Written by epgonline.org - Last updated 29 May 2018

An inflammatory condition of the airways, asthma typically presents during childhood. It is very common, and affects hundreds of millions of people worldwide. Asthma is often thought of as a mild disease in the public consciousness, but is responsible for nearly half a million deaths globally every year.

The clinical picture can be variable, although characteristic features are wheeze, shortness of breath, sensation of ‘tight’ breathing and a nocturnal cough. Frequently asthma may be related to a more generalised triad of atopy, with eczema and allergies. Exposure to triggers such as dust, animal fur, infections and psychological stress may cause an acute exacerbation – bronchial constriction and reduced mucus clearance leading to worsening of symptoms.

Diagnosis is based on symptom patterns, but can be aided by spirometry and peak flow measurements. From a practical perspective, peak flow monitoring is simple, cost-effective, and can be self-performed. It is more variable than spirometry, which can give an effective diagnosis immediately by demonstrating reversibility, and is the gold standard for testing.

Treatment for asthma revolves around avoiding exacerbations, managing the disease symptomatically on a daily basis, using long-term medications to combat chronic pulmonary changes, and managing exacerbations when they occur.

Prognosis is generally good, but there is huge variation in mortality statistics, with a hundred-fold discrepancy between the highest and lowest death rates internationally. As a very treatable condition this should be viewed with some concern as a clear example of the global inequalities in healthcare provision.

GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;385: 117–171.
Global Asthma Network Study Group. The Global Asthma Report 2014. Available from http://www.globalasthmareport.org/resources/Global_Asthma_Report_2014.pdf (last accessed July 2016).


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