Current approaches in adult asthma: assessment, education and emergency management

Asthma is a chronic respiratory disease characterized by smooth-muscle constriction of the airway, bronchial hyperresponsiveness, and an ongoing inflammatory process. Although more common in children, asthma in adults also requires careful management to decrease morbidity and mortality. The majority of chronic asthma cases have an allergic component; therefore, efforts to identify and eliminate environmental triggers may decrease the symptoms of most asthmatics. Asthma-education programs based on patient self-management have been shown to decrease asthma morbidity. Mastery of the following topics is necessary for patient self-management: identifying and avoiding exposure to symptom precipitators, using prescribed medications correctly, managing medication side effects, and recognizing and responding to exacerbations. Advances in diagnostic and treatment modalities include the home use of peak-flow meters to monitor respiratory function, and the use of metered-dose inhalers and spacers for the delivery of inhaled medication. Inhaled beta-adrenergic agonists, administered in higher than usual doses, have become the bronchodilators of choice in the treatment of acute asthma. Studies have demonstrated that metered-dose inhalers can be used for this purpose, even with severe asthma attacks that require hospitalization. Systemic corticosteroids are also important in the management of acute attacks. Care providers who teach patients about common symptom triggers and encourage avoidance techniques, who employ current strategies to enhance patients' medication use and patients' recognition of exacerbations, and who incorporate up-to-date treatment plans for acute asthma attacks may help reverse distressing trends in asthma morbidity and mortality.