Table of Contents
Overview
Definition and Symptoms
Asthma is defined as a chronic condition that inflames and narrows the airways in the lungs, leading to various respiratory symptoms. It is one of the most common long-term diseases affecting children, although adults can also be diagnosed with asthma.[2.1] The primary symptoms of asthma include wheezing, breathlessness, chest tightness, and coughing, particularly at night or early in the morning.[3.1] During an asthma attack, the airways become swollen and produce an excessive amount of mucus, which can significantly obstruct airflow and make breathing difficult.[20.1] This exacerbation of symptoms can vary in severity and may require immediate medical attention if quick-relief medications do not alleviate the situation.[21.1] Healthcare providers assess the severity of asthma based on the frequency and intensity of these symptoms, which can change between attacks.[6.1] Understanding and managing asthma triggers—such as allergens, air pollution, and respiratory infections—are crucial for controlling symptoms and preventing attacks.[11.1]Types of Asthma
Asthma can be categorized into different types based on the triggers that provoke symptoms. The two primary types are allergic asthma and nonallergic asthma. Allergic asthma is the most common form, where symptoms are triggered by allergens such as pollen, dust mites, mold, and pet dander. Individuals with allergic asthma often experience symptoms like wheezing, coughing, and difficulty breathing when exposed to these allergens. Managing exposure to these triggers can significantly reduce asthma-related flare-ups, and strategies such as allergy testing or maintaining a symptom journal can help identify specific triggers.[35.1] In contrast, nonallergic asthma is characterized by symptoms that are not triggered by allergic reactions. This less common form typically develops later in life and is often more severe. The exact causes of nonallergic asthma remain unclear, but factors such as stress, viral respiratory infections, exercise, and certain food additives have been implicated in its onset.[33.1] Individuals with nonallergic asthma may also experience similar symptoms to those with allergic asthma, including wheezing and coughing, but the triggers differ significantly.[34.1] Both types of asthma require careful management to minimize exposure to triggers. For allergic asthma, avoiding known allergens is crucial, while for nonallergic asthma, it may involve reducing exposure to irritants such as smoke, cold air, and stress.[37.1] Healthcare providers can assist patients in recognizing their specific triggers and developing tailored strategies to improve air quality and reduce symptoms.[38.1]History
Ancient Understanding of Asthma
Asthma has been recognized as a medical condition since ancient times, with its earliest mentions found in the works of Aretaeus of Cappadocia around 100 A.D. He described asthma as a distinct entity, although the comprehensive understanding of its symptoms and causes evolved significantly over the centuries. The modern clinical definition of asthma, characterized by "laborious respiration with lifting of the shoulders and wheezing," was articulated by John Floyer in 1698, marking a pivotal moment in the history of asthma diagnosis and treatment.[57.1] In ancient Egypt, inhalation treatments for asthma were practiced as early as 3000-1200 B.C. The Ebers Papyrus, dating to around 1550 B.C., included numerous remedies for various ailments, including asthma, reflecting the Egyptians' belief in the importance of respiration.[58.1] They utilized the inhalation of smoke from dried and crushed herbs as a therapeutic approach.[59.1] Similarly, ancient Greek medicine emphasized lifestyle modifications to manage asthma, advocating for a balanced humoral state through practices such as blood-letting and evacuations to alleviate phlegm accumulation in the lungs.[60.1] In the Indian medical tradition, which significantly influenced European pharmacology in the 17th century, Stramonium derived from the thorn apple was employed as a treatment for asthma, showcasing the diverse approaches to managing respiratory issues across cultures.[61.1] The term "asthma" itself is derived from the Ancient Greek word "aazein," meaning sharp breath, and was notably referenced in Homer's "Iliad," indicating its longstanding presence in medical discourse.[67.1] Over time, the understanding of asthma transitioned from a focus on acute symptoms to recognizing it as a chronic inflammatory disease, reflecting advancements in medical knowledge and treatment strategies.[68.1]Evolution of Treatments
The treatment of asthma has evolved significantly over the centuries, beginning with ancient practices and advancing to modern targeted therapies. Around 1500 BC, the Ebers Papyrus from ancient Egypt recommended inhaling the smoke of herbs as a treatment for asthma, while in ancient China, the herb ma-huang (Ephedra sinica) was used, which later revealed the muscle relaxant ephedrine as its active component.[54.1] The mid-20th century marked a pivotal shift in asthma management with the introduction of systemic corticosteroids, followed by inhaled corticosteroids (ICS), which have been in use for over 35 years.[78.1] The development of inhaled therapies, particularly ICS, has been recognized as a cornerstone of asthma treatment since the launch of the first pressurized metered-dose inhaler (pMDI) in 1956.[76.1] This innovation initiated a new era in asthma care, allowing for more effective delivery of medication directly to the lungs. In the last four decades, the landscape of asthma treatment has further transformed with the advent of targeted therapies, including cromones, antileukotrienes, and anti-IgE treatments.[78.1] The introduction of biologic therapies has shifted the management of severe asthma from a standardized approach to a more personalized 'treatment-to-target' strategy, addressing specific molecular pathways involved in the disease.[66.1] The discovery of ephedrine in the 1920s provided a significant breakthrough, as it could be administered orally and became widely adopted for asthma treatment until its use began to decline in the late 1950s.[75.1] The synthesis of salbutamol, a β2-agonist, followed this trend, further diversifying the treatment options available.[75.1]In this section:
Recent Advancements
New Medications and Treatments
