Asthma is a chronic airway disease characterized by: bronchial obstruction, that is usually reversible either spontaneously or with appropriate treatment, bronchial hyperreactivity, and reduced lung function, that in some cases may progress to irreversible airway obstruction. Clinically, asthma presents with cough, dyspnea (i.e. shortness of breath), wheeze, and chest tightness of varying intensity.
Asthma is one of the most common diseases in the world, although it should be noted that its distribution varies considerably between different countries and even between different regions within the same country.
Asthma attacks occur when an individual predisposed to develop the disease comes in contact with irritating factors or with substances to which he or she is allergic. In many cases there is a familial predisposition. Environmental factors that may cause the onset of asthma symptoms are the so-called “allergens,” the most common of which are: mites that live in house dust; pollens of various plants, which in Italy include mainly olive tree, Parietaria (wall pellitory), and grasses; hair and organic material from cats and other (domestic and non-domestic) animals. Also not-allergenic factors, such as environmental and occupational pollution, stress, tobacco smoke, and recurrent respiratory infections, can cause asthma.
Asthma is a chronic inflammatory disease, that lasts for many years or throughout life, although it may remain asymptomatic for a long time. Patients often become aware they have asthma only when they suffer from an acute attack, the so-called “exacerbation” (i.e. flare-up). The diagnosis of asthma is based primarily on a detailed medical history, aimed at identifying the presence of risk factors and main symptoms of asthma.
In addition to patient's medical history, the following are crucial for the diagnosis:
• physical examination;
• performance of lung function tests such as spirometry;
• bronchial provocation and reversibility testing.
When deciding to start regular treatment for asthma, a gradual, “stepwise” approach is recommended, which involves, for each patient, the selection of the best option within the step of care chosen according to the severity of the disease. In any case, one must try to reach treatment goals using the lowest possible dose of medication with a simple treatment regimen. The treatment is adjusted over time based on the achievement of asthma control; if necessary, this can be done either by increasing (“step-up”) or decreasing (“step-down”) the treatment, or choosing different options within the same step.