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Asthma

Last update Thursday 07 April 2016

Asthma is a chronic inflammatory disease, which can occur at any age. Diagnosis is based on characteristic symptoms and variable airflow limitation. Symptoms (shortness of breath, wheeze and cough) vary considerably over time and are triggered by multiple factors (allergen, viral infections, exercise, emotions or irritants). Asthma-related comorbidities are rhinosinusitis, gastroesophageal reflux, obesity, obstructive sleep apnea, depression and anxiety. Spirometry is helpful to assess bronchodilator reversibility (increase in FEV1 >12% and >200mL). Exacerbation is an acute worsening of symptoms treated with oral corticosteroid (OCS) short course. The objectives of management are symptom control, exacerbations reduction and lung function normalization. Inhaled short-acting beta-2 agonist (SABA) is the major class of bronchodilator used for symptoms relief. Inhaled corticosteroid (ICS) is the first-line controller therapy. Add-on therapies include long-acting beta-2 agonist (LABA), leukotriene receptor antagonist and long-acting muscarinic receptor antagonist (LAMA). The options for severe asthma treatment are anti-IgE and long-term OCS.

Chronic obstructive pulmonary disease (COPD) is characterized by a chronic inflammatory response to noxious particles or gases. Common symptoms include chronic cough and sputum production followed by exertional dyspnea. COPD develop usually after the age of 40 years in patients with a smoking history of at least 20 pack-years. Spirometry is required to detect persistent airflow limitation (post-bronchodilator FEV1/FVC < 0.70). COPD patients are at increased risk for cardiovascular diseases, osteoporosis, respiratory infections, depression, diabetes, and lung cancer. Frequency of exacerbations, lung function decline and comorbidities contribute to the disease severity. Smoking cessation is essential in slowing the progression of COPD. Inhaled SABAs are prescribed on as-needed basis to reduce symptoms. Long-acting inhaled bronchodilators (LABA, LAMA) prevent exacerbations and improve symptoms and quality of life. Training programs can increase exercise tolerance. Patients with pronounced hypoxemia benefit from long-term administration of oxygen (> 15 hours per day).