Current Trends in Asthma

Park, Yong Mean

Abstract

Asthma is a complex genetic disorder that is characterized by airway inflammation and reversible airflow obstruction. Asthma is increasing in prevalence worldwide as a result of factors associated with a western lifestyle. The heterogeneous nature of the clinical manifestation 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 airway may also occur over time. Choosing appropriate medications depends on the disease severity (mild 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 age of onset (infancy, childhood, adulthood). Early recognition and early intervention for childhood asthma is an issue of great interest, and new information is forthcoming at a rapid pace. Current asthma guidelines identify inhaled corticosteroids as the preferred initial long-term control therapy even in young children.