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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
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For the Chapter in the Schwinghammer Handbook, please go to Chapter 79, Asthma.
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KEY CONCEPTS
Asthma is a highly prevalent disease resulting from genetic predisposition and environmental factors; 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.
Chronic asthma is characterized by either the intermittent or persistent presence of variable degrees of airflow obstruction from airway wall inflammation and bronchial smooth muscle constriction; in some patients, persistent changes in airway structure occur.
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 and forming a partnership in asthma care is essential for optimal health outcomes and includes trigger avoidance and self-management techniques.
The inflammatory process in asthma is treated most effectively with corticosteroids, with the inhaled corticosteroids (ICS) having the greatest efficacy and safety with long-term use. ICS may be used in combination with bronchodilators (short-acting or rapid-onset long-acting β2-adrenergic receptor agonists) or with long-acting muscarinic agonists (LAMA) as daily maintenance therapy.
Acute bronchial smooth muscle constriction is prevented or treated most effectively with inhaled short-acting β2-adrenergic receptor agonists (SABA) alone or in combination with ICS; or with rapid-onset, long-acting β2-adrenergic receptor agonists (LABA) in combination with ICS.
Intermittent as-needed SABA with an ICS can be used concomitantly in mild persistent asthma. The combination of formoterol (a LABA) with ICS can be used as daily maintenance and reliever therapy in moderate persistent asthma to reduce exacerbation frequency.
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BEYOND THE BOOK
Watch the five short videos in the series Asthma Management Academy https://www.youtube.com/watch?v=pC2BrtVTYrU. These videos provide a brief overview of the following topics:
The videos are useful to enhance students understanding of the consequences of asthma, triggers, medications, delivery devices, and monitoring. These videos are also useful for patient education.
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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 a person with asthma was made by Aretaeus in the second century.1
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The Global Initiative for Asthma (GINA) provides a practical definition of asthma2: “Asthma is a heterogeneous disease, usually characterized by chronic ...