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Asthma

**tip: Find an extended version of this teaching on the pulmonology rotation page

Objectives:

  1. Develop an understanding of the pathogenesis and diagnosis of asthma
  2. Develop a differential diagnosis for wheeze and cough in early childhood. Understand the relationship between early childhood wheezing, chronic cough and asthma
  3. Understand the National Asthma Education and Prevention Program (NAEPP) and Global Initiative for Asthma (GINA) guidelines and review recent updates in clinical management
  4. Understand treatment options including anti-inflammatory “controller” medications and rescue medications, including methods of medication delivery and treatment side effects
  5. Recognize common asthma triggers and learn how to manage environmental factors
  6. Review management of asthma exacerbations and the rationale for institutional protocols

Articles:

  • GINA 2024 Guidelines - GINA = Global Strategy for Asthma Management and Prevention!  The new guideline incorporates new scientific information about asthma based on a review of recent scientific literature by an international panel of experts on the GINA Science Committee. This comprehensive and practical resource about one of the most common chronic lung diseases worldwide contains extensive citations from the scientific literature and forms the basis for other GINA documents and programs.
  • Excellent Lancet paper from 2018 with a great summary of asthma pathophysiology. The paper includes a very useful diagnostic table showing features, symptoms and signs that will help differentiate between different respiratory disease processes.  The manuscript has detailed rationale for each step of asthma control.  It also includes a summary of the clinical trial data for the new biologic therapies.  The paper concludes with a practical way to evaluate a patient having a suspected asthma exacerbation. Note: References the GINA guidelines [Objectives 1,2,3,4,6]
  • Must-read 2019 article from Pediatrics in Review. It includes a great summary of differential diagnoses by age.  It is a fantastic review all currently available asthma medications, and the paper also comments on the evidence supporting various treatments for asthma in the acute setting.  [Objectives 1,4,6]  
  • This Pediatrics in Review article is most useful for diagnostic approach, asthma exacerbation management and patient education. Note: References the NAEPP guidelines [Objectives 1,6]
  • Not all that wheezes is asthma! This paper is a great review on the differential diagnosis of childhood wheeze.  [Objective 2]
  • This is a great review paper of common asthma triggers and ways to mitigate them! The paper includes practical advice for patients and families to help avoid asthma exacerbations.  [Objective 5] 

Additional Resources:

  • Handy Asthma Care Guide developed by Dr. Dy and updated intermittently by our pulm team
  • The 2023 GINA Pocket guide provides an in-depth view into the diagnosis and management of asthma. It is a very useful read to understand the rationale for treatment options, including a discussion on new asthma guidelines recommending ICS-formoterol as Step 1 therapy.  The guide also includes a glossary of all medication classes, when to consider using each and the potential adverse effects.  These guidelines differ somewhat from the NAEPP guidelines, mainly in terms of the use of ICS-LABAs for patients with mild disease.  [Objectives 3,4]
  • NAEPP asthma guidelines provide excellent tables on classifying asthma severity. Also included is a useful table with common outpatient medications and appropriate dosages by age. These guidelines differ somewhat from the GINA guidelines, mainly in terms of the use of ICS-LABAs for patients with mild disease.  [Objectives 3,4]
  • See these videos from OpenPediatrics to help learn clinical assessment of asthma and the pathophysiology and advanced care [Objectives 1,4, 6]
  • Clinical pathways improve outcomes for patients who need to be managed acutely for asthma exacerbations. A clinical pathway is a treatment protocol that aims to ensure that all patients receive standard, guidelines-based treatment, improve outcomes, and reduce costs.  Here is an example of a Pediatric ED clinical pathway for an asthma exacerbation and an inpatient clinical pathway.  [Objective 6]
  • An asthma action plan provides patients with clear information about the use of their medicines, the actions they are to take at home for asthma attacks, and either the degree of symptoms and/or the actual peak flow measurements that they should use as a guide. Please be sure to make them in Epic for our patients![Objective 4]
  • Videos demonstrating how to use asthma devices: [Objective 4]

Self-Assessment:

coming soon!