Chapter 15. Asthma

• 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.
• 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.
• 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.
• 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.
• Bronchial smooth muscle constriction is prevented or treated most effectively with inhaled β2-adrenergic receptor agonists.
• 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.
• Ongoing patient education, for a partnership in asthma care, is essential for optimal patient outcomes and includes trigger avoidance and self-management techniques.

On completion of this 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 airway 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.

16. Describe the controversy surrounding the use of combination inhaled corticosteroids and long-acting inhaled β2-agonists.

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 ...