Asthma in adults

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

ბოლო მიმოხილვა: 11 Sep 2025

ბოლო განახლება: 18 Sep 2025

01 Aug 2024

GINA reiterates montelukast safety warning

The 2024 GINA guideline update reminds prescribers of the potential risk of neuropsychiatric adverse events in patients receiving montelukast, including:[3]

new-onset nightmares,
behavioral and mood problems (e.g., agitation, hyperactivity, irritability, nervousness, aggression), and
suicidal ideation.

Healthcare professionals should consider the benefits and risks before prescribing montelukast and have an open discussion with patients about potential adverse effects.

Healthcare professionals and patients should be alert to, and monitor for, serious behavior and mood-related changes during treatment.

განახლების პირველწყარო

Asthma in adults presents with recurrent episodes of shortness of breath, chest tightness, wheezing, or coughing.

Exam typically demonstrates an expiratory wheeze; however, in severe asthma, poor air entry may lead to diminished breath sounds.

Treatment is stepwise and follows a guideline-based approach to starting, stepping up, and stepping down therapy.

Patient education, including the provision of an asthma action plan, is key to effective management.

Some patients may develop progressive, irreversible obstructive lung disease.

Despite the improved understanding of pathophysiology and treatment methods, asthma remains undertreated.

განსაზღვრება

Asthma is a chronic inflammatory airway disease characterized by intermittent airway obstruction and hyper-reactivity. Many cellular components are involved in the asthma pathway, including mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells. In susceptible people, inflammation causes increased bronchial hyperresponsiveness and recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, which are usually associated with widespread but variable airway obstruction that is reversible either spontaneously or with treatment.[1]

ანამნეზი და გასინჯვა

ძირითადი დიაგნოსტიკური ფაქტორები

recent upper respiratory tract infection
dyspnea
cough
expiratory wheezes
nasal polyposis

სრული ტექსტი

რისკფაქტორები

family history
gene polymorphisms and epigenetics
allergen/irritant exposure
occupational exposure
air pollution
atopic disease history
obesity
cigarette smoking
vaping
early life respiratory viral infection and viral wheeze
nasal polyposis
aspirin and nonsteroidal anti-inflammatory drug (NSAID) use
low socioeconomic status
gastroesophageal reflux
obstructive sleep apnea
sex
preterm birth
polycystic ovary syndrome
vitamin D deficiency

სრული ტექსტი

დიაგნოსტიკური კვლევები

1-ად შესაკვეთი გამოკვლევები

FEV₁/FVC ratio
peak expiratory flow (PEF)

სრული ტექსტი

გასათვალისწინებელი კვლევები

chest x-ray
CBC with differential
fractional exhaled nitric oxide (FeNO)
bronchial challenge test
serum radioallergosorbent test (RAST) immunoassay for allergen-specific IgE
skin-prick allergy testing
high-resolution CT (HRCT) chest
CT sinus

სრული ტექსტი

ახალი ტესტები

sputum eosinophil count

მკურნალობის ალგორითმი

მწვავე

initial treatment step 1: asthma symptoms 1-2 days per week or less and no risk factors for exacerbations

initial treatment step 2: asthma symptoms less than 3-5 days per week and normal (or mildly reduced) lung function

initial treatment step 3: asthma symptoms most days (e.g., 4-5 days per week or more), or waking due to asthma once a week or more, low lung function, and risk factors for exacerbations

initial treatment step 4: daily asthma symptoms, waking at night once a week or more, and low lung function

მიმდინარე

ongoing treatment step 1: patients using short-acting beta agonist (SABA) alone or with newly diagnosed asthma, with normal (or mildly reduced) lung function

ongoing treatment step 2: asthma not controlled on step 1 treatment

ongoing treatment step 3: asthma not controlled on steps 1-2 treatment (track 1) or step 2 treatment (track 2), with risk factors for exacerbations

ongoing treatment step 4: asthma not controlled on step 3 treatment

ongoing treatment step 5: asthma not controlled on step 4 treatment and patient reviewed by specialist

კონტრიბუტორები

ავტორები

Lauren E. Eggert, MD

Clinical Assistant Professor

Division of Pulmonary, Allergy, and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

გაფრთხილება:

LEE has participated on advisory boards for Regeneron and AstraZeneca.

Sourav Majumdar, MD

Clinical Assistant Professor (Affiliated)

Division of Pulmonary and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

გაფრთხილება:

SM declares that he has no competing interests.

მადლიერება

Dr Lauren E. Eggert and Dr Sourav Majumdar would like to gratefully acknowledge Dr Irwani Ibrahim, Dr Kay Choong See, Dr Francis Thien, and Dr Catherine Weiler, previous contributors to this topic.

გაფრთხილება:

II, KCS, FT, and CW declare that they have no competing interests.

