Fast Facts: Asthma

T.S.C. Hinks, J.A. Douglass

Description

Asthma is the world’s most common chronic respiratory condition, affecting over 350 million people worldwide and inflicting a heavy individual, social and economic burden of disease. In this rapidly changing field, a plethora of new inhaled therapies and devices have emerged, as well as a better understanding of disease phenotyping and biology. This fully updated fifth edition of 'Fast Facts: Asthma' discusses recent trends in an easy-reference format, while highlighting imminent new developments, to provide a valuable resource for general practitioners, specialist asthma nurses and others with a keen interest in improving the outcomes of the very many people living with asthma. Table of Contents: • Pathophysiology • Epidemiology, etiology and natural history • Diagnosis and classification • Asthma medications • Management principles • Severe and refractory asthma • Acute asthma attacks • Preventing asthma attacks • Asthma in special circumstances • Developments

Sujets

• Respiratory Medicine
• Pulmonology
• Médecine

Informations

• Publié par: S. Karger AG
• Date de parution: 29 avril 2021
• Nombre de lectures: 0
• EAN13: 9781910797754
• Langue: English
• Poids de l'ouvrage: 4 Mo

Extrait

Asthma

Jo A Douglass BMedSc MBBS MD FRACP James Stewart Professor of Medicine Department of Medicine, The University of Melbourne Director of Research, The Royal Melbourne Hospital Parkville, Victoria, Australia

