The impact of asthma exacerbations and preventive strategies

Abstract

Objective:

To review the pathophysiologic mechanisms underlying asthma exacerbations, the impact of exacerbations, and both current and future treatment strategies to establish asthma control and reduce the risk of future exacerbations.

Research design and methods:

Relevant adult data were identified via PubMed, with additional references obtained by reviewing bibliographies from selected articles.

Results:

Asthma exacerbations or ‘attacks’ are acute episodes of progressive worsening of symptoms which occur in patients with all degrees of asthma severity and are an important cause of morbidity and mortality. For patients, these asthma attacks constitute a considerable part of the disease burden in terms of both personal suffering and economic impact. Exacerbations are characterized in part by decreases in expiratory flow or lung function. The pathophysiologic mechanism underlying these changes is likely to be different depending on the specific asthma phenotype. Asthma exacerbations are commonly initiated by upper respiratory tract infections and/or environmental allergens, although there are other known factors which increase the risk of a patient developing exacerbations, such as cigarette smoking.

Establishing asthma control and reducing the risk of future exacerbations is the main goal of asthma treatment. Inhaled corticosteroids alone or in combination with long-acting β₂-agonists, in addition to other step-up strategies such as leukotriene receptor antagonists and theophylline, are recommended. The anti-immunoglobulin E monoclonal antibody omalizumab should also be considered in difficult-to-treat allergic asthma.

Conclusions:

Despite the currently available treatments, many patients with asthma remain symptomatic and experience exacerbations regardless of disease severity. New therapies, including long-acting anticholinergics, anti-cytokines, and chemoattractant receptor-homologous molecules, are under investigation with some promising results. In addition to increased education and use of self-management plans, these novel therapies are essential to help improve asthma control and reduce exacerbation risk.

Keywords: :

• Anti-asthmatic agents
• Asthma
• Asthma exacerbations
• Asthma/physiopathology
• Asthma/prevention and control

Transparency

Declaration of funding

Editorial assistance was funded by Boehringer Ingelheim. The authors have not received any honorarium in relation to this paper from the sponsor or publisher.

Declaration of financial/other relationships

L.M.G. has disclosed that he has received research grants from and has been an advisor to Teva, Meda, and Boehringer Ingelheim. He has also been on the speaker bureau for Teva, Meda, and AstraZeneca. N.E. has disclosed that he has no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors take full responsibility for the scope, direction, and content of the manuscript and have approved the submitted manuscript. Sam Yarwood PhD at Complete HealthVizion provided assistance in the preparation and revision of the draft manuscript, developed under the authors’ conceptual direction and based on detailed discussion and feedback from the authors.

Notes

*Asthma Control Test is a registered trademark of QualityMetric Incorporated, Lincoln, RI, USA

*Respimat is a registered trademark of Boehringer Ingelheim, Ingelheim am Rhein, Germany

†SoftMist is a registered trademark of Boehringer Ingelheim, Ingelheim am Rhein, Germany