Bronchial asthma is characterized by chronic airway
inflammation, which manifests clinically as variable airway narrowing (wheezes and
dyspnea) and
cough. Long-standing
asthma may induce
airway remodeling and become intractable. The prevalence of
asthma has increased; however, the number of patients who die from it has decreased (1.3 per 100,000 patients in 2018). The goal of
asthma treatment is to control symptoms and prevent future risks. A good partnership between physicians and patients is indispensable for effective treatment. Long-term management with therapeutic agents and the elimination of the triggers and risk factors of
asthma are fundamental to its treatment.
Asthma is managed by four steps of
pharmacotherapy, ranging from mild to intensive treatments, depending on the severity of disease; each step includes an appropriate daily dose of an inhaled
corticosteroid, which may vary from low to high. Long-acting β2-agonists,
leukotriene receptor antagonists, sustained-release
theophylline, and long-acting
muscarinic antagonists are recommended as add-on drugs, while anti-
immunoglobulin E antibodies and other biologics, and oral
steroids are reserved for very severe and persistent
asthma related to
allergic reactions.
Bronchial thermoplasty has recently been developed for severe, persistent
asthma, but its long-term efficacy is not known. Inhaled β2-agonists,
aminophylline,
corticosteroids,
adrenaline,
oxygen therapy, and other approaches are used as needed during acute exacerbations, by selecting treatment steps for
asthma based on the severity of the exacerbations.
Allergic rhinitis, eosinophilic chronic
rhinosinusitis, eosinophilic
otitis,
chronic obstructive pulmonary disease,
aspirin-exacerbated respiratory disease, and pregnancy are also important conditions to be considered in
asthma therapy.