Timothy SC Hinks BMBCh MRCP PhD Wellcome Trust Fellow, Respiratory Medicine Unit Nuffield Department of Medicine, University of Oxford Honorary Consultant, John Radcliffe Hospital, Oxford, UK With additional contributions from Sarah Poole MRPharmS MSc.
Declaration of Independence
This book is as balanced and as practical as we can make it. We are very grateful for the time and effort given by our many peer reviewers from academia, medicines regulators and industry who read, commented, edited and helped us to correct and improve this book. Ideas for improvement are always welcome: [e-mail]
Fast Facts: Asthma
First published 1999; second edition 2006; reprinted 2007; third edition 2010; fourth edition 2013, reprinted 2018
Fifth edition 2021
Text 2021 Jo A Douglass, Timothy SC Hinks
2021 in this edition S. Karger Publishers Limited
S. Karger Publishers Limited, Elizabeth House, Queen Street, Abingdon, Oxford OX14 3LN, UK
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All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the express permission of the publisher.
The rights of Jo A Douglass and Timothy SC Hinks to be identified as the authors of this work have been asserted in accordance with the Copyright, Designs Patents Act 1988 Sections 77 and 78.
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A CIP record for this title is available from the British Library.
ISBN 978-1-912776-61-0
ISBN 978-1-912776-63-4 (ePub)
Douglass JA (Jo)
Fast Facts: Asthma/
Jo A Douglass, Timothy SC Hinks
Medical illustrations by Dee McLean and Jane Fallows, London, and Graeme Chambers, Belfast.
Typesetting by Amnet, Chennai, India.
Printed in the UK with Xpedient Print.
Abbreviations and glossary
Introduction
Pathophysiology
Epidemiology, etiology and natural history
Diagnosis and classification
Asthma medications
Management principles
Severe and refractory asthma
Acute asthma attacks
Preventing asthma attacks
Asthma in special circumstances
Developments
Useful resources
Index
Abbreviations and glossary
AMP: adenosine 5 -monophosphate
ASA: acetylsalicylic acid (aspirin)
Atopy: a condition characterized by excessive production of immunoglobulin (Ig)E in response to allergens
Basophil: a type of white blood cell, distinguishable on staining
B lymphocyte: a type of white blood cell that produces antibodies
COPD: chronic obstructive pulmonary disease
COX: cyclooxygenase, a rate-limiting enzyme involved in prostaglandin biosynthesis
CT: computed tomography
CysLTs: cysteinyl leukotrienes, a powerful class of bronchoconstricting mediators
Cytokine: a peptide secreted by cells involved in inflammation and the immune response; cytokines can control the activity and growth of the cell that secreted them, or nearby cells
Daily variability: variability in daily peak expiratory flow (PEF), calculated as a percentage of the mean daily PEF value
DPI: dry-powder inhaler
Eosinophil: a type of white blood cell involved in allergic responses, distinguishable on staining
FeNO: fractional concentration of exhaled nitric oxide, a near-patient measure of steroid-responsive, type-2 airways inflammation
FEV 1 : forced expiratory volume in 1 second, a measure of lung function
FVC: forced vital capacity, a measure of lung function
GERD: gastroesophageal reflux disease
GINA: Global Initiative for Asthma, an international scientific initiative created to provide and encourage the use of scientific reports on asthma and asthma research
HDM-SLIT: house dust mite sublingual allergy immunotherapy
ICS: inhaled corticosteroid(s)
IFN: interferon, a group of cytokines with the capacity to inhibit the development of the allergic pathways, under normal conditions
IgE: immunoglobulin class E, a class of antibody secreted by B lymphocytes on exposure to allergen; binding of IgE to certain cells involved in the immune response results in the release of inflammatory mediators
IL: interleukin, a cytokine that controls a specific aspect of hemopoiesis or the immune response
ILC2: type-2 innate lymphoid cell
LABA: long-acting 2 -agonist
LAMA: long-acting muscarinic antagonist
Leukocyte: white blood cell
Mast cell: a large cell containing chemical mediators that are released in inflammatory and allergic responses
NO: nitric oxide
NO 2 : nitrogen dioxide
NSAID: non-steroidal anti-inflammatory drug
OCS: oral corticosteroid
Pa CO 2 : partial pressure of carbon dioxide in arterial blood
Pa O 2 : partial pressure of oxygen in arterial blood
PEF: peak expiratory flow, a measure of lung function
pMDI: pressurized metered-dose inhaler
SABA: short-acting 2 -agonist
SpO 2 : oxygen saturation measured by pulse oximeter
Tc2 cell: type-2 cytokine-secreting CD8+ T cell
T lymphocyte: a type of white blood cell that is mainly responsible for cell-mediated immunity
Th lymphocyte: T helper lymphocyte; a type of T lymphocyte that is activated on exposure to allergen and releases cytokines
Trigger: a stimulus that increases asthma symptoms and/or airflow limitation
TSLP: thymic stromal lymphopoietin, an alarmin released in response to allergens
WHO: World Health Organization
Introduction
Asthma is the world s most common chronic respiratory condition, affecting over 350 million people worldwide and inflicting a heavy individual, social and economic burden of disease. 1 In developed countries, severe and difficult-to-treat asthma remain major problems in terms of healthcare costs, hospital admissions, pressure on healthcare providers and individual quality of life. In low- and middle-income countries, asthma and associated allergy are increasing in prevalence, while high mortality rates point to inadequate diagnosis and lack of use of affordable, effective asthma treatments. However, the field is rapidly changing. As well as a plethora of new inhaled therapies and devices, a better understanding of disease phenotyping and biology has led to the emergence of a growing range of highly effective biological therapies for selected patients with severe disease and greater precision in treating those with mild asthma.
This fully updated fifth edition of Fast Facts: Asthma reflects these recent developments. Perhaps the key paradigm shift over the past 6 years has been an emphasis on carefully differentiating asthma into distinct phenotypes, deconstructing diseases of the airways into specific traits that can be measured and, in some cases, modified (treatable traits), facilitated by the identification of simple biomarkers. This shift away from considering asthma as a homogeneous disease on a single continuous spectrum of severity has direct clinical applicability, enabling the practice of personalized medicine , targeting specific therapies and approaches to those patients most likely to derive the greatest benefit from them.
In light of this appreciation of treatable traits, an understanding of the biology of disease and the biological relevance of biomarkers is increasingly important. We have updated and expanded our review of the basic biology of airway diseases to reflect the previously unappreciated role of alarmins and the role of innate-like lymphocytes and type-2 cytokine-secreting CD8+ T cells (Tc2 cells). This is linked to the mechanism of action of novel biological therapies, which are outlined in a new section encompassing agents that target immunogloblin (Ig) E and the type-2 cytokine pathway. We point to future biologics that target alarmins and to a potential future generation of orally active type-2 cytokine inhibitors.
Given the complex and heterogeneous nature of asthma, definitions of the disease and its classification have evolved and are revised in this edition. We have also updated algorithms for the stepwise management of asthma to reflect the latest international management guidelines. These have been influenced by recent trial data on the utility of fixed-dose as-required fast-acting 2 agonist/inhaled corticosteroid (ICS) combination inhalers.
We have incorporated several other recent changes in therapeutics, including an updated section on new inhaler devices, a discussion of fixed airflow obstruction - a source of significant recent debate - and an important new section on the role of macrolides in non-eosinophilic asthma. Lastly, consonant with these rapid changes in therapeutics, we have entirely revised the section on future developments.
Overall, the field of asthma is exciting and rapidly evolving. Our aim with this new edition of Fast Facts: Asthma is to incorporate recent trends in an easy-refer