Recent advancements in asthma treatment have led to the development of new medications and therapies aimed at improving patient outcomes and quality of life. One significant breakthrough is the introduction of biologic medications, which have transformed the management of severe asthma. The first biologic approved for severe asthma treatment was omalizumab, which targets immunoglobulin E (IgE) and has been instrumental in providing relief for patients with allergic asthma.[106.1] In addition to biologics, new treatment options now include surgical techniques and leukotriene modifiers, expanding the therapeutic arsenal available to clinicians.[101.1] These advancements have shifted the focus of asthma management from traditional inhaled corticosteroids and bronchodilators to more precise, targeted approaches that address specific molecular pathways involved in asthma.[106.1] Despite these innovations, challenges remain, particularly in treating severe asthma driven by non-type 2 inflammation, which continues to pose significant difficulties for healthcare providers.[102.1] Ongoing research is dedicated to developing new biologics that can effectively target these complex forms of asthma.[99.1] The impact of these advancements on patient care is notable; for instance, patients have reported significant improvements in their quality of life, with many experiencing fewer asthma attacks and a reduced need for oral steroids.[104.1] Personal accounts highlight the transformative effects of these treatments, with individuals expressing a newfound confidence in managing their condition.[105.1] Overall, the evolution of asthma therapies represents a promising direction in the quest for better management of this chronic condition.Biologic Therapies
The development of biologic therapies has significantly transformed the management of severe asthma, particularly for patients with type 2 (T2) inflammation. Since the introduction of the first monoclonal antibody, omalizumab, in 2004, a variety of biologics targeting specific pathways involved in asthma pathophysiology have emerged, leading to improved outcomes for patients suffering from severe asthma.[120.1] Currently, six biologics are approved for use in severe asthma, each employing different targeting strategies, including anti-IgE, anti-IL-5, and anti-IL-4 receptor therapies.[116.1] Despite the advancements in biologic therapies, challenges remain, particularly in addressing non-type 2 (non-T2) inflammation, which affects a significant subset of asthma patients. Non-T2 asthma is characterized by the absence of eosinophilic inflammation and is mediated by various cell types and cytokines, including Th1 and Th17 cells.[111.1] The lack of signature biomarkers for non-T2 asthma complicates the development of targeted biologics, as current therapies primarily focus on T2-driven mechanisms.[125.1] As a result, there is an ongoing need for research to identify new biomarkers and develop biologics specifically aimed at non-T2 asthma.[127.1] The impact of biologic therapies on patient management has been profound, as they have been shown to reduce exacerbations, hospitalizations, and the need for systemic steroids, while also enhancing the quality of life for patients with severe asthma.[119.1] However, the heterogeneity of asthma pathogenesis necessitates a tailored approach to treatment, with ongoing studies aimed at understanding the specific mechanisms underlying different asthma phenotypes.[120.1] The pharmaceutical industry recognizes the substantial unmet clinical need in this area and is actively pursuing the development of new treatments to address the complexities of severe asthma.[126.1]Causes And Triggers
Common Asthma Triggers
Asthma triggers can be categorized into various types, including environmental factors, medications, and psychological influences. Environmental triggers are significant contributors to asthma exacerbations. Common allergens such as pollen, dust mites, mold, and pet dander can provoke asthma symptoms. Additionally, air pollution is a well-documented factor that can worsen asthma, as exposure to polluted air can trigger symptoms and even lead to the onset of the disease in some individuals.[156.1] Climate change further exacerbates these issues by extending pollen seasons and increasing the potency of allergens, particularly from plants like ragweed and grass.[154.1] Warmer weather conditions associated with climate change also lead to longer allergy seasons, which can significantly impact individuals with asthma.[153.1] Medications can also act as triggers for asthma attacks. Certain pain relievers, particularly non-steroidal anti-inflammatory drugs (NSAIDs) such as acetylsalicylic acid (commonly found in Aspirin), are known to cause serious breathing problems in susceptible individuals.[143.1] It is crucial for individuals with asthma to be aware of their sensitivities to specific medications to avoid potential triggers. Psychological factors, including stress and anxiety, have been shown to interact with asthma symptoms. Chronic stress can exacerbate asthma, and relaxation techniques may help improve respiratory function by managing these psychological states.[148.1] The interplay between psychological well-being and asthma highlights the importance of addressing mental health in asthma management strategies.Individual Variability in Triggers
Asthma is characterized by significant individual variability in triggers, which can lead to differing degrees of airway inflammation and symptom severity among patients. Each person with asthma may have unique triggers that exacerbate their condition, including allergens, environmental factors, and emotional stressors.[182.1] Emotional triggers, such as anxiety, anger, and excitement, can provoke asthma symptoms by altering breathing patterns, leading to hyperventilation and airway constriction.[173.1] Research indicates that emotional stress and strong emotions are associated with more severe asthma symptoms, increased nighttime symptoms, and a higher reliance on oral corticosteroids.[171.1] Identifying personal emotional triggers is crucial for effective asthma management, as these triggers can significantly impact the quality of life and overall asthma control.[175.1] In addition to emotional factors, the physiological response to various triggers can differ among individuals. For instance, exposure to specific allergens can lead to the release of pro-inflammatory cytokines, which drive airway inflammation and hyperresponsiveness.[181.1] This inflammatory response can vary based on the type of trigger, necessitating personalized treatment approaches that consider the unique trigger profile of each patient.[185.1]In this section:
Impact On The Respiratory System
Effects on Lungs
Asthma significantly impacts lung function through both immediate and long-term effects. During an asthma attack, which can be triggered by allergens or irritants, there is a rapid peak in airway inflammation. This acute phase leads to severe symptoms such as shortness of breath, coughing, chest tightness, and wheezing, all of which are indicative of compromised lung function.[212.1] Over time, if asthma remains uncontrolled, it can result in permanent changes to lung structure, a process known as airway remodeling. This includes thickening of the airway walls and a loss of elasticity in lung tissues, ultimately leading to decreased lung function.[194.1] The inflammation caused by asthma not only affects the lungs but can also involve other parts of the respiratory system, such as the nose and vocal cords, further complicating the condition.[193.1] The long-term consequences of poorly managed asthma include not only reduced lung function but also an increased frequency of hospitalizations due to severe asthma attacks.[195.1] The chronic inflammation associated with asthma can lead to persistent breathing difficulties, even when the condition is not actively flaring up.[194.1] Thus, effective management of asthma is crucial to mitigate these detrimental effects on lung health and overall respiratory function.Management And Treatment
