Asthma
Asthma Season - Autumn 2020 Written by Sergei Belenky, MD, PhD – Office of Allergy, Asthma, & Immunology
Highly unusual and grim circumstances are setting the stage for this year’s asthma fall season which is full throttle underway across the United States. COVID-19 has created an all year round viral season with staggering consequences for communities around the country and worldwide. Autumn is commonly associated with numerous respiratory viruses, like rhinovirus, metapneumovirus, adenovirus, and influenza virus. The latter and the former are the most important groups triggering seasonal exacerbations of asthma. Asthma exacerbations or flare-ups are events in the course of the disease when utilization of care is at its utmost level, when healthcare resources are maximally employed, and medical, social, economic impact of asthma are felt the most. The toolkit that can prevent asthma exacerbations includes optimal asthma control achieved with effective and safe asthma treatment. Asthma is a common inflammatory condition of the airways affecting 340 million people worldwide, and up to 10% of the population of the United States. Seven million children are diagnosed asthma sufferers, with millions more undiagnosed. Clinical characteristics of asthma include wheezing, shortness of breath, tightness in the chest and cough. Reversible or variable airway obstruction is its main physiologic feature, and airway inflammation is
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the hallmark of its pathobiology. The goal of any asthma therapeutic plan is achieving asthma control. Ideally that involves reduction or elimination of daytime symptoms, nocturnal awakening with any difficulty breathing, improvement of the quality of life by increasing functional capacity including recreational and sports activities. Maintaining lung function at normal or near normal level as well as reduction of the risk of exacerbation are the ultimate parameters of overall success in asthma management. For the past almost 50 years inhaled corticosteroids (ICS) have been the cornerstone of asthma treatment representing so-called asthma controller therapy, whereby short-acting beta-2 agonists (SABA) being a reliever therapy - indicated for relief of symptoms whose very prevention is one of the most important therapeutic goals. Frequent use of SABA is a reliable marker of poor control of asthma with increasing risk of exacerbation. Unbridled use of SABA in the 1980s is believed to be associated with a spike in asthma mortality. And conversely wide use of ICS as the mainstay of asthma control led to decreased asthma mortality. along with many other benefits like daytime and nighttime symptom control, improvement in lung function, and decreased frequency and severity of exacerbations.
AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org
