Long term Implications of Asthma

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Asthma is a chronic disease characterized by inflammation of the airways caused by allergens and other triggers. Asthma signs and symptoms evolve from three basic characteristics that underlie the …

Asthma is a chronic disease characterized by inflammation of the airways caused by allergens and other triggers. Asthma signs and symptoms evolve from three basic characteristics that underlie the disease and its exacerbations: airway obstruction, airway hyper responsiveness and airway inflammation. Airway obstruction and hyperresponsiveness represent the classic physiology of asthma, and their contribution to the disease process and symptomatology have been well recognized for some time. Appreciation of the role of airway inflammation in asthma has evolved more recently.

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  • 1. Long term Implications of Asthma In the previous articles, we have been discussing the benefits of exhaled nitric oxide. In this article, we take a step back and assess how asthma affects the patients and the long term implications of asthma on them. This should give us an idea of why monitoring of exhaled nitric oxide in asthma patients will help in long term asthma management. One of the leading experts in asthma management devices discusses asthma and its implications. An excerpt from an article by Apieron: Asthma Overview Asthma is a chronic disease characterized by inflammation of the airways caused by allergens and other triggers. When airways are inflamed, the inner walls of the airways swell making them irregular. This causes the flow of air to become turbulent. The events that lead to obstruction of airflow and thus to asthma symptoms are complex and usually involve the following events: • Bronchoconstriction, where the smooth muscle surrounding the airways tightens in response to a trigger and narrows the airway. • Inflammation, where inner walls of airways swell. • Mucus formation within the airways that obstructs airflow. • Typical asthma symptoms include wheezing, coughing, chest tightness (dyspnea) and shortness of breath. The Role of Inflammation in Asthma Asthma signs and symptoms evolve from three basic characteristics that underlie the disease and its exacerbations: airway obstruction, airway hyper responsiveness and airway inflammation. Airway obstruction and hyperresponsiveness represent the classic physiology of asthma, and their contribution to the disease process and symptomatology have been well recognized for some time. Appreciation of the role of airway inflammation in asthma has evolved more recently. Today asthma experts consider airway inflammation a central feature of asthma pathogenesis and its clinical manifestations. In fact, airway inflammation likely plays a critical role in airway obstruction and hyper responsiveness. In recent years, clinical and scientific knowledge of asthma has evolved from a
  • 2. model of episodic constriction of bronchial smooth muscle to a model which involves chronic airway inflammation. Airway inflammation precedes symptoms. Evidence of inflammation is present at the onset of symptoms in newly diagnosed patients with asthma. Accordingly, treatment algorithms for asthma have emphasized treatment of the underlying inflammation, as well as the bronchoconstrictive symptoms. By acquiring a better understanding and appreciation of the inflammatory process, physicians can employ treatments to inhibit specific steps in the process and improve control over asthma and its symptoms. The Cost of Asthma Asthma affects 22 million Americans. A principal clinical consequence of both acute and chronic inflammation is the development of asthma exacerbations. Exacerbations of asthma are not only an important clinical marker of inadequately controlled or worsening asthma but are probably the most important outcomes from both a humanistic and health economics viewpoint. Severe asthma exacerbations lead to about 4,000 deaths and nearly 500,000 hospitalizations per year. Healthcare costs for asthma include outpatient visits to physician offices and hospital outpatient departments, visits to hospital emergency departments (EDs) and hospitalizations. When considering the prevalence of asthma and the frequency of such visits, as outlined in the statistics below, the costs become monumental. • 34.1 million people have been diagnosed with asthma during their lifetime. • 22.8 million people have asthma. • There were 14.1 million outpatient asthma visits to private physician offices and hospital outpatient departments. • Children less than 18 years had 7 million physician office and outpatient visits. Mortality There are about 4,000 deaths due to asthma each year, many of which are avoidable with proper treatment and care. Social and Economic Costs • The annual cost of asthma is estimated to be nearly $18 billion. • Direct costs accounted for nearly $10 billion (hospitalizations the single largest portion of direct cost) and indirect costs of $8 billion (lost earnings due to illness or death)
  • 3. • For adults, asthma is one of the leading causes of work absenteeism and “presenteeism,” resulting in nearly 13 million missed or lost (“less productive”) workdays each year.9 • Among children ages 5 to 17, asthma is the leading cause of school absences from a chronic illness. It accounts for an annual loss of more than 13 million school days per year.3 It is estimated that children with asthma spend a nearly 8 million days per year restricted to bed The link to download the complete article, Advancing Asthma Management with Exhaled Nitric Oxide http://www.apieron.com/asthma-information-downloads/index.php