Long-term Management Strategies
Long-term management of asthma involves a multifaceted approach that emphasizes patient education, control of triggers, monitoring, and pharmacologic therapy. The four essential components of asthma management include patient education, control of asthma triggers, monitoring for changes in symptoms or lung function, and pharmacologic therapy, which applies to both children and adults.[228.1] The 2023 GINA Global Strategy report has provided updated guidance on asthma management, including a clarification of terminology for asthma medications, where the term "controller" has been replaced with "maintenance treatment" or "inhaled corticosteroid (ICS)-containing treatment".[225.1] Effective asthma management also requires a structured approach to patient education, which is considered a cornerstone of care. Educational programs that focus on practical aspects of asthma management and encourage active patient participation have been shown to be particularly effective.[230.1] Studies indicate that such programs can reduce healthcare utilization, including emergency room visits and hospital admissions, thereby improving overall asthma control.[233.1] Community engagement plays a crucial role in enhancing asthma management strategies, particularly in underserved populations. Initiatives like the Community Health Interventions to Advance Self-Management of Asthma (CHI-ASMA) project aim to improve asthma control and reduce rates of asthma-related complications through community-based approaches.[235.1] Additionally, models led by community health workers have demonstrated success in improving patient outcomes and reducing healthcare utilization.[236.1] The integration of patient perspectives into treatment planning through shared decision-making (SDM) has also been shown to enhance asthma outcomes.[239.1] This collaborative approach fosters trust and engagement between patients and healthcare providers, ultimately leading to more effective management strategies.[240.1]In this section:
Patient EducationGlobal StrategyCommunity EngagementUnderserved PopulationsCommunity Health
Research And Future Directions
Ongoing Studies and Trials
Recent advancements in asthma research have led to a significant focus on the development of targeted biologic therapies, which have shown promise in improving patient outcomes. These biologics are designed to modify cytokine responses that drive asthma, allowing for a more personalized approach to treatment.[268.1] The ongoing research in this area is bolstered by the validation of basic research that has identified new therapeutic molecules, alongside advances in high-throughput sequencing that provide extensive "omics" data related to the genetic and epigenetic factors influencing asthma.[269.1] The understanding of asthma pathophysiology has also evolved, emphasizing the roles of genetic and epigenetic factors, immune system dynamics, and airway remodeling.[270.1] Current studies are exploring asthma biomarkers and novel treatments, including innovative drug delivery systems, which aim to enhance the efficacy of existing therapies.[270.1] Despite these advancements, challenges remain, particularly in treating severe asthma driven by non-type 2 inflammation, prompting the development of new biologics to address this issue.[271.1] Genetic and epigenetic interactions are critical in understanding asthma susceptibility and severity. Research has identified numerous genetic variants associated with asthma, primarily located in non-coding genomic regions, complicating the understanding of their functional impacts.[283.1] Furthermore, studies have demonstrated that interactions between single-nucleotide polymorphisms (SNPs) and DNA methylation can significantly affect gene expression and asthma risk.[285.1] This interplay suggests that both genetic predispositions and environmental factors contribute to the heritability of asthma, with epigenetic changes potentially being passed down through generations.[286.1] Incorporating patient feedback and real-world evidence into clinical trials is becoming increasingly important in asthma research. The development of biologic therapies necessitates a reassessment of outcomes used in clinical studies, emphasizing the need for a core outcome set (COS) that reflects patient priorities.[289.1] Real-world evidence, which encompasses data from electronic medical records and patient registries, can provide insights into the management of severe asthma and the efficacy of treatments in diverse populations.[293.1] This approach aims to ensure that clinical trials are more representative of the general patient population, ultimately enhancing the relevance and applicability of research findings in clinical practice.[293.1]Potential Future Treatments
Currently, treatment options for non-type 2 asthma remain limited, but there is a promising development of new therapies targeting critical mediators, which are currently in phase I clinical trials. These emerging biologics aim to address the unique challenges posed by non-type 2 inflammation asthma, which is characterized by a poor response to standard treatments such as inhaled corticosteroids (ICS) and a higher symptom burden among patients.[297.1] Over the past two decades, the management of severe asthma has evolved from a reliance on inhaled corticosteroids and bronchodilators to more targeted approaches, including monoclonal antibodies that address specific molecular pathways.[273.1] The introduction of biologics has significantly transformed care for patients with severe asthma, with studies indicating that their use can reduce exacerbation rates by 25% to 50%, although the effects on lung function and asthma-related symptoms can vary.[274.1] Despite these advancements, the integration of biologics into standard clinical practice faces challenges, particularly for patients with non-type 2 asthma, who often exhibit resistance to conventional therapies and have a higher severity of disease.[298.1] The need for a personalized approach to biologic therapy is underscored by the limited use of dual biologic treatments, which increased only slightly from 0% to 2.5% of patients over a study period.[275.1] This highlights the importance of tailoring treatments based on individual patient responses and the potential benefits of switching biologics when initial treatments are suboptimal.[275.1] The role of biomarkers in personalizing asthma treatment is also gaining attention, as they can help identify patients who are most likely to benefit from specific therapies. Current biomarkers used in clinical practice include blood eosinophil count, fractional exhaled nitric oxide (FeNO), and total IgE levels, which can guide treatment decisions.[278.1] However, the effective implementation of precision medicine in asthma management requires the identification of phenotype-specific markers that are quantifiable, reproducible, and easy to obtain.[295.1]References
[2] Asthma - What Is Asthma? | NHLBI, NIH — Asthma is a chronic condition that inflames and narrows the airways in the lungs. Learn about asthma symptoms, attacks, causes, triggers, and treatments.
