The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

New Guidelines for Asthma Management

천식 치료의 최신 지견

  • Kwon, Soon Seog (Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Catholic University of Korea College of Medicine)
  • 권순석 (가톨릭대학교 의과대학 호흡기 알레르기내과)
  • Published : 2014.08.01
⟨ Previous Next ⟩

Abstract

Asthma is a chronic airway inflammatory disease that is characterized by symptoms such as shortness of breath, wheezing, chest tightness, and nighttime or early morning coughing, together with variable expiratory airflow limitation. Asthma is a heterogeneous disease involving various underlying processes that have been described based on causal or exacerbating factors, the pattern of airflow obstruction, severity of disease, pattern of cellular inflammation, and structural changes among patients with asthma. However, there is considerable overlap among these clinical variants, which are not correlated strongly with specific pathological processes or treatment responses. The Global Strategy for Asthma Management and Prevention 2014 (GINNA 2014) emphasizes the importance of confirming the diagnosis to minimize both under- and over-treatment with respect to the heterogeneity of asthma. To assess asthma control, it is necessary to assess not only the symptom control but also the future risks of an adverse outcome. Lung function is the most used indicator of future risk. This article reviews the treatment of adult asthma, including patients already receiving treatment according to GINA 2014 and the Health Insurance Review and Assessment Service.

