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What is asthma?

Doc. dr Snežana Živanović

Asthma is a disease of the airways characterized by inflammation and reversible broncho-obstruction. Asthma occurs in people of all races and at any age and was recognized as a disease thousands of years ago. The first descriptions of asthma come from ancient China when Shen-Nung (the ˝Chinese Emperor of Fire˝ 2838-2698 BC) described the first asthma-like symptoms and observed the therapeutic effect of the mahuang plant from which ephedrine was extracted. In ancient Rome, ephedrine taken with wine was used to treat asthma.

Despite great progress in the knowledge of its pathophysiology, there is no single, universally accepted definition of asthma. One of the problems in defining asthma is that it is not a simple entity, but under the term asthma we describe a whole set of symptoms conditioned by the action of numerous partially understood mechanisms. Common factors are hyperresponsive airways that respond to a wide range of stimuli, reversible airway narrowing, and occasional variable symptoms.

The National Heart, Lung, and Blood Institute and the World Health Organization established the Global Asthma Initiative in 1993. Over the past thirty years, guidelines for the prevention and treatment of asthma have changed in line with scientific knowledge. GINA from 2023 defines asthma as:

  • ˝a heterogeneous disease characterized by chronic inflammation of the airways that causes typical respiratory symptoms: wheezing, shortness of breath, chest tightness and cough, which vary over time and are of variable intensity. These symptoms are associated with variable expiratory airflow obstruction. Airway obstruction can become persistent over time.
  • Asthma is usually associated with bronchial hyperreactivity and airway inflammation, although these are not necessary or sufficient for the diagnosis.
  • Recognizable groups (clusters) of demographic, clinical, and/or pathophysiological characteristics denote the ``asthma phenotype''. Asthma phenotype does not always correlate with a specific pathological process or response to therapy.

The definition of asthma is based on the typical characteristics of asthma before the introduction of control drugs.

Recognizing asthma in the first five years of life is not easy due to frequent respiratory viral infections of the upper respiratory tract, which are often accompanied by wheezing at this age. Deciding exactly when asthma started is difficult.

Asthma is the most common chronic disease in childhood and the leading cause of morbidity (assessed by school absences, emergency department visits, and hospitalizations) compared to other chronic diseases. Asthma most often begins in early childhood. The onset of asthma is earlier in boys than in girls.

There are no interventions that prevent the development of asthma or modify its long-term nature. Atopy is manifested in most children with asthma after the
age of three, and specific sensitization to allergens (especially at an early age) is an important risk factor for the development of asthma.

Asthma is likely in younger children with a history of wheezing when the child has:

  • Wheezing or coughing on exertion, laughing or crying, or in the absence of a visible respiratory infection
  • History of other allergic diseases (eczema or rhinitis), allergen sensitization or asthma in a first-degree relative
  • Clinical improvement after 2-3 months of treatment with asthma control drugs and worsening after discontinuation of therapy.

Literature

  • Đorđević D. Epidemiology, etypotaogenesis and classification of bronchial asthma, historical review. In: Bronchial asthma, ed. Faculty of Medicine in Niš. 2005: 7-25.
  • https://ginasthma.org/2023-gina-main-report/

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