According to the 2023 Global Initiative for Asthma (GINA) report, asthma is defined as a heterogeneous disease with diverse underlying disease processes that is typically characterized by chronic airway inflammation and is defined by the history of respiratory symptoms, which may fluctuate over time and intensity, together with varying limitations of expiratory airflow.

The 2023 GINA report indicates that asthma has numerous phenotypes, and examples of the most common clinical asthma phenotypes include allergic asthma, nonallergic asthma, adult-onset late asthma, asthma with persistent airflow limitation, and asthma with obesity.

Allergic asthma is the most easily recognized asthma phenotype and often begins during childhood. Patients with this phenotype of asthma frequently have a personal and/or family history of allergic diseases such as eczema, allergic rhinitis, or food or drug allergy. Patients with this phenotype of asthma typically respond well to inhaled corticosteroid (ICS) treatment.

Nonallergic asthma occurs in patients without a history of allergy. Patients with this phenotype often demonstrate a lesser short-term response to ICS therapy.

Adult onset (late-onset) asthma manifests during adulthood and occurs especially in women. Patients with this phenotype often tend not to have a history of allergies and warrant higher doses of ICS or are relatively refractory to ICS. Occupational asthma should be ruled out in patients presenting with this phenotype.

Asthma with persistent airflow limitation may arise in patients with long-standing asthma airflow limitation that is persistent or incompletely irreversible.

Asthma with obesity occurs in some obese patients who experience asthma-prominent respiratory symptoms and minor eosinophilic airway inflammation.

While the exact incidence is unknown, most recent statistics from the Asthma and Allergy Foundation of America (AAFA) indicate that asthma affects more than 27 million individuals in the United States, representing an estimated one in every 12 individuals. On average in the U.S., an estimated 10 individuals die every day from asthma, and the majority of those mortalities could have been prevented with proper and prompt clinical intervention and care. The Global Asthma Report 2022 indicates that across the globe, more than 1,000 individuals die every day due to asthma and its related complications.

Key statistics from the AAFA include the following:

• Within the adult patient population, asthma occurs more commonly in females than in males, affecting 10.8% and 6.5%, respectively
• Asthma is the principal cause of chronic disease in pediatric patients, affecting more than 4.5 million pediatric patients aged younger than 18 years
• Asthma occurs more commonly among male pediatric patients compared with female patients, affecting an estimated 7% and 5.4%, respectively
• More than 22 million adults aged 18 years and older have been diagnosed with asthma
• In 2020, deaths related to asthma increased for the first time in 2 decades.

The 2023 GINA report notes that globally, asthma affects over 260 million individuals and accounts for over 450,000 mortalities annually, the majority of which are preventable.

Asthma typically manifests during childhood, and patients with asthma frequently also have a history of eczema and allergic rhinitis (hay fever). The researchers have identified numerous modifiable and nonmodifiable risk factors that may contribute to the manifestation of asthma and that often feature a multifaceted and complex interaction between genetic and environmental factors. Factors that may augment an individual’s risk of developing asthma include perinatal factors (i.e., being born prematurely, increased maternal age, maternal smoking, and prenatal exposure to tobacco smoke), familial history of asthma, allergies, exposure to viral respiratory infections during infancy and childhood, exposure to household and environmental allergens/irritants, and obesity.

Examples of common triggers of an asthma flare-up/exacerbation include:

• Exposure to household, environmental, and occupational allergens, including inhaled irritants, pollution, cigarette smoke, perfumes, paint fumes and cleaning products, dust mites, pet dander, pollen, etc.
• Exposure to cold, dry air
• Respiratory infections such as COVID-19, influenza, respiratory syncytial virus, rhinovirus, pneumonia, and sinus infections
• Exercise
• Extreme stress, anxiety, and excitement
• Use of aspirin and other nonsteroidal anti-inflammatory drugs and the use of certain beta-blockers, including ophthalmic beta-blockers
• Certain comorbidities, including obstructive sleep apnea, chronic obstructive pulmonary disease, gastroesophageal reflux disease, nasal polyps, etc.

Patients with asthma may present with one or more of the classic symptoms associated with asthma in varying degrees of frequency and intensity, including dyspnea, coughing with or without sputum, chest tightness, wheezing, and airflow limitations. Symptoms often occur intermittently and are frequently worse during or after exercise, at night, or in the early morning. Depending on the frequency and severity of symptoms, asthma may be classified as mild, moderate, or severe.

Since early diagnosis and clinical intervention are critical for thwarting and/or reducing the complications linked with poorly controlled asthma, patients and/or caregivers should be encouraged to adhere to the recommended asthma treatment plan, maintain routine healthcare, and pursue medical care if they are experiencing any adverse effects and/or symptoms associated with asthma flare-ups/exacerbations.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.