Keywords

References

  1. Martinez FD, Vercelli D. Asthma. Lancet 2013;382:1360-1372. https://doi.org/10.1016/S0140-6736(13)61536-6
  2. Lotvall J, Akdis CA, Bacharier LB, et al. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome. J Allergy Clin Immunol 2011;127:355-360. https://doi.org/10.1016/j.jaci.2010.11.037
  3. Global Strategy for Asthma Management and Prevention: 2014 Global Initiative for Asthma (GINA) [Internet]. Vancouver: Global Initiative for Asthma, c2014 [cited 2014]. Available from: http://www.ginasthma.org., Data last updated. 2014
  4. Taylor DR, Bateman ED, Boulet LP, et al. A new perspective on concepts of asthma severity and control. Eur Respir J 2008;32:545-554. https://doi.org/10.1183/09031936.00155307
  5. Aroni R, Goeman D, Stewart K, et al. Enhancing validity: what counts as an asthma attack? J Asthma 2004;41:729-737. https://doi.org/10.1081/JAS-200027980
  6. Meltzer EO, Busse WW, Wenzel SE, et al. Use of the Asthma Control Questionnaire to predict future risk of asthma exacerbation. J Allergy Clin Immunol 2011;127:167-172. https://doi.org/10.1016/j.jaci.2010.08.042
  7. Haselkorn T, Fish JE, Zeiger RS, et al. Consistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in the Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) Study. J Allergy Clin Immunol 2009;124:895-902.e1-4. https://doi.org/10.1016/j.jaci.2009.07.035
  8. Suissa S, Ernst P, Boivin JF, et al. A cohort analysis of excess mortality in asthma and the use of inhaled beta-agonists. Am J Respir Crit Care Med 1994;149(3 Pt 1):604-610. https://doi.org/10.1164/ajrccm.149.3.8118625
  9. Ernst P, Spitzer WO, Suissa S, et al. Risk of fatal and near-fatal asthma in relation to inhaled corticosteroid use. JAMA 1992;268:3462-3464. https://doi.org/10.1001/jama.1992.03490240070039
  10. Melani AS, Bonavia M, Cilenti V, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med 2011;105:930-938. https://doi.org/10.1016/j.rmed.2011.01.005
  11. Osborne ML, Pedula KL, O'Hollaren M, et al. Assessing future need for acute care in adult asthmatics: the Profile of Asthma Risk Study: a prospective health maintenance organization-based study. Chest 2007;132:1151-1161. https://doi.org/10.1378/chest.05-3084
  12. Sturdy PM, Victor CR, Anderson HR, et al. Psychological, social and health behaviour risk factors for deaths certified as asthma: a national case-control study. Thorax 2002;57:1034-1039. https://doi.org/10.1136/thorax.57.12.1034
  13. Fitzpatrick S, Joks R, Silverberg JI. Obesity is associated with increased asthma severity and exacerbations, and increased serum immunoglobulin E in inner-city adults. Clin Exp Allergy 2012;42:747-759. https://doi.org/10.1111/j.1365-2222.2011.03863.x
  14. Pawankar R, Bunnag C, Khaltaev N, Bousquet J. Allergic rhinitis and its impact on asthma in Asia Pacific and the ARIA update 2008. World Allergy Organ J 2012;5(Suppl 3):S212-217. https://doi.org/10.1186/1939-4551-5-S3-S212
  15. Burks AW, Tang M, Sicherer S, et al. ICON: food allergy. J Allergy Clin Immunol 2012;129:906-920. https://doi.org/10.1016/j.jaci.2012.02.001
  16. Belda J, Giner J, Casan P, Sanchis J. Mild exacerbations and eosinophilic inflammation in patients with stable, well-controlled asthma after 1 year of follow-up. Chest 2001;119:1011-1017. https://doi.org/10.1378/chest.119.4.1011
  17. Murphy VE, Clifton VL, Gibson PG. Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes. Thorax 2006;61:169-176. https://doi.org/10.1136/thx.2005.049718
  18. Turner MO, Noertjojo K, Vedal S, Bai T, Crump S, Fitzgerald JM. Risk factors for near-fatal asthma: a case-control study in hospitalized patients with asthma. Am J Respir Crit Care Med 1998;157(6 Pt 1):1804-1809. https://doi.org/10.1164/ajrccm.157.6.9708092
  19. Miller MK, Lee JH, Miller DP, Wenzel SE; TENOR Study Group. Recent asthma exacerbations: a key predictor of future exacerbations. Respir Med 2007;101:481-489. https://doi.org/10.1016/j.rmed.2006.07.005
  20. O'Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW; START Investigators Group. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med 2009;179:19-24. Erratum in: Am J Respir Crit Care Med 2010;182:983-984. https://doi.org/10.1164/rccm.200807-1126OC
  21. Lange P, Parner J, Vestbo J, Schnohr P, Jensen G. A 15-year follow-up study of ventilatory function in adults with asthma. N Engl J Med 1998;339:1194-1200. https://doi.org/10.1056/NEJM199810223391703
  22. Ulrik CS. Outcome of asthma: longitudinal changes in lung function. Eur Respir J 1999;13:904-918. https://doi.org/10.1034/j.1399-3003.1999.13d35.x
  23. Foster JM, Aucott L, van der Werf RH, et al. Higher patient perceived side effects related to higher daily doses of inhaled corticosteroids in the community: a cross-sectional analysis. Respir Med 2006;100:1318-1336. https://doi.org/10.1016/j.rmed.2005.11.029
  24. Roland NJ, Bhalla RK, Earis J. The local side effects of inhaled corticosteroids: current understanding and review of the literature. Chest 2004;126:213-219. https://doi.org/10.1378/chest.126.1.213
  25. Rosi E, Stendardi L, Binazzi B, Scano G. Perception of airway obstruction and airway inflammation in asthma: a review. Lung 2006;184:251-258. https://doi.org/10.1007/s00408-005-2590-z
  26. Zeiger RS, Baker JW, Kaplan MS, et al. Variability of symptoms in mild persistent asthma: baseline data from the MIAMI Study. Respir Med 2004;98:898-905. https://doi.org/10.1016/j.rmed.2004.02.016
  27. Bateman ED, Harrison TW, Quirce S, et al. Overall asthma control achieved with budesonide/formoterol maintenance and reliever therapy for patients on different treatment steps. Respir Res 2011;12:38. https://doi.org/10.1186/1465-9921-12-38

Cited by

  1. 소아 천식 치료의 국외 보완대체의학 임상 연구 동향 vol.29, pp.3, 2014, https://doi.org/10.7778/jpkm.2015.29.3.001