Asthma

Asthma is a heterogenous condition, generally characterised by chronic inflammation of the respiratory tracts.
Asthma

It is defined by the appearance of respiratory symptoms such as wheezing, dyspnea, chest tightness and cough, which vary in time and intensity, alongside a variable limitation of air flow, which can become persistent 1.

Asthma is the most common non-transmissible chronic illness. It affects between 1% and 18% of the global population, with the latest estimations establishing that 260 million people in the world have asthma 1 .

According to an international study, the prevalence of asthma on a global scale increased by 12,5% between 1990 and 2015 . This increase mainly affects middle aged adults and women, and mainly corresponds to allergy-induced asthma. Despite this, the mortality rate dropped considerably (59% approximately) 3 .

Asthma
RISK FACTORS

Asthma is caused by many factors, meaning that there is not one single cause. Risk factors for asthma include 4:

  • Family history.
  • Allergies such as eczema or rhinitis.
  • Living in urban areas.
  • Being born prematurely.
  • Exposure to tobacco smoke.
  • Viral respiratory illnesses.
  • Exposure to certain allergens.
  • Being overweight or obese.
Symptoms and exacerbations

Symptoms may vary, but the most common are:

  • Wheezing .
  • Dyspnea or breathing difficulties.
  • Chest tightness or pain.
  • Cough.
  • Limitation of respiration. If the illness is advanced, this limitation may be constant.
Asthma

The presence of these symptoms may vary over time, as can their intensity. There are conditioning factors such exercise, exposure to substances that can produce an allergic reaction (allergens), climate change or other respiratory infections which can make these symptoms worse 1.

On occasions, people with asthma may experience worsening symptoms every now and again. These attacks or sporadic outbreaks are called exacerbations. The correct identification and correct management of these crises are very important, if patients are to avoid putting their health at risk 1.

Alergias
Asthma phenotypes and treatment

Asthma is a heterogenous illness which can be classified into five main groups which are called asthma phenotypes 1 5 6:

  1. Allergic asthma is the most easily identifiable and symptoms usually appear in early childhood. In general people with this type of asthma have a family history of different allergies.
  2. Non-allergic asthma.
  3. Late-onset asthma, some people begin showing symptoms in adulthood and do not have allergies.
  4. Airflow obstruction asthma which can be persistent or irreversible.
  5. Asthma with obesity.

Treating asthma is focused on two main objectives 7:

  1. Adequate symptom control favouring the patient’s quality of life.
  2. Minimising the risk of associated complications such as exacerbations or persistent limited airflow. It is worth pointing out that illness and fatality associated with asthma can be prevented, especially with the use of inhaled corticosteroids 8.
Paediatric asthma characteristics

Asthma is one of the most common chronic illnesses in children. In Spain, around 10% of children have asthma (similar to the EU-wide figure) 9 . The highest figures are seen in coastal areas and in boys between 6 and 7 years old 10 11. According to different estimations, more than half of adult asthmatics also suffered with the condition during childhood 12.

In children, it is important to evaluate the impact that asthma has on their daily lives in activities such as sports, playing, social life and school attendance. It is possible that children with poorly-controlled asthma may avoid certain activities which make their symptoms worse without telling their parents or doctors. This may lead to a false perception of appropriate asthma control increasing the risk of poor fitness or obesity. If the child is more irritable, tired or moody than usual this could indicate that their asthma is not as controlled as it should be 13.

Asma pediátrico

  • 1 Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2021. Fontana, WI, USA: GINA, 2021. Página 20. Disponible en: ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf
  • 2 Global Burden of Disease 2015
  • 3 GBD 2015 Chronic Respiratory Disease Collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 Lancet Respir Med. 2017; 5(9): 691-706.
  • 4 Organización Mundial de la Salud. Asma. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/asthma
  • 5 Bel EH. Clinical phenotypes of asthma. Curr Opin Pulm Med 2004;10:44-50
  • 6 Wenzel SE. Asthma phenotypes: the evolution from clinical to molecular approaches. Nature Medicine 2012;18:716-25.
  • 7 Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2021. Fontana, WI, USA: GINA, 2021. Página 44. Disponible en: ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf
  • 8 Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2021. Fontana, WI, USA: GINA, 2021. Página 46. Disponible en: ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf
  • 9 Sociedad Española de Neumología y Cirugía Torácica. GEMA 5.0 Guía Española para el Manejo del Asma. 2020
  • 10 Study of Asthma and Allergies in Childhood (ISAAC)
  • 11 Carvajal-Urueña I, García-Marcos L, Busquets-Monge R, Morales M, García de Andoin N, Batlles-Garrido J, et al. Variaciones geográficas en la prevalencia de síntomas de asma en los niños y adolescentes españoles. International Study of Asthma and Allergies in Childhood (ISAAC) fase III España. Arch Bronconeumol. 2005; 41: 659-66.
  • 12 Bercedo A, Redondo C, Lastra L, Gómez M, Mora E, Pacheco M ,et al. Prevalencia de asma bronquial, rinitis alérgica y dermatitis atópica en adolescentes de 13-14 años de Cantabria. Bol. Pediatr. 2004; 44 (187): 9-19.
  • 13 Tai A, Tran H, Roberts M, Clarke N, Gibson A-M, Vidmar S, et al. Outcomes of childhood asthma to the age of 50 years. J Allergy Clin Immunol. 2014; 133: 1572-78.
  • 14 Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2021. Fontana, WI, USA: GINA, 2021. Página 34. Disponible en: ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf.
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