___________________________________________________________ Asthma: Diagnosis and Management
INTRODUCTION Asthma has existed for thousands of years, but only in the past century has the medical community developed a better understanding of it. Even with the great progress made toward improved treatments and concepts of asthma, the disorder is frequently misdiagnosed and mismanaged in many healthcare settings. Furthermore, the condition is increasingly common, and most healthcare professionals will encounter patients with asthma. In the United States alone, it is estimated that 8.9% of adults and 6.7% of individuals 18 years of age or younger have asthma, and cases have been trending upward in both age groups for decades [1; 2]. This increase in the number of asthma cases extends globally. In 2019, it was estimated that there were 262 million individuals worldwide with asthma, although exact numbers are difficult to estimate due to differ- ences in diagnosis and reporting methods [3]. Among the general population, 6.3% of patients seen by a physician in the office setting have a diagnosis of asthma in their medical records [2]. In 2021, 939,000 individuals in the United States visited an emergency department and received a primary diagnosis of asthma. In addition, there were 4.9 mil- lion office-based physician visits for asthma [2]. The utilization and costs associated with health care related to asthma put a tremendous burden on healthcare systems and professionals as well as on patients and public organizations. Direct healthcare costs for asthma in the United States total more than $50.3 billion annually; indirect costs (mainly lost productivity) and mortality add an additional $3 billion and $29 billion, respectively [4]. In addition to direct and indirect costs, prescription drugs for the treatment of asthma repre- sented the largest single direct medical expenditure, accounting for more than $17 billion annually [5]. Proper treatment and management can minimize the effects of asthma. Along with pharmacologic treatment, there are many contributing agents (known as triggers or asthmagens) that, once identified, can be addressed with the patient and suc- cessfully managed. Reviewing the signs and symptoms, patho- physiology, risk factors, diagnosis, treatment and management, and prevention strategies allows healthcare professionals to be prepared to provide optimal care for the patient with asthma.
HISTORY OF ASTHMA The first record of asthma-like symptoms was documented in Egyptian manuscripts circa 1500 B.C.E. Hippocrates first referred to asthma as a specific condition, using the Greek word asthma, meaning the act of panting or labored breathing. Asthma-like symptoms and their treatments were described thousands of years ago in ancient Chinese writings. The herbal medicine ma-huang traditionally used in Chinese medicine to treat asthma-like symptoms, comes from the bark of trees of the genus Ephedra equisetina . The modern medication ephedrine, a common ingredient in some asthma medicines, is derived from this plant [6; 7]. In the early 1700s, Bernardino Ramazzini, an Italian physician, noted links between people with asthma and their occupations. Ramazzini documented asthma resulting from mill workers’ exposure to mill dust and farmers’ contact with animal dander. This was one of the first attempts to identify asthmagens or triggers as causes of asthma attacks. Although most physi- cians in the 18th century were in agreement that asthma was a new disorder, it remained difficult to auscultate the lungs and examine the patients’ lung tissue or secretions. By 1761, Leopold Auenbrugger, an Austrian physician, discovered a new technique for examining the lungs by percussion, or tapping on the patient’s chest, to elicit differences in reverberating sounds. Approximately 60 years later, French physician René Laënnec, who had asthma, designed the first crude stethoscope—a rolled piece of paper held to the chest to listen to a patient’s heart and lungs. The following decade would also bring improvements in microscopic technology that allowed physicians to examine lung tissue and secretions [6; 7]. British surgeon John Hutchinson developed the first spirom- eter around 1850. It was originally intended for his research in respiratory physiology, as a tool to measure respiratory flow rates. Soon, smaller devices were being widely used by patients with lung disease in Europe, Australia, and the United States [6; 7]. By the end of the 19th century, many companies were shipping asthma “medications” all over the country and around the world. These were in the form of powders, tablets, and liquids and often labeled as secret formulas. It was not uncommon to find alcohol, cocaine, and/or morphine as active ingredients. Until the late 20th century, inhaling medications via steam or smoke was one of the only ways of introducing medications directly into the bronchial tubes and lungs of a patient with asthma [6; 7].
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