Biography: Bimal Roy Krishna
Asthma is considered to be primarily an inflammatory disorder with secondary
bronchoconstriction. Patient manifestations usually are shortness of breath, wheezing, cough
and chest tightness. The intensity may vary over time and become exacerbated with external
factors that further irritate the airway.
While bronchial hyperactivity and airway inflammation may likely be present they are not the
only factors that determine diagnosis. Identification of external and other factors that
exacerbate asthma is crucial and smoking is also a modifiable factor.
High risk patients including geriatric and pediatric patients may require more aggressive
The long term goals of management are to achieve long term symptomatic relief which may
include the use of prophylactic agents. Management of asthma initially supported the use of a
short acting bronchodilator and prophylactic management where deemed necessary.
The categories of asthma medications include controller, reliever, prophylactic and add-on
Effective 2019 the GINA guidelines no longer support the use of short acting bronchodilators as
preferred initial therapy. Preferential therapy now favors the use of inhaled corticosteroids
with a short acting bronchodilator. A step-up approach is initiated when necessary, which
includes dosage adjustment of inhaled corticosteroids with bronchodilators and eventually to
include adjunct medications and monoclonals.
This presentation outlines the pathogenesis of asthma, patient presentation and diagnosis current treatment guidelines.