[3] Asthma - Symptoms and causes - Mayo Clinic — Also, the airway linings may make too much mucus. The result is an asthma attack. Asthma is a condition in which your airways narrow and swell and may produce extra mucus. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack. Asthma can't be cured, but its symptoms can be controlled.
[6] Asthma - StatPearls - NCBI Bookshelf — Fatalities related to asthma highlight missed opportunities in recognizing disease severity and escalating therapy, emphasizing the critical role of continual patient education and routine symptom control assessment for successful long-term management. Tables 1 and 2 below include the NAEPP and GINA asthma severity classifications and treatment initiation guidelines based on the patient's symptoms and lung function. Patients experiencing an acute asthma exacerbation may manage symptoms at home or need urgent medical care depending on their symptom severity and risk factors for fatal asthma. During these follow-up visits, clinicians should assess asthma control, lung function, exacerbations, inhaler technique, adherence, adverse effects of medication, quality of life, and patient satisfaction with care.
[11] How to Recognize and Prevent Asthma Triggers Effectively — While asthma has no cure, it can be managed by identifying and avoiding triggers that worsen symptoms. Recognizing what causes asthma flare-ups is the first step in leading a healthier and more comfortable life. In this blog, we'll discuss common asthma triggers, how to recognize them, and practical ways to prevent asthma attacks effectively.
[20] Asthma attack - Symptoms and causes - Mayo Clinic — Asthma attack - Symptoms and causes - Mayo Clinic Symptoms of asthma attack include coughing, wheezing, tightness in the chest and difficulty getting enough air. This tells them what medicines to take if they have an asthma attack and when to get emergency care. Symptoms of asthma attacks may include: An asthma action plan tells you when to call your healthcare professional and when to get emergency care. If you do not have an asthma action plan, get emergency care if quick-relief medicine is not helping symptoms. Life-threatening asthma attacks are more likely for people who frequently use quick-relief medicines, have had emergency room visits or hospital stays to treat asthma, or have other long-term illnesses.
[21] Asthma Attack: Symptoms, Causes, Treatment, and More - Health — An asthma attack is a flare-up of asthma symptoms when you might experience trouble or changes in breathing. Quick treatment is needed.
[33] What is the Difference Between Allergic and Nonallergic Asthma? — Nonallergic Asthma Nonallergic asthma is asthma that isn't triggered by an allergic reaction. A less common form of asthma, it usually develops later in life and is more severe. Doctors are unsure what causes this type of asthma, but studies have shown that stress, viral respiratory infections, exercise, and food additives may contribute to
[34] What's the Difference Between Allergic and Nonallergic Asthma? — How are allergic and nonallergic asthma different? People with allergic and nonallergic asthma have the same symptoms. This includes wheezing, coughing, and trouble breathing. The main differences between allergic and nonallergic asthma are what causes symptoms and when symptoms start. 2. Allergic asthma is the most common type.
[35] Asthma vs. Allergies: How to Tell the Difference and Find Relief — Yes! Many people experience allergic asthma, where allergens trigger asthma symptoms. Managing allergy exposure can often help reduce asthma-related flare-ups. Finding Relief: Steps You Can Take. 1. Identify Your Triggers. Understanding what causes your symptoms is the first step. Allergy testing or keeping a symptom journal can provide
[37] Lifestyle hacks reduce exposure to asthma triggers - About Asthma A ... — Non-allergy triggers include smoke, exercise, cold air and viruses. Other triggers include stress, hormonal changes, and some medications. Unfortunately, it is very difficult to completely avoid triggers in our everyday lives. However, you can take some precautions to reduce exposure to some substances that may trigger your asthma.
[38] Reduce Asthma Triggers | American Lung Association — Reduce Asthma Triggers Your healthcare provider can help you recognize what makes your asthma worse, and help find simple solutions to reduce and avoid asthma triggers. Mold is an allergen that can trigger asthma symptoms. Removing Asthma Triggers in the Home By removing asthma triggers in the home we improve air quality and reduce asthma symptoms in children and adults. What Triggers Your Asthma? Asthma Triggers in the Home Join over 700,000 people who receive the latest news about lung health, including research, lung disease, air quality, quitting tobacco, inspiring stories and more! Join over 700,000 people who receive the latest news about lung health, including research, lung disease, air quality, quitting tobacco, inspiring stories and more!
[54] Past, Present and Future Therapeutics of Asthma: A Review — Around 1500 BC in ancient Egypt, Ebers Papyrus, which was unearthed in Thebes in 1862, recommended the inhalation of the smoke of herbs as a treatment for patients with asthma.1 Almost 5000 years ago in ancient China, asthma was treated with the Chinese herb ma-huang (Ephedra sinica), which was later found to contain the muscle relaxant ephedrine.1 These agents were based on the mechanisms of
[57] Asthma | One Hundred Years of Treatment and Onward - ATS Journals — Although asthma has been described as a medical entity since the time of Aretaeus, the Cappadocian, in approximately 100 a. d.(see review by Marketos and Ballas []), the constellation of physical findings and signs that we currently recognize as asthma dates from the work of John Floyer in 1698.Floyer defined asthma as "laborious respiration with lifting of the shoulders and wheezing."
[58] A History of Allergies & Asthma, Part One: The Ancients' Perspective — Egypt (c. 3000-1200 BC) - Ancient Inhalation Treatments for Asthma. Ancient Egyptians believed respiration was the most vital function of the human body, as delineated in the Ebers Papyrus (c. 1550 BC), which contained an impressive number of remedies for maladies including asthma, hepatitis, bubonic plague, dandruff, and more.
