Asthma

Asthma is a variable inflammatory airway disease. The bronchi can narrow quickly through smooth-muscle constriction, mucosal swelling, and thick mucus, then improve—spontaneously or with treatment. That variability is the clinical signature. A patient may have a normal examination between episodes and still have asthma. The practical distinction is not simply whether the patient is wheezing. Ask whether airflow limitation varies, whether symptoms are controlled, and whether the patient is at risk of a dangerous exacerbation. Night waking, activity limitation, repeated reliever use, previous severe attacks, poor adherence, incorrect inhaler technique, smoking, and low lung function all change the risk picture. Asthma treatment has also moved beyond the old rescue-inhaler-only model. SABA-only treatment is not recommended at any step because it relieves bronchospasm without treating airway inflammation. An ICS-containing strategy is required. For adults and adolescents, the preferred pathway uses low-dose ICS-formoterol when needed, with the same combination used for maintenance and relief at higher treatment steps when prescribed as MART. Salmeterol-containing products must not be used as relievers. Diagnosis requires documented variable expiratory airflow limitation, not symptoms alone. A normal...