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  • Image not available. Asthma is a disease of increasing prevalence that is a result of genetic predisposition and environmental interactions; it is one of the most common chronic diseases of childhood.
  • Image not available. 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 not available. 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 not available. The inflammatory process in asthma is treated most effectively with corticosteroids, with the inhaled corticosteroids having the greatest efficacy and safety profile for long-term management.
  • Image not available. Bronchial smooth muscle constriction is prevented or treated most effectively with inhaled β2-adrenergic receptor agonists.
  • Image not available. 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 not available. Ongoing patient education, for a partnership in asthma care, is essential for optimal patient outcomes and includes trigger avoidance and self-management techniques.

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

  • 1. List at least six factors that can trigger asthma symptoms in patients with asthma.
  • 2. Describe the four primary pathophysiologic events that lead to airways obstruction in asthma.
  • 3. Describe the symptoms that patients with asthma are likely to experience.
  • 4. Describe the characteristics that classify a patient as having intermittent, mild persistent, moderate persistent, and severe persistent asthma.
  • 5. State the NAEPP’s recommendations for the treatment of intermittent, mild persistent, moderate persistent, and severe persistent asthma in adults and children 5 to 11 years old, and younger than 5 years old.
  • 6. Describe the NAEPP’s recommended therapy for exercise-induced bronchospasm.
  • 7. Describe the appropriate technique for using a metered dose-inhaler (MDI) and an MDI with a spacer/holding chamber.
  • 8. Describe the appropriate technique for using a breath activated dry-powder inhaler (DPI) device.
  • 9. State at least two determinants of lung delivery for MDIs, DPIs, nebulizers, and spacer devices.
  • 10. Describe the recommended therapy for an acute exacerbation of asthma at home, in the emergency department, and in the hospital.
  • 11. Describe how to monitor patients in the hospital with an acute exacerbation of asthma for both efficacy of therapy and potential side effects from therapy.
  • 12. List the possible systemic effects of β2-agonists.
  • 13. List at least four potential systemic adverse effects from high-dose inhaled corticosteroids.
  • 14. Describe the differences in efficacy between inhaled corticosteroids and leukotriene modifiers.
  • 15. List two advantages of combination therapy with inhaled corticosteroids and long-acting inhaled β2-agonists over increased dose of inhaled corticosteroids.

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 ...

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