Chronic Asthma Therapy

Kenny Y.C. Kwong; Craig A. Jones

doi:10.1542/pir.20-10-327

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Kenny Y.C. Kwong, MD^*
Craig A. Jones, MD^†

^*Assistant Clinical Professor of Pediatrics, Division of Allergy-Immunology.
^†Assistant Professor of Pediatrics, Chief, Division of Allergy-Immunology, LAC+USC Medical Center, Los Angeles, CA. Dr Jones has received grants from and has served as a speaker and consultant for the following companies: Glaxo-Wellcome, Merck, Schering, Pfizer, and Hoechst Marion Roussel.

OBJECTIVES

Upon completing the article, the reader should be able to:

Describe the symptoms of persistent asthma with chronic airway inflammation.
List the types of medications required by patients who have persistent asthma.
Delineate the coexisting conditions that can exacerbate asthma.
Describe the benefits and risks of inhaled steroids for the treatment of persistent asthma.
List the benefits of an asthma action plan for a patient.

Introduction

During the past 20 years, asthma-related morbidity and mortality have increased in industrialized countries worldwide. This has led to expanded research on the pathophysiology of the disease and the development of more effective therapeutic agents for its control. In addition, national and international organizations have established and disseminated guidelines for the evaluation and treatment of asthma. Despite these efforts, asthma remains a leading cause of pediatric emergency department visits and hospitalizations. However, these trends in outcomes can be reversed through early recognition of disease severity and initiation of appropriate preventive therapy.

Current emphasis in asthma therapy is directed toward accurate assessment of asthma severity, avoidance of environmental risk factors, and appropriate use of agents to control inflammation in the airways. This strategy is based on an improved understanding of the pathogenesis of asthma and an appreciation of the link between airway inflammation, airway hyper-responsiveness, and asthma severity. The pathophysiology of this disease is a complex interplay between inflammation, structural airway changes, and airway responsiveness. Persistent airway inflammation, characterized by the presence of CD4+ lymphocyte subsets (TH2), eosinophils, and mast cells, is considered central to the disease process (Fig. 1⇓) . This inflammation has been associated with an increase in airway responsiveness to various stimuli and pathologic airway changes, including epithelial cell damage, airway edema, airway smooth muscle hypertrophy, mucous gland hypertrophy, and abnormal collagen matrix deposition with thickening of the basement membrane. Long-term …