Asthma in the Primary Care Setting

Overview

Journal Med Clin North Am

Specialty General Medicine

Date 2019 Apr 9

PMID 30955512

Citations 35

Authors

Tianshi David Wu

Emily P Brigham

Meredith C McCormack

Affiliations

Soon will be listed here.

Abstract

Asthma is one of the commonest respiratory diseases in the United States, affecting approximately 8% of adults. This article reviews the epidemiology, diagnosis, and treatment of asthma, with integration of recommendations from professional societies, with special attention to differential diagnosis. A framework for outpatient management of patients with asthma is presented, including indications for subspecialist referral. With integration of objective diagnostic information, systematic approach through modification of disease triggers and adjustment of controller medications, and patient empowerment to respond to varying symptoms using an asthma action plan, most individuals with asthma are successfully managed in the primary care setting.

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References

Cockcroft D . Direct challenge tests: Airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest. 2010; 138(2 Suppl):18S-24S. DOI: 10.1378/chest.10-0088. View

Tarlo S, Lemiere C . Occupational asthma. N Engl J Med. 2014; 370(7):640-9. DOI: 10.1056/NEJMra1301758. View

Jamrozik E, Knuiman M, James A, Divitini M, Musk A . Risk factors for adult-onset asthma: a 14-year longitudinal study. Respirology. 2009; 14(6):814-21. DOI: 10.1111/j.1440-1843.2009.01562.x. View

Kitch B, Paltiel A, M Kuntz K, Dockery D, Schouten J, Weiss S . A single measure of FEV1 is associated with risk of asthma attacks in long-term follow-up. Chest. 2004; 126(6):1875-82. DOI: 10.1378/chest.126.6.1875. View

Schatz M, Sorkness C, Li J, Marcus P, Murray J, Nathan R . Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J Allergy Clin Immunol. 2006; 117(3):549-56. DOI: 10.1016/j.jaci.2006.01.011. View

Dixon A . Rhinosinusitis and asthma: the missing link. Curr Opin Pulm Med. 2008; 15(1):19-24. PMC: 2774711. DOI: 10.1097/MCP.0b013e32831da87e. View

Borak J, Lefkowitz R . Bronchial hyperresponsiveness. Occup Med (Lond). 2015; 66(2):95-105. DOI: 10.1093/occmed/kqv158. View

Dougherty R, Fahy J . Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype. Clin Exp Allergy. 2009; 39(2):193-202. PMC: 2730743. DOI: 10.1111/j.1365-2222.2008.03157.x. View

Cockcroft D, Swystun V . Asthma control versus asthma severity. J Allergy Clin Immunol. 1996; 98(6 Pt 1):1016-8. DOI: 10.1016/s0091-6749(96)80185-0. View

10.

Gibson P, Henry R, Coughlan J . Gastro-oesophageal reflux treatment for asthma in adults and children. Cochrane Database Syst Rev. 2003; (2):CD001496. DOI: 10.1002/14651858.CD001496. View

11.

McFadden Jr E, elSanadi N, Dixon L, Takacs M, Deal E, Boyd K . Protocol therapy for acute asthma: therapeutic benefits and cost savings. Am J Med. 1995; 99(6):651-61. DOI: 10.1016/s0002-9343(99)80253-8. View

12.

Chupp G, Laviolette M, Cohn L, McEvoy C, Bansal S, Shifren A . Long-term outcomes of bronchial thermoplasty in subjects with severe asthma: a comparison of 3-year follow-up results from two prospective multicentre studies. Eur Respir J. 2017; 50(2). PMC: 5593347. DOI: 10.1183/13993003.00017-2017. View

13.

Cates C, Bara A, Crilly J, Rowe B . Holding chambers versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2003; (3):CD000052. DOI: 10.1002/14651858.CD000052. View

14.

McKeever T, Mortimer K, Wilson A, Walker S, Brightling C, Skeggs A . Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations. N Engl J Med. 2018; 378(10):902-910. DOI: 10.1056/NEJMoa1714257. View

15.

Gamble J, Stevenson M, Heaney L . A study of a multi-level intervention to improve non-adherence in difficult to control asthma. Respir Med. 2011; 105(9):1308-15. DOI: 10.1016/j.rmed.2011.03.019. View

16.

Petsky H, Cates C, Kew K, Chang A . Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis. Thorax. 2018; 73(12):1110-1119. DOI: 10.1136/thoraxjnl-2018-211540. View

17.

Niimi A . Cough and Asthma. Curr Respir Med Rev. 2011; 7(1):47-54. PMC: 3182093. DOI: 10.2174/157339811794109327. View

18.

Henneberger P, Redlich C, Callahan D, Harber P, Lemiere C, Martin J . An official american thoracic society statement: work-exacerbated asthma. Am J Respir Crit Care Med. 2011; 184(3):368-78. DOI: 10.1164/rccm.812011ST. View

19.

McFadden Jr E, Gilbert I . Exercise-induced asthma. N Engl J Med. 1994; 330(19):1362-7. DOI: 10.1056/NEJM199405123301907. View

20.

Miller M, Dickinson S, Hitchings D . The accuracy of portable peak flow meters. Thorax. 1992; 47(11):904-9. PMC: 464089. DOI: 10.1136/thx.47.11.904. View