Asthma Overview

Introduction

• Asthma is a chronic inflammatory respiratory condition characterized by symptoms like dyspnea, cough, and wheezing.
• Diagnosis involves identifying variable expiratory airflow obstruction via spirometry.
• Management focuses on symptom control and prevention of exacerbations through tailored treatment plans.
• Asthma often develops in childhood, influenced by genetic and environmental factors associated with atopy.

Pathophysiology

• Involves airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness.
• Activation of mast cells by cytokines contributes to asthma symptoms.
• Airflow obstruction results from airway narrowing, mucus plugging, and airway remodeling.

Etiology

Genetics

• Genetic factors play a role in asthma development, with associations identified near ORMDL3 and GSDMB genes.
• The EVE Consortium identified TSLP as a susceptibility locus involved in inflammation.

Risk Factors

• Atopy, characterized by the tendency to produce IgE antibodies, is a major risk factor.
• Prenatal factors include maternal smoking and vitamin D deficiency.
• Childhood factors: viral infections, air pollution, obesity.
• Adulthood factors: tobacco smoke, occupational exposure.

Epidemiology

• Affects 260 million individuals globally; prevalence varies by region.
• Asthma-related mortality remains a concern despite declining death rates.
• In the U.S., asthma prevalence differs across demographics, with higher rates among Black individuals.

Diagnostic Evaluation

Spirometry

• Key diagnostic tool assessing FEV1 and FVC ratios.
• Positive bronchodilator response (BDR) indicates asthma.

Additional Testing

• Bronchoprovocation tests (e.g., methacholine challenge) for atypical symptoms.
• Peak flow meter and exhaled nitric oxide tests support diagnosis and monitoring.
• Imaging and lab tests help rule out other conditions.

Treatment and Management

Patient Education

• Emphasis on understanding asthma triggers and proper medication use.
• Personalized action plans help manage exacerbations.

Asthma Severity and Treatment

• Managed in a stepwise approach based on severity and frequency of symptoms.
• GINA and NAEPP guidelines provide treatment frameworks.

Acute Exacerbation Management

• Includes fast-acting bronchodilators and oral glucocorticoids.
• Hospitalization and emergency care may be necessary for severe cases.

Complications and Prognosis

• Asthma complications include decreased lung function and medication side effects.
• Prognosis is affected by genetic and environmental factors as well as access to care.

Enhancing Healthcare Team Outcomes

• Effective asthma management requires interprofessional collaboration and communication.
• Regular patient education and monitoring are crucial for reducing morbidity and enhancing patient outcomes.