EC Microbiology

Introduction: Asthma is a diverse chronic clinical illness that causes inflammation and airway constriction and primarily affects the lower respiratory tract and is characterized by wheezing, dyspnea, and coughing that may be episodic or ongoing. It frequently manifests in childhood and is frequently accompanied by ailments like eczema and hay fever. This activity describes the diagnosis, management, and involvement of the interprofessional team in the care of patients with asthma. These signs and the spirometry-based proof of reversible airway blockage are necessary for the diagnosis of asthma. It is helpful to identify allergy sensitivities that are clinically significant. While daily inhaled corticosteroids are the gold standard of therapy for persistent asthma, inhaled short-acting 2-agonists can quickly relieve acute symptoms. For patients for whom inhaled corticosteroids alone are not sufficient, combination therapy with long-acting 2-agonists is useful. Inhaled long-acting 2-agonists should not be used exclusively. Long-acting muscarinic antagonists (such as tiotropium) and biological medicines that target proteins involved in the etiology of asthma are further controller strategies (e.g. omalizumab, mepolizumab, reslizumab).

Aim of the Study: The purpose of the literature review is to understand various investigations, differential diagnoses, and treatments of asthma.

Methodology: The present study is a comprehensive research of PUBMED since the year 2011 to 2022.

Conclusion: Variable airway obstruction, airway hyperresponsiveness, and airway inflammation are hallmarks of asthma. Avoiding aggravating environmental factors, having access to short-acting 2-agonists for quick symptom relief, and using inhaled corticosteroids on a daily basis are all necessary for the management of chronic asthma. In cases of moderate and severe asthma, additional controller drugs, such as long-acting bronchodilators and biologics, can be needed. In general, patients with severe asthma benefit from speaking with an asthma expert to discuss possible additional treatments, such as injectable biologics.

Keywords: Asthma; Airway Obstruction; Wheezing; Bronchodilators; Chest X-Ray

1. Global Initiative for Asthma. Global Strategy for asthma management and prevention (2015).
2. Ray A., et al. “Emerging molecular phenotypes of asthma”. American Journal of Physiology-Lung Cellular and Molecular Physiology2 (2015): L130-L140.
3. Tripple JW., et al. “Biologic therapy in chronic obstructive pulmonary disease”. Immunology and Allergy Clinics2 (2017): 345-355.
4. McCracken JL., et al. “Diagnosis and management of asthma in adults: a review”. The Journal of the American Medical Association 3 (2017): 279-290.
5. Horak F., et al. “Diagnosis and management of asthma–Statement on the 2015 GINA Guidelines”. Wiener Klinische Wochenschrift15 (2016): 541-554.
6. Pijnenburg MW., et al. “Monitoring asthma in children”. European Respiratory Journal4 (2015): 906-925.
7. Hashmi M F., et al. “Asthma”. In Stat Pearls. Stat Pearls Publishing (2022).
8. Gosens R and Gross N. “The mode of action of anticholinergics in asthma”. European Respiratory Journal4 (2018).
9. Almadhoun K and Sharma S. “Bronchodilators”. In Stat Pearls. Stat Pearls Publishing (2021).
10. Rajan S., et al. “The global initiative for asthma guidelines (2019): change in the recommendation for the management of mild asthma based on the SYGMA-2 trial–A critical appraisal”. Lung India: Official Organ of Indian Chest Society2 (2020): 169.
11. Szefler SJ., et al. “Management of asthma based on exhaled nitric oxide in addition to guideline-based treatment for inner-city adolescents and young adults: a randomised controlled trial”. The Lancet9643 (2008): 1065-1072.
12. Price D., et al. “Leukotriene antagonists as first-line or add-on asthma-controller therapy”. New England Journal of Medicine18 (2011): 1695-1707.
13. McCracken J., et al. “Biologic therapy in the management of asthma”. Current Opinion in Allergy and Clinical Immunology4 (2016): 375.
14. National Asthma Education, Prevention Program (National Heart, Lung, Blood Institute). Second Expert Panel on the Management of Asthma, National Heart, Lung, and Blood Institute. National Asthma Education Program. Expert Panel on the Management of Asthma. (1998). Expert panel report 2: guidelines for the diagnosis and management of asthma. National Institutes of Health, National Heart, Lung, and Blood Institute (1998).
15. Humbert M., et al. “Omalizumab in asthma: an update on recent developments”. The Journal of Allergy and Clinical Immunology: In Practice5 (2014): 525-536.
16. Busse W., et al. “Omalizumab, anti-IgE recombinant humanized monoclonal antibody, for the treatment of severe allergic asthma”. Journal of Allergy and Clinical Immunology2 (2001): 184-190.
17. Bel EH., et al. “Oral glucocorticoid-sparing effect of mepolizumab in eosinophilic asthma”. New England Journal of Medicine13 (2014): 1189-1197.
18. Ortega HG., et al. “Mepolizumab treatment in patients with severe eosinophilic asthma”. New England Journal of Medicine13 (2014): 1198-1207.