https://orcid.org/0000-0002-9722-833X
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ABSTRACT
Introduction
Asthma is a common chronic respiratory disease characterized by chronic airway inflammation, airway hyperresponsiveness, reversible airflow limitation, and airway remodeling. Mild asthma is the most common type of asthma, but it is the most neglected. Sometimes mild asthma can lead to acute severe exacerbations or even death.
Areas covered
This article reviews the epidemiology, risk factors, and possible predictors of acute severe exacerbations and disease progression in mild asthma to improve the understanding of mild asthma and its severe acute exacerbations and progression.
Expert opinion
There is a necessity to improve asthma patient categorization and redefine mild asthma’s concept to heighten patient and physician attention. Identifying mild asthma patients that are highly vulnerable to severe acute exacerbations and researching the mechanisms are future prioritizations.
Article highlights
Mild asthma may not be truly ‘mild,’ as this label could result in neglectful treatment and management of patients with mild asthma.
Some patients with mild asthma are at risk for poor control, acute exacerbations, reduced lung function and even death.
Multiple risk factors and biomarkers have the potential to recognize individuals with asthma who may have unfavorable outcomes.
Future research should focus on improved categorization of asthma, more effective management of emergency medication usage, and redefining the classification of ‘mild asthma.’
Abbreviations
| ACQ | = | Asthma control score |
| ALPL | = | Alkaline phosphatase, liver/bone/kidney |
| AX | = | Area of reactance |
| BAS | = | Basophils |
| CPA3 | = | Carboxypeptidase A3 |
| CTLA-4 | = | Cytotoxic T-lymphocyte-associated protein 4 |
| CLC | = | Charcot-Leyden crystal galectin |
| CMV | = | Cytomegalovirus |
| CXCR2 | = | Chemokine (C‐X‐C motif) receptor 2 |
| DNASEIL3 | = | Deoxyribonuclease I‐like3 |
| EOS | = | Eosinophils |
| FEV1 | = | Forced expiratory volume in the first second |
| FEF 25–75% | = | Forced expiratory flow rate between 25% and 75% |
| GAWS | = | Genome-wide association studies |
| HHV | = | Human herpesvirus |
| H2S | = | Hydrogen sulfide |
| ICS | = | Inhaled corticosteroids |
| IL1B | = | Interleukin 1 beta |
| IOS | = | Impulse oscillometry |
| LBP | = | Lipopolysaccharide binding protein |
| MBNW | = | Multiple nitrogen washout |
| NEU | = | Neutrophils |
| NFA | = | Near-fatal asthma |
| PAL | = | Persistent airflow limitation |
| PFTs | = | Pulmonary function tests |
| R5 | = | The resistance at 5 Hz |
| R20 | = | The resistance at 20 Hz |
| RV | = | Rhinovirus |
| SABA | = | Short-acting beta-agonists |
| sCD | = | Soluble cluster of differentiation |
| SNP | = | Single nucleotide polymorphism |
| sST2 | = | Soluble growth stimulation expressed gene 2 |
| TGFB1 | = | Transforming growth factor beta 1 |
| X5 | = | Respiratory system impedance at 5 Hz |
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
A peer reviewer on this manuscript has received an honorarium from Expert Review of Respiratory Medicine for their review work. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.