Chapter 131: Asthma
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DEFINITION AND EPIDEMIOLOGY
Asthma is a syndrome characterized by airflow obstruction that varies both spontaneously and with specific treatment. Chronic airway inflammation causes airway hyperresponsiveness to a variety of triggers, leading to airflow obstruction and respiratory symptoms including dyspnea and wheezing. Although asthmatics typically have periods of normal lung function with intermittent airflow obstruction, a subset of pts develop chronic airflow obstruction.
The prevalence of asthma has increased markedly over the past 30 years. In developed countries, approximately 10% of adults and 15% of children have asthma. The majority of asthmatics have childhood-onset disease. Most asthmatics have atopy, and they often have atopic dermatitis (eczema) and/or allergic rhinitis. A minority of asthmatic pts do not have atopy (negative skin prick tests to common allergens and normal serum total IgE levels). These individuals, occasionally referred to as intrinsic asthmatics, often have adult-onset disease. Occupational asthma can result from a variety of chemicals, including toluene diisocyanate and trimellitic anhydride, and often has onset in adulthood.
Asthmatics can develop increased airflow obstruction and respiratory symptoms in response to a variety of different triggers. Inhaled allergens can be potent asthma triggers for individuals with specific sensitivity to those agents. Viral upper respiratory infections (URIs) commonly trigger asthma exacerbations. β-Adrenergic blocking medications can markedly worsen asthma symptoms and should typically be avoided in asthmatics. Exercise often triggers increased asthma symptoms, which usually begin after exercise has ended. Other triggers of increased asthma symptoms include air pollution, cold air, occupational exposures, and stress.