Get ready to energize your life?
Top Offers Only Today
Support your health and step-up your mental focus
post in: Health, Video Date:28 Sep 2017, 16:42 views:1101
Although much progress has been made in our understanding of bronchial asthma in recent years, asthma remains a commonly encountered condition that challenges physicians in the office setting as well as in acute care settings.
1-3, although the 1980s were characterized by increases in asthma morbidity and mortality in the United States, these trends reached a plateau in the 1990s, and asthma mortality rates have declined since 1999. In recent decades, a surge in asthma prevalence also occurred in the United States and other Western countries; data suggest this trend may also be reaching a plateau. Tremendous progress has been made in our fundamental understanding of asthma pathogenesis by virtue of invasive research tools such as bronchoscopy, bronchoalveolar lavage, airway triggers biopsy, and measurement of airway gases, although the cause of airway inflammation remains obscure.
The knowledge that asthma is an inflammatory disorder has become fundamental to our definition of asthma. Evidence-based practice guidelines have been disseminated with a goal of encouraging more frequent use of anti-inflammatory therapy to improve asthma outcomes. To this extent, there has been much emphasis on early diagnosis and longitudinal care of patients with asthma, along with ensuring adherence to recommended therapies.
In this context, there have been advances in our pharmacologic armamentarium in both chronic and acute therapy with the development and approval of novel medications. Yet, as exciting as this revolution has been in asthma research and practice, a number of controversies persist, and further fundamental developments in novel therapeutics are imminent.
This review of asthma for the practicing clinician summarizes these developments, including an update on the definition of asthma, its epidemiology, natural history, cause, and pathogenesis. In addition, there is a discussion of the appropriate diagnostic evaluation of asthma and co-occurring conditions, management of asthma, and newer therapies for the future.
Definitions, asthma is a chronic, episodic disease of the airways that is best viewed as a syndrome. In 1997, the National Heart, Lung, and Blood Institute (nhlbi) included the following features as integral to the definition of asthma 4 : recurrent episodes of respiratory symptoms; variable airflow obstruction that is often reversible, either spontaneously or with treatment; presence of airway hyperreactivity; and.
All of these features need not be present in any given asthmatic patient.
The Expert Panel Report (EPR) 3 guidelines, 5 issued in 2007, state that the immunohistopathologic features of asthma include inflammatory cell infiltration involving neutrophils (especially in sudden-onset, fatal asthma exacerbations; occupational asthma; and patients who smoke eosinophils, and lymphocytes, with activation of mast cells and.
Heterogeneity in the pattern of asthma inflammation has been recognized, consistent with the interpretation that phenotypic differences exist that influence treatment response. The inflammation of asthma leads to an associated increase in the existing bronchial hyperresponsiveness to a variety of though the absolute minimum criteria to establish a diagnosis of asthma are not widely agreed on, the presence of airway hyper-reactivity can be regarded as a sine.
Epidemiology and natural history, several government agencies have been charged with surveillance for asthma, including the nhlbi's National Asthma Education and Prevention Program (naepp the Department of Health and Human Services (Healthy People 2010 and the Centers for Disease Control and Prevention (CDC). Data published by the CDC indicate that approximately 20 million Americans have asthma.