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Asthma Management Handbook 2006

April 29th, 2009

This book contains:

updated diagnostic, management and prescribing guidelines
expanded material on asthma and allergy, exercise-induced asthma, occupational asthma, asthma in pregnancy and in older people, and comorbidities
more detail on diet and complementary medicine
new chapters on smoking cessation and asthma prevention
practical advice on providing structured asthma care in the primary care setting.

Sample

Definition of asthma

Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment.

The inflammation also causes an associated increase in the existing bronchial hyperresponsiveness to a variety of stimuli.10

Airflow obstruction (excessive airway narrowing) in asthma is the result of contraction of the airway smooth muscle and swelling of the airway wall due to:

smooth muscle hypertrophy and hyperplasia

inflammatory cell infiltration

oedema

goblet cell and mucous gland hyperplasia

mucus hypersecretion

protein deposition including collagen

epithelial desquamation.

This inflammatory process can cause permanent changes in the airways. Long-term changes include increased smooth muscle, increase in bronchial blood vessels, thickening of collagen layers and loss of normal distensibility of the airway.

Potential triggers for the inflammatory process in asthma include allergy, viral respiratory infections, gastrooesophageal reflux disease (GORD), irritants such as tobacco smoke, air pollutants and occupational dusts, gases and chemicals, certain drugs, and non-specific stimuli such as cold air exposure and exercise.

Education of people with asthma about the nature of the disease – that it is more than bronchospasm, and is an inflammatory disease – helps them gain a greater understanding of the need for separate types of medication for asthma management:

bronchodilator (also referred to as reliever) medication

anti-inflammatory (also referred to as preventer) medication

long-acting beta2 agonist (also known as symptom controller) medication usually prescribed in combination with an inhaled corticosteroid (ICS) preventer.

Combination medications consist of an ICS and a symptom controller in a single inhaler device. In addition, education about other measures to improve asthma control is important:

allergen avoidance/control

use of a written asthma action plan

smoking cessation, diet and exercise (including specific management of exercise-induced asthma if required).