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What is asthma?

Guy B. Marks

www.woolcock.org.au

Symptoms
Wheeze, chest tightness, shortness of breath, cough (usually dry) Episodic Triggered Reversible

Diagnostic features
Typical symptoms and episodic nature Airflow obstructive
Variable Reversible Inducible

Airway inflammation
Special type of airway inflammation

Major consequences
Distress due to symptoms Exacerbations
Hospitalisation Death (rare)

Disability Impaired quality of life Adverse effects of treatment

Life Course
May start at any age
Typically, in childhood

Childhood asthma may remit


Typically, if mild and not associated with allergy

Asthma persisting into adulthood rarely remits May wax and wane during life Some cases progress to chronic airflow obstruction

Associated illnesses
Atopy (allergy)
This, in turn, associated with eczema and allergic rhinitis (hayfever)

Nasal polyps

Causes
Generally not known Occupational sensitisers cause occupational asthma Maternal smoking during pregnancy increases risk of childhood wheezing

Triggers and exacerbating factors


Viral respiratory tract infections
Most commonly, the common cold Also influenza, RSV, others

Allergens, if sensitised
HDM, grasses, animal danders, moulds Occupational sensitisers

Exercise, laughter, rapid breathing (anxiety) Irritants


Insect sprays, perfumes, cigarette smoke

Other triggers less common


Food additives
Only in some people

Aspirin
Rarely

Other medications

Epidemics
Thunderstorms
Grass pollens Moulds

30/31 October 1997, Wagga


ED attendances for asthma Hospital admissions for asthma Intubated in ICU 215 41 2

80 60
3

40 Grains / m 20 0 12 13 14 15 16 17 18 19 20 21 22 23 24

Time (hrs)

Rainfall

direction

Wind

speed

Wind

Wagga Wagga 30th October 1997 12:00 - 24:00

Variation in asthma
Age of onset and life course Severity and prognosis Type of inflammation Association with allergy Response to treatments Triggers and exacerbating factors

Treatment for asthma


Suppress inflammation
Steroids Other non-steroid agents that target components of the inflammatory response

Relax airway smooth muscle and allow airways to open


Short-term, rapid onset Longer-term (12-24 hours)

Various methods of delivery

How common is asthma?

ISAAC data reported in The Global Asthma Report, the UNION, 2011

Prevalence of current asthma by age and National Health Survey, Australia

Source: National Health Survey

Prevalence of current asthma by socioeconomic status

Source: National Health Survey 200708

Recent trends in deaths due to asthma by sex, all ages and people aged 534 years. Australia

Source: AIHW National Mortality Database

Deaths due to COPD and asthma, by sex. Australia

Source: AIHW National Mortality Database

The ACAM team

Report and slides available at: www.aihw.gov.au and www.asthmamonitoring.org

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