[59] Check Out These Old Asthma Treatments and Remedies! — The ancient Egyptians inhaled smoke of dried and crushed herbs. In 1833, Atropine was discovered as the active ingredient. It is a muscarinic asthma medicine. It was a top-line asthma medicine during the 1980s. It was inhaled in nebulizer breathing treatments. A better, safer, muscarinic was introduced to the market in the late 1970s.
[60] "Divine Stramonium": The Rise and Fall of Smoking for Asthma — Ancient Greek remedies for asthma focused largely on promoting a healthy lifestyle, supplemented when necessary by blood-letting and evacuations, in order to restore humoral balance and to prevent or remove the accumulation of phlegm in the lungs.
[61] Ancient cure for allergies and asthma | Curious History — The Indian medicine system was quite developed and became the backbone of European pharmacy in the 17th century. Stramonium obtained from thorn apple helped in treating asthma. The British army practiced this method of treatment. America (A.D. 1600) In ancient America, a mixture of plants and religious customs treated respiratory problems
[66] Novel asthma treatments - Annals of Allergy, Asthma & Immunology — Over the past 2 decades, the management of severe asthma has shifted from relying on inhaled corticosteroids and bronchodilators to more precise, targeted approaches. Monoclonal antibodies designed to address specific molecular pathways in asthma have transformed care for patients with severe asthma. Because therapy targeting IgE became the first biologic developed for allergic asthma in 2003
[67] Asthma historical perspective - wikidoc — Overview Asthma was first mentioned in Homer's Iliad. It was later studied by influential thinkers such as, Hippocrates, Galen, and Moses Maimonides. Asthma treatment methods emerged in the late 1800s. Historical Perspective The word asthma is derived from the Ancient Greek word aazein, meaning sharp breath. The word first appeared in Homer's
[68] The natural history of asthma and early intervention — The understanding of the natural history of asthma has changed significantly during the last 4 decades, with the view that asthma is a disease of chronic inflammation and varying degrees of severity replacing that of it being a disease of reversible airway obstruction. Treatment has progressed in accordance with the growing knowledge about the pathophysiologic mechanisms of asthma
[75] The history of ephedra: A powerful lung medicine from China — Ephedrine solved all these problems, leading to excitement amongst physicians in Europe and the USA, where it was widely adopted for treating asthma from 1926 the 1950s (16). Work on adrenaline led to the synthesis in the laboratory of several similar chemicals, one of which was salbutamol which became the next main treatment for asthma.
[76] A brief history of inhaled asthma therapy over the last fifty years — Inhaled therapy, particularly inhaled corticosteroids (ICS), is the cornerstone of asthma treatment , , . This short review outlines the development of inhaled asthma therapy during the fifty years after the introduction of the first pressurised metered-dose inhaler (pMDI) in 1956.
[78] Asthma | One Hundred Years of Treatment and Onward | American Journal ... — Systemic treatment with corticosteroids was introduced into the treatment of asthma in the mid-20th century; inhaled corticosteroids have been in use for over 35 years. The last 40 years have also seen the development of the first targeted asthma treatments: cromones, antileukotrienes, and anti-IgE.
[99] Recent Advances and New Therapeutic Goals in the Management of ... - PubMed — In addition, the concept of clinical remission has emerged as a treatment goal, further clarifying the objectives of asthma management. However, despite these advancements, the treatment of severe asthma driven primarily by non-type 2 inflammation remains a major challenge, and new biologics are currently being developed to address this issue.
[101] New Medications and Treatments for Severe Asthma - Healthline — New treatments for severe asthma may include biologics, surgical techniques, and leukotriene modifiers, among others. Researchers are still searching for new drugs to prevent and relieve asthma.
[102] Recent Advances and New Therapeutic Goals in the Management of ... - PubMed — Recent Advances and New Therapeutic Goals in the Management of Severe Asthma - PubMed Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation Search: Search Your saved search Name of saved search: Search in PubMed Add to Search Recent Advances and New Therapeutic Goals in the Management of Severe Asthma Recent Advances and New Therapeutic Goals in the Management of Severe Asthma Search in PubMed Add to Search However, despite these advancements, the treatment of severe asthma driven primarily by non-type 2 inflammation remains a major challenge, and new biologics are currently being developed to address this issue. Aleem A, et al. Chu R, et al. Salisbury L, et al. PMID: 38174816 Free PMC article.
[104] Asthma Success Stories | Arlington, VA | Virginia Hospital Center — None of these therapies cure asthma, but they have been shown to decrease asthma attacks, improve quality of life and reduce the need for oral steroids. "Patients are achieving better control of their asthma while lowering their need for maintenance medications," Dr. Wyckoff says.
[105] From Hopeless Severe Asthma to Nearly Full Recovery - My Story - Reddit — I very rarely need albuterol unless to be safe, and feel confident this medication has changed my life. I know I will always have asthma, my chest still feels tight after a max effort run, but day-to-day I went from severe hopeless asthma to genuinely feeling cured. But let me reiterate over and over again, this is my personal experience!!!
