Asthma – A Quick Review

About this course

Asthma is a chronic respiratory disease that is characterized by inflammation and narrowing of the airways. Symptoms of asthma often begin in childhood and often include cough, shortness of breath, and wheezing. This online learning activity provides an overview of asthma, diagnosis, and treatment and management options.

Learning objectives

• Describe asthma in various populations
• Describe exercise induced bronchospasm
• Review tests and tools useful in diagnosing asthma
• Identify physical presentations of asthma
• Understand treatment and management options of asthma

Course outline

22 sections · finish in any order across devices

1. 1

   Introduction

   Asthma is a chronic disease of the air passages that is characterized by hyper-responsiveness, reversible airway inflammation, and narrowing of the airways. ¹ Asthma occurs in episodes with symptom-free periods and acute exacerbations. Most asthma attacks are short-lived. Asthma is quite common and

   4 min

2. 2

   Childhood Asthma

   In childhood asthma, the lungs and airways can become inflamed when they are triggered by certain factors, including environmental allergens, or respiratory tract infections. ³In children, asthma can cause daily symptoms that interfere with play, sports, school, and sleep. When it is uncontrolled, a

   4 min

3. 3

   Pregnancy Induced Asthma

   Asthma is one of the most common chronic diseases in pregnancy. Asthma exacerbation in pregnancy represents a major clinical problem that can lead to maternal and fetal morbidity and mortality. ⁴

   4 min

4. 4

   Exercise-Induced Bronchoconstriction

   Exercise-Induced bronchoconstriction (EIB) occurs during physical exertion and involves a narrowing of the airways. ⁵ It occurs in 40% to 90% of people with asthma and up to 20% of those without asthma. The benefits of regular exercise are well established, however, people with EIB may avoid physica

   4 min

5. 5

   Severe Asthma

   Severe asthma (status asthmaticus) is a severe form of asthma that is unresponsive treatment. It is the extreme form of asthma exacerbation and is characterized by hypercarbia, hypoxemia, and secondary respiratory failure. ⁷ It is a medical emergency that requires immediate recognition and treatment

   4 min

6. 6

   Obtaining the History and Physical

   People suspected of asthma will usually have a history of coughing or wheezing that is exacerbated by allergens, exercise, cold, or viral infections. ¹˒²They also may have a history of eczema or hay fever and may experience increased symptoms at night and decreased symptoms during the day. When acut

   4 min

7. 7

   Exercise Challenge Testing

   Exercise challenge testing is an effective means of diagnosing exercise induced bronchoconstriction (EIB). The test should be performed in a controlled, dry environment. Exercise testing parameters include recommendations on ventilation level, heart rate, time at maximal capacity, and medications to

   4 min

8. 8

   Methacholine Challenge Test

   A methacholine challenge test is a type of bronchoprovocation test used to help diagnose asthma. Methacholine is an inhaled drug that causes mild narrowing of the airways in the lungs. The test should not be performed in women who are pregnant or nursing, or in those who have an aortic or brain aneu

   4 min

9. 9

   Peak Flow Measurement

   Peak flow measurement is a quick test to measure air flowing out of the lungs. The measurement is also called the peak expiratory flow rate (PEFR) or the peak expiratory flow (PEF). Peak flow measurement can show the amount and rate of air that can be forcefully breathed out of the lungs and can hel

   4 min

10. 10

    Pulse Oximetry

    Pulse oximetry can be useful in assessing the severity of an asthma attack or monitoring for deterioration of one who is experiencing the attack. The pulse oximeter attaches to the skin and uses light wavelengths to measure the percentage of hemoglobin molecules carrying oxygen. It is important to n

    4 min

11. 11

    Spirometry

    Spirometry can help diagnosis asthma in the general population and in pregnancy by detecting reversible airway obstructive patterns and helping to monitor response to asthma treatment. Spirometry is the diagnostic method of choice and should be done before initiating treatment to determine the sever

    4 min

12. 12

    Treatment and Management Options

    When a person is diagnosed with asthma, they initially will have a treatment plan developed that manages their asthma symptoms and prevents asthma attacks. ¹⁰ The treatment usually depends on their age, severity of asthma, and responses to any previous treatments. Their treatment plan should be adju

    4 min

13. 13

    Short Acting Beta 2 Agonists

    Anyone who is diagnosed with asthma should be prescribed a short-acting beta-2 agonist (SABA) rescue inhaler. The SABA most often prescribed is an albuterol metered-dose inhaler (MDI). Short acting beta-2 agonist medications function by relaxing the airway smooth muscles. The bronchodilation effect

