Global Initiative for Asthma (GINA) 2006). However, this classification has been recently modified and emphasis has moved away from severity classification toward classifying asthma by level of control. According to a new classification, patients with asthma should be categorized as controlled, partly controlled or uncontrolled (Table 6.2). This new concept recognizes that asthma is a disease with variable presentation where an individual’s asthma symptoms may change over months or years. While severity reflects the chronic, underlying state of the disease, asthma control better reflects the variable day-to-day pattern of asthma. Therefore, ...

The diagnosis of asthma continues to require characteristic symptoms and evidence of variable airflow limitation on pulmonary function testing. The characteristic symptoms, especially in adults, include wheezing, shortness of breath, cough, and chest tightness that are worse at night or early in the morning; vary over time and in intensity; and are triggered by viral infections (colds), exercise, allergen exposure, changes in weather, laughter, or irritants. Features that decrease the likelihood of asthma include cough in the absence of other respiratory symptoms, chronic production of sputum, shortness of breath associated with light-headedness or paresthesia, chest pain, and exercise-induced dyspnea with noisy inspiration. In asthma, lung function can vary between normal and severely obstructed, especially when poorly controlled. In adults with characteristic symptoms, an increase or decrease in forced expiratory volume in one second (FEV 1) of greater than 12% and 200 mL from baseline or a change in peak expiratory flow of at least 20% is consistent with asthma. Bronchial provocation testing is useful for ruling out asthma but less useful for making the diagnosis, and it should be limited to diagnosing asthma in athletes or in patients with symptoms despite normal spirometry findings or when spirometry is unavailable. Although the presence of atopy increases the likelihood of allergic asthma, its absence does not rule out asthma. Asthma severity is defined by the treatm...

Write down your symptoms in an asthma diary each day. Recording symptoms can help you recognize when you need to make treatment adjustments according to your asthma action plan. Use your asthma diary to record: • Shortness of breath or whistling sounds when you exhale (wheezing). • Disturbed sleep caused by shortness of breath, coughing or wheezing. • Chest tightness or pain. • Quick-relief (rescue) inhaler use — record when you need to use your quick-relief inhaler, such as albuterol (Proventil HFA, Ventolin HFA, ProAirHFA), and write down how many puffs you take. • Disruptions to work, school, exercise or other day-to-day activities caused by asthma symptoms. • Asthma symptoms during exercise. • Changes in color of phlegm you cough up. • Hay fever symptoms such as sneezing and runny nose. • Anything that seems to trigger asthma flare-ups. Your doctor may have you periodically record results of breathing tests (lung function tests). If your lungs aren't working as well as they should be, your asthma may not be under control. There are two main lung function tests: • Peak flow. This test is done at home with a simple hand-held device called a peak flow meter. A peak expiratory flow measurement indicates how fast you can force air out of your lungs. Peak flow readings are sometimes gauged as a percentage of how your lungs work at their best. This is called your personal best peak flow. • Spirometry. Spirometry tests can be done at your doctor's office with a machine called ...

Your asthma may be uncontrolled if you experience frequent symptoms that can affect your daily life. Uncontrolled asthma may require changing your treatment plan to avoid health complications. Uncontrolled asthma is when you experience frequent or bothersome asthma symptoms, even with a treatment plan. Uncontrolled asthma can happen if your asthma is mild, moderate, or severe. The Centers for Disease Control and Prevention (CDC) estimates that about Getting Not controlling asthma can lead to chronic health conditions that affect you mentally and physically, such as lung infections, anxiety, depression, and Many people with asthma accept their symptoms as part of having the condition. But if your asthma is under control, your symptoms have a People with uncontrolled asthma may experience frequent, often daily, symptoms that include: • • • • • Your asthma • use at least two puffs of your • refill quick relief medication two or more times yearly • wake up with asthma symptoms two or more times a month • visit an emergency department frequently • stay in the hospital because of asthma symptoms • have frequent flare-ups and • regularly miss school or work due to asthma symptoms • want to withdraw from daily activities because of your symptoms • are unable to be physically active • rely heavily on caregivers • experience adverse effects on relationships with friends and family • rely more on relief medication than • experience chronic fatigue, inability to walk up stairs, or bre...