[106] Novel asthma treatments - Annals of Allergy, Asthma & Immunology — Over the past 2 decades, the management of severe asthma has shifted from relying on inhaled corticosteroids and bronchodilators to more precise, targeted approaches. Monoclonal antibodies designed to address specific molecular pathways in asthma have transformed care for patients with severe asthma. Because therapy targeting IgE became the first biologic developed for allergic asthma in 2003
[111] Advances in non-type 2 severe asthma: from molecular insights ... - PubMed — This review covers the molecular mechanisms, clinical phenotypes, causes and promising treatments of non-T2 severe asthma. Specifically, we discuss the signalling pathways for non-T2 asthma including the activation of inflammasomes, interferon responses and interleukin-17 pathways, and their contributions to the subtypes, progression and
[116] Choosing the Right Biologic for the Right Patient With Severe Asthma — In this installment of the How I Do It series on severe asthma, we tackle the clinical conundrum of choosing the right biologic for the right patient with severe asthma. With six biologics now approved for use in this area comprising four different targeting strategies (anti-Ig E: omalizumab; anti-IL-5 and anti-IL-5-receptor: mepolizumab, reslizumab, and benralizumab; anti-IL-4-receptor
[119] Biologics in severe asthma: a state-of-the-art review - PubMed — Biologics in severe asthma: a state-of-the-art review - PubMed Print 2025 Jan. Biologics in severe asthma: a state-of-the-art review Biologics in severe asthma: a state-of-the-art review Biologic therapies play a significant role in reducing exacerbations, hospitalisations and the need for maintenance systemic steroids, while also improving the quality of life in patients with severe asthma. This review synthesises findings from early, pivotal RCTs and subsequent studies following the approval of biologics for severe asthma. Severe asthma immunopathogenesis in type 2 (T2)-high asthma and the specific targets of biologic therapies. Biologic agents licensed for severe asthma: a systematic review and meta-analysis of randomised controlled trials. . Biologics and airway remodeling in severe asthma. Biologic therapies for severe asthma.
[120] Biologics in severe asthma: A pragmatic approach for choosing the right ... — The development of monoclonal antibody therapies targeting specific components of the pathways relevant to asthma pathophysiology has revolutionized treatment of severe asthma both in adults and children and helped to further unravel the heterogeneity of this disease. However, the availability of multiple agents, often with overlapping eligibility criteria, creates a need for pragmatic
[125] From bedside to bench to clinic trials: identifying new treatments for ... — A major obstacle in the development of new treatments for severe asthma is the heterogeneous pathogenesis of the disease, which involves multiple mechanisms and cell types. Furthermore, new therapies might need to be targeted to subgroups of patients whose disease pathogenesis is mediated by a specific pathway.
[126] Challenges for the development of new treatments for severe asthma: a ... — The pharmaceutical industry is interested in developing new treatments for severe asthma (SA), recognising that there is a substantial unmet clinical need in this area. ... Challenges for the development of new treatments for severe asthma: a pharmaceutical perspective Curr Pharm Des. 2011;17(7):699-702. doi: 10.2174/138161211795429019.
[127] Recent Advances and New Therapeutic Goals in the Management of Severe ... — Recent Advances and New Therapeutic Goals in the Management of Severe Asthma - PubMed Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation Search: Search Your saved search Name of saved search: Search in PubMed Add to Search Recent Advances and New Therapeutic Goals in the Management of Severe Asthma Recent Advances and New Therapeutic Goals in the Management of Severe Asthma Search in PubMed Add to Search However, despite these advancements, the treatment of severe asthma driven primarily by non-type 2 inflammation remains a major challenge, and new biologics are currently being developed to address this issue. Aleem A, et al. Chu R, et al. Salisbury L, et al. PMID: 38174816 Free PMC article.
[143] Asthma - Causes and Triggers - NHLBI, NIH — Asthma - Causes and Triggers | NHLBI, NIH Asthma Asthma < Back To Asthma Asthma < Back To Asthma What Is Asthma? Asthma in Children Asthma Asthma Causes and Triggers What causes asthma? Many factors may work together to cause you to develop asthma, such as: How asthma affects the lungs NHLBI-supported research on asthma has led to more and better treatment options to improve the health of people who have asthma. Through our current research, we hope to better understand how our genes and the environment we live in affect our risk for developing asthma. Learn more about our asthma research. Asthma triggers Certain medicines, such as aspirin, which may cause serious breathing problems in people with asthma that is difficult to treat
[148] Psychological aspects of asthma - PubMed — Asthma can be affected by stress, anxiety, sadness, and suggestion, as well as by environmental irritants or allergens, exercise, and infection. It also is associated with an elevated prevalence of anxiety and depressive disorders. Asthma and these psychological states and traits may mutually potent …
[153] Global change, climate change, and asthma in children: Direct and ... — One of the greatest impacts of climate change on health, but also a major reminder of its effects, is on childhood asthma. 17, 19 Measures to reduce climate change impacts on health have been introduced in some countries and these include the design and construction of buildings, and use of air conditioning systems in homes to protect from
[154] Asthma and Climate Change: What You Need to Know — Individuals who have allergic asthma are also at a greater risk of allergy symptoms as a result of climate change. The warmer weather from climate change contributes to longer pollen seasons and more potent pollen. As temperatures increase, plants produce more pollen, such as ragweed, grass, tree, and other allergens. Also, moisture from
[156] Air Pollution and Asthma: Triggers, Causes, and Prevention — Air pollution has become one of the leading environmental threats worldwide, with severe consequences for respiratory health. For individuals with asthma, exposure to polluted air can be particularly harmful, triggering symptoms and even causing the onset of the disease in some cases.
[171] Perceived Triggers of Asthma: Key to Symptom Perception and Management ... — Emotional triggers (e.g. stress, intense emotions) are associated with more severe asthma, occurrence of nighttime symptoms, and oral corticosteroid use . Furthermore, emotional triggers are linked to a decrease in quality of life and increased anxiety and depression .
[173] Emotions and asthma - Lung UK — Strong emotions - like anger, fear, stress, and excitement - can trigger your asthma. So can emotional responses, like laughing and crying. This is because your body's response to different emotions changes the way that you breathe. When you're feeling emotional, you might start to take fast and deep breaths. This is called hyperventilating and it can make your airways narrow, causing
[175] Understanding Asthma: What It Is, What Triggers It, and How to Take ... — Stress or strong emotions Recognizing and avoiding your personal triggers is one of the most effective ways to prevent asthma attacks. How to Manage Asthma Although asthma cannot be cured, it can be managed effectively with the right care. A personalized asthma action plan is an essential tool for keeping symptoms under control.
