Johnathan Grant D.O. FACOI Asthma Review Johnathan Grant D.O. FACOI

Asthma

Objectives 1. Define asthma 2.Diagnosis asthma 3. Treat asthma

Disclosures I have no disclosures.

Introduction Asthma is one of the oldest known diseases, but it has only been recognized as a major public health problem since the mid 1970s. The prevalence of asthma has increased dramatically and asthma is now recognized as a major cause of disability, medical expense, and preventable death.

Definition While asthma is readily recognized in its classic presentation, with cough, wheeze, and shortness of breath brought on by common triggers and relieved by bronchodilators, it is difficult to provide a definition that distinguishes asthma from similar and overlapping conditions; one acceptable to clinicians, physiologists, and pathologist.

Definition The National Asthma Education and Prevention Program has defined asthma as “a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms of airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation.

Risk Factors Asthma may develop at any age, although new-onset asthma is less frequent in older adults compared to other age groups. 1. Hygiene Hypothesis: (Th)1-mediated immune response with down regulation of (Th)2-mediated response. 2. Infections: Viral 3. Atopy: Allergies and Eczema

Risk Factors 4. Obesity: Adipose tissue hormones 5. Genetics: TLR4 polymorphisms, IL-4 and IL-5 6. Tobacco and Environmental Exposures

Clinical Features Asthma triggers ( Allergens, exercise, viral infection, smoke, fumes etc..) that cause 1. Wheeze 2. Cough often dry and at night 3. Shortness of breath

Clinical Features These symptoms can occur within five minutes of the exposure or may develop afterwards or may only occur at work making history very important to the diagnosis.

Diagnosis No lab, X-ray, PFT, Nitrogen exhalation test, nor a Methacholine Challenge test will diagnosis asthma.

Treatment Treatment is based on severity of the asthma whether: Mild intermittent, Mild persistent, Moderate persistent, or Severe persistent

Treatment Home monitoring with Peak Flow Asthma Action Plan

Differential Diagnosis 1. Seasonal Allergies/ Allergic Rhinitis 2. Chronic Sinusitis 3. Vocal Cord Dysfunction 4. GERD/ LPR 5. COPD 6. OSA

Differential Diagnosis 7. Bronchiectasis 8. ABPA 9. ANCA Vasculitis 10. Eosinophilic Asthma ( Benralizumab, new, Nucala and Cinqair) 11. Acute/ Chronic Eosinophilic Pneumonia

Differential Diagnosis 12. Aspiration/ Aspiration of foreign body 13. CHF 14. Lung Cancer

References 1. National Asthma Education and Prevention Program: Expert panel report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD: National Heart, Lung, and Blood Institute, 2007. 2. Global Initiative for Asthma. Global strategy for asthma management and prevention ( Updated 2015). 3. Fahy JV, O’Byrne PM. “Reactive airways disease”. A lazy term of uncertain meaning that should be abandoned. Am J Respir Crit Care Med 2001; 163:8222. 4.Serious Asthma Events with Fluticasone plus Salmeterol versus Fluticasone Alone. N Engl J Med. 2016 May 12;374(19):1822-30. 5. The Newspaper of the American College of Chest Physicians; Vol. 12, No.6, June 2017 6. Murray & Nadel’s Textbook of Respiratory Medicine 5th Edition 7. UpToDate