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Asthma is a common pulmonary condition defined by chronic inflammation of respiratory tubes, tightening of respiratory smooth muscle, and episodes of bronchoconstriction. [1] The Centers for Disease Control and Prevention estimate that 1 in 11 children and 1 in 12 adults have asthma in the United States of America. [1]
The 2005 Oxford Textbook of Medicine distinguishes type 1 brittle asthma by "persistent daily chaotic variability in peak flow (usually greater than 40 per cent diurnal variation in PEFR more than 50 per cent of the time)", while type 2 is identified by "sporadic sudden falls in PEFR against a background of usually well-controlled asthma with normal or near normal lung function". [8]
Asthma phenotyping and endotyping has emerged as a novel approach to asthma classification inspired by precision medicine which separates the clinical presentations of asthma, or asthma phenotypes, from their underlying causes, or asthma endotypes. The best-supported endotypic distinction is the type 2-high/type 2-low distinction.
Asthma phenotyping and endotyping is a novel approach to asthma classification inspired by precision medicine. It seeks to separate the clinical presentations or clusters of signs and symptoms of asthma, known as asthma phenotypes, from their underlying etiologies or causes, known as asthma endotypes. [1] [2] [3]
The major criteria are: a persistent airflow limitation (a ratio of forced expiratory volume in 1 second divided by forced vital capacity of less than 0.7 or below the lower limit of normal), a significant exposure history to tobacco smoke (defined as a greater than 10-pack/year history), or significant exposure to other indoor or outdoor air ...
Specifically, clinical characteristics such as allergy and bronchial hyperresponsiveness that are commonly observed in individuals afflicted with asthma were viewed as likely determinants of the life-threatening disease, COPD (in the Netherlands, the term chronic non-specific lung disease was adopted as an umbrella term for asthma and COPD).
Airway remodelling is a multifaceted process involving multiple airway tissues. These include goblet cell hyperplasia, leading to increased mucus production, and airway smooth muscle hypertrophy (or smooth muscle cell hyperplasia), leading to the release of pro-inflammatory and pro-fibrotic messengers contributing to subepithelial fibrosis.
Due to their fast onset of action, they have been selected as first-line therapy for quick relief in persistent and intermittent asthma and bronchospasm. [6] Patients may experience dizziness, heart palpitations, hyperglycemia, diarrhea and muscle cramps when taking these medications.
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