Asthma Week

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General Information

Asthma Week

Asthma is not a single disease but a syndrome of unknown causes that presents with wide heterogeneity, individual prognosis, and varied response to treatment. Important progress has been made in the last decades regarding our understanding of risk factors, genetic contribution, and environmental influences to asthma pathogenesis. Because asthma prevalence is still increasing in many countries, and it is unlikely that our genetic makeup has sufficiently changed over the past few decades, external factors must be crucial when explaining the rapid increase in the occurrence of asthma. Allergens, viral and bacterial respiratory infections, cigarette smoke, air and occupational pollutants, exercise and cold air, are all known triggers of asthma exacerbations, and their avoidance are critical to prevent asthma episodes. Exciting discoveries on the role of the microbiota (the community of microbes that resides in our lungs, skin, and guts) are providing new insights into the interactions of the lung with these communities, and the potential of their manipulation to alleviate or prevent asthma.

Inflammation and remodeling are key features of asthmatic airways. The latter encompasses changes in the structure of the airway wall thought to occur as a consequence of the chronic inflammatory process and injury. Remodeling includes subepithelial fibrosis, mucous metaplasia, airway smooth muscle hypertrophy and hyperplasia, and presence of myofibroblasts. Remodeling of the nerves and the vasculature has been also reported, and new studies suggest alterations in the lymphatic vessels and the cartilage. Remodeling can appear early in disease, as seen by airway alterations in pediatric asthma.

The gold standard for asthma treatment has been the use of inhaled corticosteroid to control airway inflammation, and beta agonists as rescue medicines to achieve direct broncodilation. However, these interventions are not effective in some asthmatics. Oral steroids, theophylline, leukotriene modifiers, and anticholinergic are drugs used to treat difficult asthma. Bronchial thermoplasty is a relatively new non-pharmacological intervention that ablates smooth muscle abundance and provides improvement in quality of life of certain severe persistent adult asthmatics.

As basic and clinical research on asthma continues, novel pathways and targets are revealed, which would not only assist in disease classification but would better guide diagnosis and therapy. Asthma endotypes are proposed subtypes that are defined by distinct genetic, pharmacologic, physiologic, biologic, and/or immunologic pathophysiological mechanisms. Endotypes promise to be useful for disease management, clinical study design and drug development. Recent approved medications that include antibodies against IgE, cytokines and some cytokine receptors have shown effectiveness in particular populations of asthma patients. These biologics represents a shift towards targeting the source and not the symptoms of asthma. Ultimately, multidisciplinary efforts for discovery of effective biomarkers to select responsive patients will ensure delivery of individualized treatment for each asthmatic patient.

Important Facts About Asthma and Allergy

  1. All asthma is serious. It is a chronic and incurable condition, and about 10 people each day die from the disease.

  2. More than 24 million Americans have asthma: this includes 17.7 million adults aged 18 and over (7.4%) and 6.3 million children (8.6%), according to CDC.

  3. The most common symptoms of asthma are coughing (especially at night), wheezing, chest tightness and shortness of breath. Many children also experience frequent colds that settle in their chest.

  4. About 1 in 10 people experience asthma-related coughing or shortness of breath during or shortly after physical activity.