विवरण
GINA advises using short-acting beta2 agonists (SABAs) for children aged six to eleven and as-needed ICS/formoterol for adults to treat patients with mild intermittent asthma as needed. 4 However, the Focused Updates panel did not address this matter and continued to support the use of SABA as required. The whole alveolar surface of the lungs is coated with pulmonary surfactant, a special blend of lipids and proteins that are only found in surfactants. Surfactant is present in upper airway secretions and reaches terminal conducting airways in addition to the alveolar compartment.
सारांश
- Asthma is defined as a chronic inflammatory airway disorder characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and cough, especially at night or early morning, or after allergen exposure. Diagnosis includes assessing symptoms, detailed history, and examination. Guidelines from the Global Initiative for Asthma (GINA) are typically followed for asthma management.
- To assess asthma control in outpatient settings, parameters include daytime symptoms, activity limitations, nocturnal symptoms, short-acting beta2-agonist usage, and lung function, aiding differentiation between controlled, partially controlled, or poorly controlled asthma. Spirometry is the preferred method for lung function testing, assessing reversibility with bronchodilators. Peak expiratory flow rate can also be used, looking for improvements post-bronchodilator.
- For adults and adolescents, asthma management includes a stepwise approach, with the first step involving a controller and preferred reliever combination, often a low-dose inhaled corticosteroid (ICS) plus formoterol. The strategy is adjusted according to symptom control and asthma severity.
- Exacerbations can be triggered by viruses, pollen, pollution, and poor treatment adherence. It's crucial to ensure correct diagnosis, address risk factors, and correct inhaler techniques. Treatment of modifiable risk factors, such as smoking or exposure to allergens, and correcting inhaler technique are essential.
- For severe asthma, biologic therapies are considered based on phenotypes, such as eosinophilic asthma. These therapies include anti-IgE, anti-interleukin-5, and anti-interleukin-4/13 antibodies, targeting specific inflammatory pathways.
- In acute asthma exacerbations, the primary goals are rapid reversal of airflow limitation and correction of hypercapnia or hypoxemia. Supplemental oxygen should be administered, targeting saturation of 93-95% to avoid hypercarbia.
- Initial emergency management involves repeated administration of inhaled beta-2 agonists, such as albuterol, via nebulization. Ipratropium, a short-acting anticholinergic, is added for severe exacerbations. Systemic glucocorticoids are also essential, given orally or intravenously.
- Magnesium sulfate may be considered for life-threatening exacerbations unresponsive to initial therapies. In cases of impending or actual respiratory arrest, non-invasive ventilation (NIV) or invasive mechanical ventilation may be required.
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