Interdisciplinary monitoring of the patient with bronchial asthma

Abstract

Bronchial asthma is characterized by chronic inflammation of the airways, associated with variable obstruction that li­mits air flow, and bronchial hyperactivity caused by va­rious sti­muli. The most common symptoms present in asth­ma­tic peo­ple are wheezing, dyspnea, cough and chest con­stric­tion. Bronch­ial asthma has a high variability, which makes its phenotyping very important for guiding treat­ment. Among the most common phenotypes, we mention allergic asth­ma, nonallergic asthma, late-onset bronchial asthma, per­sis­tent asthma with a fixed limitation of airflow, and asth­ma associated with obesity. A thorough anamnesis and performing spirometry with bronchodilator test help us to establish the diagnosis of bronchial asthma. The increase in the maximum expiratory volume per second (VEMS) by 12% and 200 ml from the initial value after taking four short-acting bronchodilator puffs is suggestive of bronchial asth­ma. The ACT questionnaire is used to show whether the di­sease is well controlled therapeutically. Exposure to allergens, over­weight, gastroesophageal reflux disease, rhinosinusitis, na­sal polyposis and smoking are some of the comorbidities and trig­­gers of bronchial asthma crisis. In terms of treatment, asth­matic patients have inhaled de­vices that contain as the first line of treatment inhaled cor­ti­co­ste­roids to which a long-acting beta2-agonist is added. Choosing the right the­ra­py for each patient is made on the basis of five stages of treatment, depending on the symp­to­ma­to­logy of each in­di­vi­dual patient, the phenotype of asth­ma and the co­mor­bi­di­ties present. Patients with severe asth­ma benefit from tar­ge­ted biological therapy.