რეცენზენტები

Javed Sheikh, MD

Clinical Director

Division of Allergy and Inflammation

Beth Israel Deaconess Medical Center/Harvard Medical School

Boston

გაფრთხილება:

JS is a consultant for Aventis, GSK, and Novartis/Genentech; is on the Speakers Bureau for Merck, Aventis, GSK, AstraZeneca, Pfizer, Novartis/Genentech, Inspire, and UCB; has had research sponsored by GSK; is an expert witness at Haemonetics; and has received publication honorarium at Emedicine.

Sheree M.S. Smith, PhD

Research Manager

Imperial College Healthcare Trust

NHLI Airways Division

Imperial College London (Honorary) Respiratory Research

Chest & Allergy

St Mary's Hospital

London

გაფრთხილება:

SMSS declares that she has no competing interests.

Neil Thomson, MBChB, MD, FRCP

Professor of Respiratory Medicine

Respiratory Medicine Section

Division of Immunology, Infection & Inflammation

University of Glasgow

Glasgow

გაფრთხილება:

NT declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

წყაროები

ჩვენი მტკიცებულებებისა და სარედაქციო ჯგუფები თანამშრომლობენ საერთაშორისო ექსპერტებსა და რეცენზენტებთან, რათა უზრუნველვყოთ თქვენი წვდომა კლინიკურად ყველაზე მნიშვნელოვან ინფორმაციაზე.

ძირითადი სტატიები

National Institutes of Health; National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. Expert panel report 3: guidelines for the diagnosis and management of asthma. Aug 2007 [internet publication].სრული ტექსტი

Global Initiative for Asthma. 2024 global strategy for asthma management and prevention. May 2024 [internet publication].სრული ტექსტი

Parsons JP, Hallstrand TS, Mastronarde JG, et al. An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction. Am J Respir Crit Care Med. 2013 May 1;187(9):1016-27.სრული ტექსტი აბსტრაქტი

Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC); Cloutier MM, Baptist AP, Blake KV, et al. 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-70.სრული ტექსტი აბსტრაქტი

გამოყენებული სტატიები

ამ თემაში მოხსენიებული წყაროების სრული სია ხელმისაწვდომია მომხმარებლებისთვის, რომლებსაც აქვთ წვდომა BMJ Best Practice-ის ყველა ნაწილზე.

დიფერენციული დიაგნოზები
- COPD
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- Breathing pattern disorder
მეტი დიფერენციული დიაგნოზები
გაიდლაინები
- Global strategy for asthma management and prevention
- 2020 focused updates to the asthma management guidelines
მეტი გაიდლაინები
პაციენტის ბროშურები
Asthma in adults: what is it?
Asthma in adults: what are the treament options?
მეტი პაციენტის ბროშურები
Videos
Polyphonic wheeze
Expiratory wheeze
მეტი ვიდეოები
შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

ამ მასალის გამოყენება ექვემდებარება ჩვენს განცხადებას

Asthma in adults

GINA reiterates montelukast safety warning

შეჯამება

განსაზღვრება

ანამნეზი და გასინჯვა

ძირითადი დიაგნოსტიკური ფაქტორები

რისკფაქტორები

დიაგნოსტიკური კვლევები

1-ად შესაკვეთი გამოკვლევები

გასათვალისწინებელი კვლევები

ახალი ტესტები

მკურნალობის ალგორითმი

initial treatment step 1: asthma symptoms 1-2 days per week or less and no risk factors for exacerbations

initial treatment step 2: asthma symptoms less than 3-5 days per week and normal (or mildly reduced) lung function

initial treatment step 3: asthma symptoms most days (e.g., 4-5 days per week or more), or waking due to asthma once a week or more, low lung function, and risk factors for exacerbations

initial treatment step 4: daily asthma symptoms, waking at night once a week or more, and low lung function

ongoing treatment step 1: patients using short-acting beta agonist (SABA) alone or with newly diagnosed asthma, with normal (or mildly reduced) lung function

ongoing treatment step 2: asthma not controlled on step 1 treatment

ongoing treatment step 3: asthma not controlled on steps 1-2 treatment (track 1) or step 2 treatment (track 2), with risk factors for exacerbations

ongoing treatment step 4: asthma not controlled on step 3 treatment

ongoing treatment step 5: asthma not controlled on step 4 treatment and patient reviewed by specialist

კონტრიბუტორები

ავტორები

Lauren E. Eggert, MD

გაფრთხილება:

Sourav Majumdar, MD

გაფრთხილება:

მადლიერება

გაფრთხილება:

რეცენზენტები

Javed Sheikh, MD

გაფრთხილება:

Sheree M.S. Smith, PhD

გაფრთხილება:

Neil Thomson, MBChB, MD, FRCP

გაფრთხილება:

Peer reviewer acknowledgements

Disclosures

წყაროები

ძირითადი სტატიები

გამოყენებული სტატიები

დიფერენციული დიაგნოზები

გაიდლაინები

პაციენტის ბროშურები

Videos

შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

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