Adult asthma
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Adult Asthma: Epidemiology, Diagnosis, and Management
Epidemiology of Adult Asthma
Asthma is a significant global health issue, affecting approximately 300 million people worldwide, with about 7.5% of adults in the United States diagnosed with the condition. While asthma is more prevalent in children, adults experience higher morbidity and mortality rates. The prevalence of asthma has increased since the 1970s, particularly in urbanized and westernized regions, and is expected to continue rising. Adult asthma is more common in women, a reversal from childhood asthma, which is more prevalent in boys .
Diagnosis of Adult Asthma
Diagnosing asthma in adults can be challenging due to its variable presentation and the presence of comorbid conditions. The European Respiratory Society recommends a diagnostic algorithm starting with spirometry followed by bronchodilator reversibility testing if airway obstruction is present. Additional tests such as exhaled nitric oxide fraction, peak expiratory flow variability, and bronchial challenge testing may be necessary if initial spirometry is inconclusive. Accurate diagnosis is crucial as both over- and under-diagnosis are common issues.
Pathophysiology and Phenotypes
Asthma in adults is characterized by airway inflammation, variable airflow obstruction, and bronchial hyperresponsiveness . It results from complex interactions between genetic and environmental factors, leading to heterogeneity in clinical presentation and airway inflammation. Adult asthma can be classified into different phenotypes, including allergic and non-allergic asthma, with severe asthma requiring high-intensity treatment to maintain control .
Comorbidities and Risk Factors
Adults with asthma often have associated comorbidities such as rhinitis, sinusitis, gastroesophageal reflux disease (GERD), obstructive sleep apnea, and depression . Factors such as increased IgE levels, elevated FeNO, eosinophilia, obesity, smoking, and low socioeconomic status are associated with more severe asthma in adults. Additionally, adult-onset asthma is linked to more respiratory symptoms and higher medication use compared to childhood-onset asthma .
Management and Treatment
The primary goal of asthma treatment is to achieve good control, minimizing symptoms and the risk of exacerbations. Standard pharmacologic treatments include inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), leukotriene antagonists, and short-acting bronchodilators. For severe asthma, new biological therapies targeting specific phenotypes offer personalized treatment options . Non-pharmacologic management, including patient education on inhaler technique and self-monitoring, is also vital.
Challenges in Older Adults
Asthma in older adults presents unique challenges, including higher rates of underdiagnosis and increased morbidity and mortality. Comorbid conditions such as cardiovascular disease, cognitive impairment, and arthritis complicate diagnosis and management. Older adults are also more susceptible to polypharmacy and medication adverse events, necessitating careful selection of treatments.
Conclusion
Adult asthma is a complex and heterogeneous disease with significant public health implications. Accurate diagnosis, understanding of phenotypes, and effective management strategies are essential to improve outcomes. Continued research into the genetic and environmental determinants of asthma, as well as the development of personalized treatments, will be crucial in addressing this growing health concern.
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