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

2. Asthma

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

4. Disclosures
I have no disclosures.

5. 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.

6. 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.

7. 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.

8. 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

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

10. 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

12. 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.

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

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

18. Treatment
Home monitoring with Peak Flow
Asthma Action Plan

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

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

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

22. 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 May 12;374(19):
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