    4 min

14. 14

    Long-Acting Beta 2 Agonists

    The long-acting beta2-agonists most used are salmeterol and formoterol. These medications function similarly to short-acting beta 2 agonists, except the half-life is much longer, which leads to a slower onset and a longer duration of action. Long-acting beta-agonists should not be used alone to trea

    4 min

15. 15

    Inhaled Corticosteroids

    If symptoms are not well controlled with the SABA or an individual is using short-acting beta-agonists more than twice a week, additional medications can be added after adherence and proper use of medications is confirmed. A daily inhaled corticosteroid (ICS) is often the first line medication for m

    4 min

16. 16

    Leukotriene Receptor Antagonists

    Leukotriene receptor antagonists (LTRA) include montelukast, zafirlukast, and zileuton. These medications are often prescribed for exercise induced bronchospasm and work by decreasing inflammation and decreasing responsiveness of the airways to immune triggers. These medications provide long-lasting

    4 min

17. 17

    Methylxanthine

    Theophylline is a methylxanthine drug that causes smooth muscle relaxation and dilation of the bronchioles, thereby reducing airway obstruction. Theophylline has a narrow window between therapeutic and toxic ranges, and therefore requires close monitoring of serum levels.

    4 min

18. 18

    Mast Cell Stabilizing Agents

    Mast cell stabilizing agents (MCSA) cromolyn and zileuton are effective in reducing the risk of exercise induced bronchospasm. Cromolyn works by reducing histamine release. Zileuton effectively decreases the inflammatory response of the immune system. Mast cell stabilizing agents are less effective

    4 min

19. 19

    Monoclonal Antibody Immune-Modulating Medications

    Monoclonal antibody immune-modulating medications can be used in certain situations when people with asthma do not respond well to inhaled corticosteroid treatment and are found to have eosinophilia (white blood cells that destroy substances in the body). Monoclonal antibody immune-modulating medica

    4 min

20. 20

    Short-Acting Muscarinic Antagonists

    Inhaled anticholinergic agents are rarely recommended as monotherapy. Short-acting muscarinic antagonists (SAMA) are less effective than short-acting beta-2 agonists (albuterol), however, they can be used in combination when tolerance to SABA develops. For instance, SAMA such as ipratropium are give

    4 min

21. 21

    Bronchial Thermoplasty

    Bronchial thermoplasty is an option for people with severe, persistent asthma that is unresponsive to treatment. In bronchial thermoplasty, a controlled therapeutic radiofrequency energy in infused into the airway wall, heating and destroying bronchial tissue. Most of what makes up the bronchial tis

    4 min

22. 22

    Conclusion

    Despite advances in medical management and access to early diagnosis and treatment, asthma remains one of the most common causes of emergency department visits. When an exacerbation of asthma occurs, the healthcare professional should urgently assess the signs and symptoms, airflow and blood gas rea

    4 min

This course satisfies

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References and resources

• Mitchell, I., & Govias, G. (2021). Asthma and asthma education: The background. Asthma Education, 3-38. https://doi.org/10.1007/978-3-030-77896-5_1
• National Institute for Health and Care Excellence. (2017). Asthma: Diagnosis, monitoring and chronic asthma management.
• De Jong, C., Pedersen, E., Goutaki, M., Trachsel, D., Barben, J., & Kuehni, C. (2019). Diagnosing asthma accurately in school-aged children suspected to have asthma. Paediatric asthma and allergy.
• Lynde, G. C. (2017). Asthma and pregnancy. Oxford Medicine Online.
• Weinberger, M., & Abu-Hasan, M. (2016). Is exercise-induced Bronchoconstriction exercise-induced asthma? Respiratory Care, 61(5), 713-713.
• Walsh Flanagan, K., & Cuppett, M. (2017). Medical conditions in the athlete (3rd ed.). Human Kinetics.
• Chung, K. F., Israel, E., & Gibson, P. G. (2019). Severe asthma. European Respiratory Society.
• Status Asthmaticus. (2020). Definitions.
• Bobolea, I. D., Melero, C., & Jurado-Palomo, J. (2016). Current and future asthma treatments: Phenotypical approach on the path to personalized medicine in asthma. Asthma - From Childhood Asthma to ACOS
• Axelsson, M., Ekerljung, L., & Lundbäck, B. (2015). The significance of asthma follow-up consultations for adherence to asthma medication, asthma medication beliefs, and asthma control. Nursing Research and Practice, 2015, 1-7.
• Yokoyama, A. (2018). Advances in asthma: Pathophysiology, diagnosis, and treatment. Springer.

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