Allergic Disorders
6. Asthma,☆☆

https://doi.org/10.1067/mai.2003.94Get rights and content

Abstract

The increasing incidence and prevalence of asthma in many parts of the world continue to make it a global health concern. The heterogeneous nature of the clinical manifestations and therapeutic responses of asthma in both adult and pediatric patients indicate that it may be more of a syndrome rather than a specific disease entity. Numerous triggering factors including viral infections, allergen and irritant exposure, and exercise, among others, complicate both the acute and chronic treatment of asthma. Therapeutic intervention has focused on the appreciation that airway obstruction in asthma is composed of both bronchial smooth muscle spasm and variable degrees of airway inflammation characterized by edema, mucus secretion, and the influx of a variety of inflammatory cells. The presence of only partial reversibility of airflow obstruction in some patients indicates that structural remodeling of the airways may also occur over time. Choosing appropriate medications depends on the disease severity (intermittent, mild persistent, moderate persistent, severe persistent), extent of reversibility, both acutely and chronically, patterns of disease activity (exacerbations related to viruses, allergens, exercise, etc), and the age of onset (infancy, childhood, adulthood). (J Allergy Clin Immunol 2003;111:S502-19.)

Keywords

Airway hyperresponsiveness
allergy
asthma
β-agonists
exacerbation
exercise-induced asthma
IgE
inflammation
inhaled corticosteroids
virus

Abbreviations

COX
Cyclo-oxygenase
EIB
Exercise-induced bronchospasm
GERD
Gastroesophageal reflux disease
GR
Glucocorticoid receptor
ICS
Inhaled corticosteroids
MDI
Metered-dose inhaler
NSAID
Nonsteroidal anti-inflammatory drug
PEF
Peak expiratory flow
RSV
Respiratory syncytial virus

Cited by (0)

Supported by NIH Grants 1PO1AI50500, 2P50HL56396, and 1RO1HL61879.

☆☆

Reprint requests: Robert F. Lemanske, Jr, MD, University of Wisconsin Hospital, 600 Highland Ave, K4/916, Madison, WI 53792.

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