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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 78, Asthma.

KEY CONCEPTS

KEY CONCEPTS

  • image Asthma is a highly prevalent disease that is a result of genetic predisposition and environmental interactions; it is one of the most common chronic diseases of childhood.

  • image Asthma is primarily a chronic inflammatory disease of the airways of the lung for which there is no known cure or primary prevention; the immunohistopathologic features include cell infiltration by neutrophils, eosinophils, T-helper type 2 lymphocytes, mast cells, and epithelial cells.

  • image Chronic asthma is characterized by either the intermittent or persistent presence of highly variable degrees of airflow obstruction from airway wall inflammation and bronchial smooth muscle constriction; in some patients, persistent changes in airway structure occur.

  • image Variability in response to medications requires individualization of therapy within existing evidence-based guidelines for management. This is most evident in patients with severe asthma phenotypes.

  • image Ongoing patient education, for a partnership in asthma care, is essential for optimal patient outcomes and includes trigger avoidance and self-management techniques.

  • image The inflammatory process in asthma is treated most effectively with corticosteroids, with the inhaled corticosteroids (ICSs) having the greatest efficacy and safety profile for long-term management.

  • image Bronchial smooth muscle constriction is prevented or treated most effectively with inhaled β2-adrenergic receptor agonists.

PRECLASS ACTIVITY

Preclass Engaged Learning Activity

Watch the five short videos in the series Asthma Management Academy. These videos provide a brief overview of the following topics Module 1 Scope of Asthma, Module 2 Triggers, Module 3 Medications, Module 4 Medication Devices, Module 5 Monitoring and Assessment. The videos are useful to enhance student understanding regarding the COLLECT and ASSESS steps in the patient care process.

INTRODUCTION

Asthma has been known since antiquity, yet it is a disease that still defies precise definition. The word asthma is of Greek origin and means “panting.” More than 2,000 years ago, Hippocrates used the word asthma to describe episodic shortness of breath; however, the first detailed clinical description of the asthmatic patient was made by Aretaeus in the second century.1

The Global Initiative for Asthma (GINA) provides a practical asthma definition2: “Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with variable expiratory airflow limitation.” The National Institutes of Health, National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 (EPR3), adds that the variable airflow obstruction is often reversible either spontaneously or with treatment, although reversibility may not be complete in some patients with asthma.3

The definitions encompass the important heterogeneity of ...

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