[181] The airway epithelium: an orchestrator of inflammation, a key ... — This results in excessive production and release of pro-inflammatory cytokines, driving key components of asthma including airway inflammation and airway hyperresponsiveness (AHR). Exposure to inhaled asthma triggers causes the release of epithelial cytokines (TSLP, IL-25 and IL-33), which promotes both innate and adaptive T2 immune responses.
[182] The Most Common Asthma Triggers and How to Avoid Them — Asthma is an ongoing (chronic) lung condition that causes airway inflammation. This leads to narrow airways and breathing problems. It also makes the airways more sensitive to allergens and other things you are exposed to. Symptoms can get worse after exposure to these triggers. 1. Each person with asthma can have different triggers.
[185] Understanding Asthma Phenotypes, Endotypes, and Mechanisms of Disease — Specific IgE that develops in response to allergen exposure binds to its high-affinity receptor FcepsilonRI (FcεRI), expressed most prominently on mast cells (MCs), and the low affinity receptor FcεRII or CD23, on APCs. In addition to mediating the immediate hypersensitivity response in allergic asthma through MC activation, allergen-specific IgE also induces a delayed phase reaction characterized by the massive influx of eosinophils and other inflammatory cells. Periostin expression in bronchial tissue is not associated with asthma severity but has been shown to be a biomarker of persistent eosinophilic airway inflammation despite corticosteroid use . The phenotypes included (1) mild, type 2, early-onset disease and preserved lung function; (2) moderately controlled Th2-high asthma with mild reversible airflow obstruction; (3) moderately controlled Th2-low asthma with fixed obstruction, and (4) severe asthma with uncontrolled reversible airflow obstruction and mixed inflammation.
[193] How does asthma affect the respiratory system? - Medical News Today — Asthma causes inflammation that affects how the lungs function. The condition may also involve other parts of the respiratory system, including the nose and vocal cords.
[194] How Asthma Affects the Lungs and Breathing - IM&PC — Long-Term Effects of Asthma on the Lungs. If asthma is not managed properly, it can lead to long-term complications, including: Airway remodeling - Permanent thickening and scarring of the airways; Reduced lung function - Difficulty breathing even when asthma is not flaring up; Frequent hospitalizations - Severe asthma attacks requiring
[195] How Does Asthma Affect the Respiratory System? - HealthCentral — Asthma wreaks havoc on the respiratory system, causing inflammation, airway constriction, and breathing difficulties. Learn more about its impact.
[212] Effects of asthma on the lungs: Structural changes and symptoms — Asthma can cause inflammation of the lungs and airways. As a result, a person may experience symptoms including coughing, wheezing, chest tightness, and shortness of breath.
[225] 2023 GINA report for asthma - The Lancet Respiratory Medicine — The 2023 GINA Global Strategy report was updated with new information and guidance on managing asthma. Some of the key changes include a clarification of terminology for asthma medications (p 56). The previous term, controller, has been substituted where appropriate by maintenance treatment or inhaled corticosteroid (ICS)-containing treatment; maintenance treatment refers to any asthma
[228] An overview of asthma management - UpToDate — The four essential components of asthma management are patient education, control of asthma triggers, monitoring for changes in symptoms or lung function, and pharmacologic therapy. This overview topic presents the goals and components of asthma management. It is applicable to both children and adults.
[230] Effect of educational programs on asthma control and qualitiy of life ... — The results of our study documented that those educational programs, which covered practical aspects of asthma management and encouraged the active role of patients in asthma-related self-care, were particularly effective.
[233] Role of Adult Asthma Education in Improving Asthma Control and Reducing ... — Asthma education significantly decreased number of patients requiring ER visits and hospital admissions (p = 0.0005 and p = 0.0015, resp.). Our study suggests that implementation of a structured asthma education program in an inner city community hospital has a positive impact on reduction of ER visits and hospital admissions with improvement in asthma control. During the post-asthma-education period, there was a significant decrease in the number of patients requiring ER visits as compared to preeducation period [preeducation (n = 94) and posteducation (n = 60); p = 0.0005, 95% CI]. In this study, we found that a comprehensive asthma education program in an inner city asthmatic group decreased hospital and ER utilization and improved asthma control as assessed by the ACT score.
[235] Community Health Interventions to Help People Manage Asthma | AAFA.org — AAFA's Community Health Interventions to Advance Self-Management of Asthma (CHI-ASMA) project aims to help people with asthma improve asthma control. This will reduce asthma rates and deaths. The CHI-ASMA project is backed by a five-year, $1 million grant from the Centers for Disease Control and Prevention (CDC).
[236] Effectiveness Of A Respiratory Therapist-Led, Community-Based Asthma ... — For instance, community health worker (CHW)-led asthma management models have shown success in improving patient outcomes and reducing healthcare utilization. 41 Telemedicine-based asthma management has also demonstrated effectiveness in enhancing patient education and self-management skills. 42 Discussing whether alternative approaches might
[239] Patient and provider perspectives on uptake of a shared decision making ... — After discussion of several evidence-based options, the patient and provider can work towards an agreement on a treatment regimen ( 15, 16 ). This SDM process has been shown to improve asthma outcomes ( 16 - 19 ).
