- A heterogeneous disease characterized as chronic inflammation of the airway (1)
- Common triggers: exercise, allergen-irritant exposure, change in weather, laughter, or viral respiratory infections
- Patient may experience symptoms-free periods alternating with sporadic flare-up (exacerbations).
- Most common asthma phenotypes:
- Allergic asthma: usually present since childhood and has strong family history of allergic diseases
- Nonallergic asthma
- Late-onset asthma: more common in females
- Asthma with fixed airflow limitation: due to airway remodeling
- Asthma with obesity
- Asthma severity is assessed retrospectively from treatment required to control symptoms.
- Mild asthma: well controlled with Step 1 or 2 treatment (i.e., with as-needed ICS-formoterol alone or with low-intensity maintenance controller treatment)
- Moderate asthma: well controlled with Step 3 or 4 treatment (i.e., low- or medium-dose ICS-LABA)
- Severe asthma: remains “uncontrolled” with optimized treatment with high dose ICS-LABA or that requires high dose ICS-LABA to prevent it from becoming “uncontrolled”
Traffic-related air pollution may be attributable to 13% of global asthma incidence.
Asthma affects 262 million individuals worldwide.
- 455,000 deaths worldwide reported in 2019 (2)
- African Americans are 3 times more likely to die from asthma
- Asthma affects about 10% of children aged 5 to 18 years in the United States.
- Asthma prevalence is greater in boys than girls; however, in adults, women are more affected.
- Obesity is associated with increased prevalence and incidence of asthma.
- Rate of asthma deaths: largest among those aged ≥65 years.
Etiology and Pathophysiology
Airway hyperreaction begins with inflammatory cell infiltration and degranulation, subbasement fibrosis, mucus hypersecretion, epithelial injury, significant smooth muscle hypertrophy and hyperreactivity, angiogenesis that then leads to intermittent airflow obstruction due to reversible bronchospasm.
Genetic association with increased interleukin (IL) or IgE production and airway hyperresponsiveness leading to asthma
- Host factors: genetic predisposition, sex, obesity, preterm or small for gestational age (SGA)
- Environmental: viral infections, animal and airborne allergens, tobacco smoke exposure, e-cigarette use, pollution, stress
- Aspirin or NSAIDs hypersensitivity
- Persons with food allergies and asthma are at increased risk for fatal anaphylaxis from those foods.
Commonly Associated Conditions
- Atopy: eczema, allergic conjunctivitis, allergic rhinitis
- Obesity (associated with higher asthma rates)
- Gastroesophageal reflux disease (GERD)
- Obstructive sleep apnea (OSA)
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