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Exacerbations of asthma are defined as acute or subacute episodes of progressively worsening shortness of breath, cough, wheezing, and chest tightness, or some combination of these symptoms. Exacerbations are characterized by decreases in expiratory airflow that can be documented and quantified by simple measurement of lung function.
As with clinical manifestations of asthma, these episodes vary widely among and within individuals over time.
Studies suggest that a complex interaction between host factors, particularly genetics, and environmental factors early in life during immune system development may lead to altered immune system response and the expression of asthma.
Patients with atopy are genetically predisposed to develop an IgE-mediated response to common environmental allergens. Atopy is the strongest predisposing factor for developing asthma.
More than half of the asthma cases in the US population age 6 to 59 years were attributable to atopy. Therefore, blocking or preventing the atopic component could reduce the prevalence of asthma in the US.
The chronic inflammation that underlies the pathophysiology of asthma is mediated by a variety of inflammatory cell types. Airway inflammation involves an interaction of many cell types and mediators within the airways.
Increased numbers of mast cells found in bronchial smooth muscle may be related to airway hyperresponsiveness.
Macrophages are activated by allergens through IgE receptors to release inflammatory mediators and cytokines that amplify the inflammatory response.
Most, not all, people with asthma have elevated numbers of eosinophils in their airways which release many inflammatory mediators, including cytokines. Increases in eosinophils can indicate greater asthma severity.
Pharmacologic therapy is used to prevent and control asthma symptoms, reduce the frequency and severity of asthma exacerbations, and reverse airflow obstruction. Asthma medications are categorized into 2 general classifications: quick-relief and long-term control medications. Quick-relief medications are taken to provide prompt reversal of acute airflow obstruction and relief of accompanying bronchoconstriction. Long-term control medications are taken daily on a long-term basis to help achieve and maintain control of persistent asthma. Patients who have persistent asthma require medication from both classifications.
The classes of asthma medications, including short-acting beta2-agonists (or SABAs), inhaled corticosteroids (or ICSs), inhaled corticosteroid/long-acting beta2-agonist (or ICS/LABA) combinations, leukotriene modifiers, and other treatments such as theophylline, oral corticosteroids, and omalizumab.
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