[240] Perspectives on decisions for treatment and care in severe asthma — To improve care, people with severe asthma would benefit from collaborative relationships with other partners who can help focus on patient-centred endpoints in clinical trials for asthma therapies (unpublished observation; data on file). 7,13 The inclusion of the perspective of people with severe asthma can promote engagement, trust, and
[268] Overview of recent advancements in asthma management — Overview of recent advancements in asthma management - PubMed Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation Search: Search Your saved search Name of saved search: Search in PubMed Add to Search Overview of recent advancements in asthma management Overview of recent advancements in asthma management Search in PubMed Add to Search This has revolutionised asthma management, allowing risk stratification of patients, targeted use of biologic agents to modify cytokine responses that drive asthma and improved patient outcomes. Keywords: asthma; biologic treatments; management; personalised medicine. The management of severe asthma in 2020. Bel EH, et al. Trivedi A, et al. Add to Search Add to Search Add to Search Add to Search Add to Search Add to Search
[269] Update on asthma biology - Journal of Allergy and Clinical Immunology — This is an exciting time to be conducting asthma research. The recent development of targeted asthma biologics has validated the power of basic research to discover new molecules amenable to therapeutic intervention. Advances in high-throughput sequencing are providing a wealth of "omics" data about genetic and epigenetic underpinnings of asthma, as well as about new cellular interacting
[270] PDF — Recent advancements in the understanding of asthma pathophysiology have highlighted the roles of genetic and epigenetic factors, immune system dynamics, and airway remodeling. ... This review explores the latest research on asthma biomarkers and novel treatments, including biologic therapies and innovative drug delivery systems. Additionally
[271] Recent Advances and New Therapeutic Goals in the Management of ... - PubMed — Recent Advances and New Therapeutic Goals in the Management of Severe Asthma - PubMed Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation Search: Search Your saved search Name of saved search: Search in PubMed Add to Search Recent Advances and New Therapeutic Goals in the Management of Severe Asthma Recent Advances and New Therapeutic Goals in the Management of Severe Asthma Search in PubMed Add to Search However, despite these advancements, the treatment of severe asthma driven primarily by non-type 2 inflammation remains a major challenge, and new biologics are currently being developed to address this issue. Aleem A, et al. Chu R, et al. Salisbury L, et al. PMID: 38174816 Free PMC article.
[273] Novel asthma treatments - Annals of Allergy, Asthma & Immunology — Over the past 2 decades, the management of severe asthma has shifted from relying on inhaled corticosteroids and bronchodilators to more precise, targeted approaches. Monoclonal antibodies designed to address specific molecular pathways in asthma have transformed care for patients with severe asthma. Because therapy targeting IgE became the first biologic developed for allergic asthma in 2003
[274] Approach to non-type 2 asthma - ScienceDirect — In a review by Menzies-Gow and colleagues, use of biologics in severe asthma reduced exacerbation by 25%-50% with a variable effect on lung function and asthma-related symptoms . It is also noteworthy that patients with non-type 2 (non-T2) asthma have higher symptom burden, are refractory to ICS therapy, have OCS resistance and have
[275] Biologic use and outcomes among adults with severe asthma treated by US ... — Dual asthma biologic use was rare and increased from 0% to 2.5% of patients throughout the study period. The meaningful exacerbation reduction associated with biologic switching highlights the need for a personalized approach to biologic therapy and the value of switching if the clinical response to the initial biologic treatment is suboptimal.
[278] Personalized Medicine in Severe Asthma: From Biomarkers to Biologics — Combining biomarkers with T2-targeting monoclonal antibodies (mAbs) is critical for developing personalized treatment strategies for severe asthma . Table 1. Summary of the current comprehension of type-2-high asthma and type-2-low asthma.
[283] Decoding the genetic and epigenetic basis of asthma - PubMed — Alongside environmental factors, asthma susceptibility is strongly influenced by genetics. ... which have identified thousands of genetic variants associated with asthma development. Virtually all these genetic variants reside in non-coding genomic regions, which has obscured the functional impact of asthma-associated variants and their
[285] Genetic-Epigenetic Interactions in Asthma Revealed by a Genome-Wide ... — There is evidence to suggest that genetic and epigenetic variation interact synergistically to affect gene expression . In fact, interactions between SNPs and DNA methylation in the genomic regions of T-helper 2 pathway genes IL4R and others were found to affect asthma risk , possibly through expression of these genes.
[286] Epigenetics and Asthma: A Systematic Review - PMC — The interaction between genes and the environment is linked by the study of epigenetics which looks at how both environmental and genetic components alter gene expression. ... Epigenetics is partly responsible for the heritability of asthma. Epigenetic changes that occur in parental DNA can be passed down to their offspring through a process
[289] P226 Amplifying Patient Voices in Research: Patient Engagement in Core ... — Development of biologic therapies for severe asthma and increased focus on patient priorities warrant reassessment of outcomes used in asthma clinical studies. Building consensus on a core outcome set (COS) by engaging patients and other key stakeholders helps to ensure high-priority outcomes are consistent in clinical study designs. Strategies to amplify the patient voice and incorporate
[293] Real-World Studies of Biologics for the Treatment of Moderate-to-Severe ... — Presently, there are 6 biologic agents available for treatment of asthma. Each of these agents has undergone robust clinical trials in their approval programs. Such studies rely upon very rigid entry criteria that may not translate to real-world efficacy. Thus, exploring the efficacy of these agents in a larger, more heterogeneous, population brings a sense of comfort regarding their efficacy
[295] Biomarkers in asthma: state of the art - Asthma Research and Practice — Asthma is a heterogenous disease characterized by multiple phenotypes driven by different mechanisms. The implementation of precision medicine in the management of asthma requires the identification of phenotype-specific markers measurable in biological fluids. To become useful, these biomarkers need to be quantifiable by reliable systems, reproducible in the clinical setting, easy to obtain
[297] Non-eosinophilic asthma: current perspectives - PMC — These risk factors, alone or in conjunction, can activate specific cellular and molecular pathways leading to non-type 2 inflammation. The most relevant clinical trait of NEA is its poor response to standard asthma treatments, especially to inhaled corticosteroids, leading to a higher severity of disease and to difficult-to-control asthma.
[298] Approach to non-type 2 asthma - Respiratory Medicine — It is also noteworthy that patients with non-type 2 (non-T2) asthma have higher symptom burden, ... Non-T2 asthma remains a difficult problem because prevailing paradigms in clinical treatment define it as the absence of evidence of T2 inflammation. In order to make further progress, the contributions of non-T2 pathways in patients who may have