MANAGEMENT OF ASTHMA

Management Of Asthma

Management of Asthma

Globally, asthma acquires a large problem of disease, influencing an approximated 300 million persons. Only recently, however, has the condition been recognized and addressed at the international level through efforts such as the Global Initiative for Asthma (GINA). As more attention is given to asthma and its increasing rates, the global campaign to address this disease and its causes will become more effective and comprehensive.

On the medical spectrum, asthma also requires a “global” perspective, representing a unique intersection of many areas of health. It draws together the fields of pediatrics and adult medicine, affecting certain subgroups in each disproportionately. It lies at the crossroads between preventive medicine, acute care, and chronic disease management. Asthma treatments and technologies involve medical specialties from pulmonology to immunology to infectious disease. Furthermore, looking into the causes of this condition invokes conversations ranging from the social determinants of health and health inequities to environmental health, and toward the genetic susceptibilities underlying asthma.

Coming to a well-accepted definition for asthma has been a difficult task, and has consequently led to the difficulty in describing asthma prevalence on local and national levels, much less on the international level. Asthma, most broadly defined, is a chronic inflammatory disorder of the airways of the respiratory tract, usually diagnosed in childhood. The signs and symptoms of asthma are nonspecific, overlapping with other respiratory and cardiovascular conditions. Cough (especially in the morning and night), wheezing, chest tightness, and intermittent dyspnea are common patient complaints. In addition, there is often an episodic nature of the symptoms, often associated with “triggers” (e.g., dust, mold, or exercise). However, an additional criteria that distinguishes asthma from chronic obstructive pulmonary disorder (COPD), a condition with similar symptoms, is the reversibility of airflow obstruction that occurs with asthma.

The diagnosis of asthma is usually made clinically, based on a patient's symptoms. For population-based estimates, surveys using validated questionnaires that assess patient symptoms have relatively good sensitivity (0.85 for children, 0.80 for adults) and specificity (0.81 for children, 0.97 for adults), using physician assessment as the “gold standard.” Epidemiologic studies, meanwhile, suggest the combination of testing for bronchial hyperresponiveness and the self-report of symptoms (e.g., wheezing). However, Litonjua and Weiss remind us that “Each method of selecting asthma patients has its inherent problems. It is likely that some bias in reporting of cases is present in each group and that the biases in each approach are different.”

Factors Associated With Asthma

The causes and contributing factors to asthma are varied, and often hard to assess. These factors may be broadly defined on a molecular/genetic level, in the context of other health conditions, and through the lens of the social determinants of this condition.

As an inflammatory condition, it is not surprising that mast cells, eosinophils, and lymphocytes are implicated in the immunologic dysregulation that appears to underlie asthma. Drazen summarizes the pathogenesis of asthma as follows: B lymphocytes set off a cascade, via cytokines, that activate mast cells and eosinophils that cause the inflammation of airways, cellular ...