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Asthma

Asthma is a disease of airway hyperresponsiveness usually characterized by chronic inflammation, resulting in episodic airway obstruction.

There is lack of a precise defintion of asthma acceptable to clinicians in various disciplines given the lack of definitive biomarkers or lab tests.

GINA definition (2025): Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory > symptoms, such as wheeze, shortness of breath, chest tightness and cough, that vary over time and in intensity, together with variable expiratory airflow.

Objectives

Section titled “Objectives”
  1. In patients of all ages with respiratory symptoms (acute, chronic, recurrent):
    • Include asthma in the differential diagnosis.
    • Confirm the diagnosis of asthma by appropriate use of:
      • history.
      • physical examination.
      • spirometry.
  2. In a child with acute respiratory distress, distinguish asthma or bronchiolitis from croup and foreign body aspiration by taking an appropriate history and doing a physical examination.
  3. In a known asthmatic, presenting either because of an acute exacerbation or for ongoing care, objectively determine the severity of the condition (e.g., with history, including the pattern of medication use, physical examination, spirometry). Do not underestimate severity.
  4. In a known asthmatic with an acute exacerbation:
    • Treat the acute episode (e.g., use beta-agonists repeatedly and early steroids, and avoid under-treatment).
    • Rule out co-morbid disease (e.g., complications, congestive heart failure, chronic obstructive pulmonary disease).
    • Determine the need for hospitalization or discharge (basing the decision on the risk of recurrence or complications, and on the patient’s expectations and resources).
  5. For the ongoing (chronic) treatment of an asthmatic, propose a stepwise management plan including:
    • self-monitoring.
    • self-adjustment of medication.
    • when to consult back.
  6. For a known asthmatic patient, who has ongoing or recurrent symptoms:
    • Assess severity and compliance with medication regimens.
    • Recommend lifestyle adjustments (e.g., avoiding irritants, triggers) that may result in less recurrence and better control.