Asthma is a chronic inflammatory disease causing breathing problems due to the narrowing of the airways. It has been known since ancient times (“Asthma” is a Greek word meaning ”panting”) and it is estimated that over 30 million people in Europe and 300 million worldwide are affected by asthma. Asthma symptoms include recurrent episodes of wheezing, shortness of breath, chest tightness and cough, triggered by different factors. In allergic asthma – the most common type– symptoms are triggered by exposure to “allergens”, such as pollen, house-dust mite, pets and moulds. Other asthma triggers include viral infections, exercise, gastro-esophageal reflux, some medications (in particular aspirin) and psychological factors.
Occupational asthma is caused by various exposures in the workplace. Asthma affects both adults and children and can be a serious disease. However, asthmatic patients, if correctly treated, should live a normal life.
The diagnosis of asthma is made based on symptoms (wheezing, chest tightness, difficulty breathing and cough). Patients with asthma will also show reversibility (airways respond to a reliever inhaler) and or bronchial hyperresponsiveness (twitchiness in airways). Spirometry is a test for assessing lung function and diagnosing asthma. If a patient is given a short-acting reliever (i.e.salbutamol) and further spirometry is performed with good improvement, then reversibility is demonstrated and the diagnosis of asthma is suggested. In the case of normal spirometry, a challenge test using an inhalation of a bronchoconstriction agent (i.e. Methacholine or Histamine) is useful to show a higher level of bronchial responsiveness. If there is evidence of it, the diagnosis of asthma is likely. Other tests that may help the doctor diagnose asthma are non-invasive tests for assessing bronchial inflammation (i.e. exhaled nitric oxide measurement or induced sputum analysis).
The goal of asthma management is to maintain asthma under control, including (daytime/nocturnal symptoms, limitation of activities, need for reliever treatment, lung function) and prevent exacerbations (severe attack of asthma) and reduce decline in lung function. Each patient should be assessed to establish his or her level of asthma control. If asthma is not controlled on the current regimen, treatment should be stepped up. In general patients should take action to avoid the trigger factors causing their asthma symptoms (e.g. Tobacco smoke airborne allergens and drugs, foods, and additives known to cause symptoms). Reliever or rescue medications should be provided for quick relief of symptoms. Increased use of rescue medications indicates that asthma is not well controlled and that a medical review is required. Many patients need daily preventive medicines to control symptoms and prevent attacks.
- Inhaled glucocorticosteroids (ICS) are the most effective controller medications currently available.
- Leukotriene receptor antagonists are not as effective as low doses of ICS. They may be of benefit in asthma patients with rhinitis.
- When low dose ICS is not sufficient to achieve asthma control, the combination of ICS and long acting ß2-agonists (LABA) is the preferred option. The use of LABA alone is not recommended.
- Anti-IgE Omalizumab is recommended in patients with severe allergic asthma that remain symptomatic despite treatment with high dose ICS.
- Oral glucocorticosteroids may be required for severe uncontrolled asthma. They are important in the treatment of severe acute exacerbation.
- Ongoing monitoring is essential to maintain asthma control and/or modify treatment. After an exacerbation, a follow-up visit should be performed within one month.
From the patient’s point of view, coping with asthma has often begun in early life. In childhood, patients often have a multi-organ disease with skin (atopic dermatitis), nose and eyes (allergic rhinitis and conjunctivitis), and airway (asthma) involvement. This can be difficult to cope with and if not well managed can lead to school absenteeism. School action plans can help the child remain in school and maximise their learning potential. Children and adolescents often have to deal with food and airborne allergens avoidance, treatments at school with action plans alternating with periods of school absenteeism. In most adults with mild to moderate asthma, the disease can be well controlled with safe and effective medication.
For patients with severe form of the disease, coping can be harder due to the limitation in daily life because of breathlessness and other symptoms, and side effects of the systemic corticosteroids which are sometimes needed to achieve symptoms control. Novel treatments are urgently needed for these patients.
From the physician’s point of view (general practitioner, allergist, pulmonologist or paediatrician) dealing with asthma will involve continuously educating the patients about the daily management of their disease: identifying and avoiding trigger factors, adapting treatments with written personalised action plans and evaluating regularly respiratory function.
From the researcher’s point of view, dealing with asthma includes exploring pathways leading to disease prevention in at-risk families (none of which have proved their efficacy to date) and investigating the pathophysiology of the disease to identify potential targets for future treatments.
For the society, dealing with asthma is team work between large networks comprising patients, physicians and researchers to with the aim to develop treatments and strategies to cure and prevent asthma.