Kevin R Murphy1. 1. Midwest Children's Chest Physicians, 16945 Frances St., Omaha, NE 68130, USA. murphknsc@aol.com
Abstract
OBJECTIVE: This review describes factors contributing to the variable nature of asthma and the versatile treatment strategies required for the clinical management of the disease. DATA SOURCES: A comprehensive review of the literature using MEDLINE was conducted. STUDY SELECTION: Included articles were selected for their relevance to variability or severity of asthma. Bibliographies of selected articles served as additional sources of considered publications. RESULTS: Asthma severity can vary substantially among patients and within individual patients because of physiologic, environmental, or behavioral factors. Inhaled corticosteroids are an effective and versatile treatment option for special populations with asthma and for patients with varying degrees of asthma severity. Inhaled corticosteroids are now the preferred treatment for all three severity levels of persistent asthma, especially in young children and pregnant women. Treatment regimens may be adjusted up or adjusted down when appropriate to maintain optimal symptom control and limit potential adverse systemic effects. CONCLUSIONS: The clinical management of asthma is challenging given the day-to-day variability of the disease. Variability in pulmonary function and asthma symptoms may be minimized through increased awareness of the factors contributing to asthma variability as well as the effective use of inhaled corticosteroid therapy. Flexible treatment strategies that consider the different severities of asthma and account for variability within individual patients may be particularly useful in improving adherence and patient outcomes.
OBJECTIVE: This review describes factors contributing to the variable nature of asthma and the versatile treatment strategies required for the clinical management of the disease. DATA SOURCES: A comprehensive review of the literature using MEDLINE was conducted. STUDY SELECTION: Included articles were selected for their relevance to variability or severity of asthma. Bibliographies of selected articles served as additional sources of considered publications. RESULTS:Asthma severity can vary substantially among patients and within individual patients because of physiologic, environmental, or behavioral factors. Inhaled corticosteroids are an effective and versatile treatment option for special populations with asthma and for patients with varying degrees of asthma severity. Inhaled corticosteroids are now the preferred treatment for all three severity levels of persistent asthma, especially in young children and pregnant women. Treatment regimens may be adjusted up or adjusted down when appropriate to maintain optimal symptom control and limit potential adverse systemic effects. CONCLUSIONS: The clinical management of asthma is challenging given the day-to-day variability of the disease. Variability in pulmonary function and asthma symptoms may be minimized through increased awareness of the factors contributing to asthma variability as well as the effective use of inhaled corticosteroid therapy. Flexible treatment strategies that consider the different severities of asthma and account for variability within individual patients may be particularly useful in improving adherence and patient outcomes.