Adult
bronchial asthma is characterized by chronic airway
inflammation, and presents clinically with variable airway narrowing (wheezes and
dyspnea) and
cough. Long-standing
asthma induces
airway remodeling, leading to intractable
asthma. The number of patients with
asthma has increased; however, the number of patients who die of
asthma has decreased (1.2 per 100,000 patients in 2015). The goal of
asthma treatment is to enable patients with
asthma to attain normal pulmonary function and lead a normal life, without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management by therapeutic agents and elimination of the causes and risk factors of
asthma are fundamental to its treatment. Four steps in
pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled
corticosteroid, varying from low to high levels. Long-acting β2-agonists,
leukotriene receptor antagonists, sustained-release
theophylline, and long-acting
muscarinic antagonist are recommended as add-on drugs, while anti-
immunoglobulin E antibody and oral
steroids are considered for the most severe and persistent
asthma related to
allergic reactions.
Bronchial thermoplasty has recently been developed for severe, persistent
asthma, but its long-term efficacy is not known. Inhaled β2-agonists,
aminophylline,
corticosteroids,
adrenaline,
oxygen therapy, and other approaches are used as needed during acute exacerbations, by choosing treatment steps for
asthma in accordance with the severity of exacerbations.
Allergic rhinitis, eosinophilic chronic
rhinosinusitis, eosinophilic
otitis,
chronic obstructive pulmonary disease,
aspirin-induced asthma, and pregnancy are also important issues that need to be considered in
asthma therapy.