Asthma

Disease Description (Causes and Symptoms)

• Definition and pathophysiology: Asthma is a disease in which airway hyperresponsiveness increases due to chronic inflammation of the airways, causing repeated narrowing of the bronchi. Inflammation, bronchoconstriction, and increased mucus secretion occur together, causing shortness of breath, wheezing (a whistling sound), coughing, chest tightness, and other symptoms.
• Major causes (triggers):
  • Allergic factors: Pollen (seasonal), house dust mites (bedding and carpets), mold spores (humid environments), cockroaches, proteins from animals (cats and dogs), etc.
  • Nonspecific irritants: Cigarette smoke, strong odors (cooking smells, perfume, air fresheners), cold air, exercise, and infections (especially upper respiratory tract infections)
  • Interaction between genetic predisposition and environmental factors
• Major symptoms:
  • Wheezing (a whistling breathing sound), paroxysmal coughing (especially at night and early morning), shortness of breath, chest tightness, and sticky phlegm
  • Symptoms are variable, with repeated worsening and improvement

Treatment Methods

• Basic principles: Regularly use long-term controller medication to control inflammation and immediately relieve symptoms with a quick-relief medication when symptoms occur. Avoiding triggers and education (inhaler technique and an action plan for exacerbations) are important.
• Medication treatment
  • Inhaled corticosteroids (ICS): First-line long-term controller medication for asthma (e.g., Pulmicort (budesonide), etc.)
  • ICS+LABA combination medication: When symptom control is needed (e.g., Seretide (salmeterol·fluticasone), Symbicort (budesonide·formoterol))
  • Short-acting beta2 agonists (SABA): Short-term relief during attacks (e.g., Ventolin/salbutamol)
  • Leukotriene receptor antagonists (e.g., montelukast): Used as an adjunct in allergic asthma or in children
  • Systemic (oral) corticosteroids: Used short-term during severe exacerbations
  • Biologic agents (for severe/refractory asthma): Anti-IgE (omalizumab), anti-IL-5 (mepolizumab·benralizumab), etc. — prescribed by a specialist according to the indications
• Nonpharmacological treatment
  • Allergen avoidance: Dust-mite-proof mattress and pillow covers, removal of carpets and cushions, pet management, and mold removal (humidity control)
  • Smoking cessation and avoidance of secondhand smoke
  • Nutrition and exercise: Regular exercise (pre-exercise preventive treatment is needed for exercise-induced asthma)
  • Immunotherapy (allergen-specific immunotherapy) when there are seasonal allergies or a clearly identified cause — long-term treatment for 3 years or more under the care of a specialist
• Emergency and severe cases
  • During a severe exacerbation (attack), treatment may include oxygen administration, repeated SABA inhalation and inhaled steroids, bronchodilators and intravenous steroids when necessary, mechanical ventilation, etc.
• Precautions
  • Learn the correct inhaler technique (to minimize side effects and maximize effectiveness)
  • Continue using the prescribed controller regularly even when there are no symptoms
  • Taper or discontinue steroid medications according to the doctor's instructions

Checklist Before an Outpatient Visit (What to Prepare and Example Questions)

• Items to prepare (recommended)
  • A list of currently used medications (including inhalers) and medication administration records
  • Previous test results (copies of recent pulmonary function test results and allergy test results, if available)
  • A symptom diary or peak expiratory flow (PEF) records (if available, covering the past several weeks)
  • A history of emergency room visits/hospitalizations or oral steroid use during recent exacerbations
  • Information about current symptoms (frequency, triggers, nighttime symptoms, symptoms during exercise, etc.) and changes in the living environment (pets, living with smokers, residential humidity, etc.)
• Show the doctor at the outpatient visit
  • Bring the inhaler device (the inhaler currently being used) to have its technique checked
  • PEF meter (if available)

Examples of General Questions to Ask the Doctor

• "What are the main side effects of this medication (inhaler)? How can I prevent oral candidiasis or hoarseness?"
• "What is the standard treatment step appropriate for my symptoms (mild/moderate/severe)?"
• "What problems can result from long-term steroid use, and how are they managed?"
• "What is the prognosis? Are there any restrictions on daily life and exercise (or pregnancy and work)?"
• "When should I receive the influenza and pneumococcal vaccines?"

Examples of Disease-Specific Questions

• Questions to determine an allergic association:
  • "Should I undergo allergy testing? Depending on the test results, would you recommend immunotherapy (allergen immunotherapy)?"
• Regarding severity and eligibility for biologic agents:
  • "I still have frequent symptoms, and they are not controlled even though I use inhaled steroids regularly. How likely is it that I need a biologic agent (such as an anti-IgE or anti-IL-5 agent)? What are the indications and what tests (blood eosinophils, IgE, etc.) are needed?"

(The information above is objective and neutral medical information. Decisions regarding an individual's diagnosis and treatment plan must be made in consultation with the treating medical professionals.)