Chronic inflammatory airway disease with variable reversible obstruction and hyperresponsiveness.
Causes
- • Atopy
- • Environmental allergens
- • Occupational exposure
- • Viral infection
Risk factors
- • FHx atopy
- • Eczema, allergic rhinitis
- • Tobacco / pollution
- • Obesity
Clinical features
- • Wheeze, cough (often nocturnal)
- • Dyspnoea
- • Chest tightness
- • Diurnal/seasonal variation
Examination
- • Polyphonic wheeze
- • Prolonged expiration
- • Hyperinflation
Investigations
- • Spirometry: FEV₁/FVC <0.7, bronchodilator reversibility ≥12% + 200 mL
- • FeNO ≥40 ppb
- • PEFR diary
- • IgE, eosinophils
Diagnosis
- • Symptom variability + objective airflow limitation
Management
- • GINA stepwise: low-dose ICS-formoterol PRN → daily ICS-formoterol → +LABA → +LAMA / biologics
- • Avoid triggers, smoking cessation
- • Inhaler technique + spacer
- • Asthma action plan
Complications
- • Exacerbation, status asthmaticus
- • Airway remodelling
- • Side effects of long-term steroids
Prevention
- • Influenza/pneumococcal vaccination
- • Trigger avoidance
Follow-up
- • Annual review: control (ACT), spirometry, technique
- • Step-down if controlled 3 months
Clinical pearls
- • SABA-only is unsafe → always pair with ICS
- • Consider biologics (omalizumab, mepolizumab, benralizumab, dupilumab) for severe eosinophilic/allergic disease
References
- • GINA 2024
Educational — verify locally.
