Allergic Disease and Asthma

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Allergic Disease and Asthma

Allergy
Author Credentials 

Kevin Wilson, MD and Michael Platt, MD, MSc
American Academy of Otolaryngic Allergy

Module Learning Objectives 
  1. Explain the pathogenesis of asthma.
  2. Recognize the main endotypes of asthma.
  3. Review diagnostic testing for asthma.
  4. Identify the treatment algorithms for asthma.

 

Anatomy

Learning Objectives 
  1. Review the concept of the Unified Airway
  2. Explain the differences between the upper and lower airways with the presence of smooth muscle that can obstruct the lower airways
  3. Cite the following: 
  • 60-70% of Asthmatics have Allergic Rhinitis
  • 20% of patients with Chronic Rhinosinusitis have asthma 
  • 30-42% of patients who undergo FESS have asthma
References 
  1. Krouse J, et al.  Asthma and the unified airway. Otolaryngol Head Neck Surg. 2007 May;136(5 Suppl):S75-106.
  2. Fox R, Lockey R. The impact of rhinosinusitis on asthma. Curr Allergy Asthma Rep. 2003 Nov;3(6):513-8

 

Pathogenesis

Learning Objectives 
  1. Explain the pathogenesis of allergic asthma: including airway hyper-reactivity, mucous production, airway remodeling, and reversible obstruction.
References 

Agrawal DK, Shao Z. Pathogenesis of Allergic Airway Inflammation. Curr Allergy Asthma Rep. 2010 Jan;10(1):39-48

Basic Science

Learning Objectives 
  1. Describe how the immunopathogenesis of allergic asthma is studied in animal models.
References 
  1. Hall S, Agrawal DK. Key Mediators in the Immunopathogenesis of Allergic Asthma. Int Immunopharmacol. 2014 Nov;23(1):316-29. 

Incidence

Learning Objectives 
  1. Cite the following: 
  • 8% in US have asthma
  • 3,500 US deaths each year
  • 1.7 million ED visits
  • 50-75% intermittent or mild 
  • 20-30% unaware of diagnosis
References 
  1. Akinbami LJ, et al. Trends in Asthma Prevalence, Health Care Use, and Mortality in the United States, 2001–2010. NCHS Data Brief; May 2012, Issue 94
  2. Krouse J. The unified airway. Facial Plast Surg Clin North Am 2012;20:55-60

Genetics

Learning Objectives 
  1. Recognize that there is an increased likelihood of Asthma if:
  • family history
  • lower socioeconomic status
  • certain racial/ ethnic groups
  • obesity

 

References 
  1. CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2014 Available: https://wwwn.cdc.gov/nchs/nhanes/ContinuousNhanes/Default.aspx?BeginYear=2011 
  2. Dold et al. Genetic risk for asthma, allergic rhinitis, and atopic dermatitis. Arch Dis Child. 1992 Aug;67(8):1018-22.

 

Patient Evaluation

Learning Objectives 
  1. Cite that: 
  • Diagnosis and management are based on history taking and clinical examination
  • Lung function measurements such as peak expiratory flow, spirometry, bronchodilator responsiveness, and bronchial provocation tests help establish airway obstruction and variability over time
  • Asthma questionnaires, lung function measurements and markers of airway inflammation could be used in combination with clinical assessments to assess ongoing asthma control

 

References 
  1. Mulholland A, Ainsworth A, Pillarisetti N. Tools in Asthma Evaluation and Management: When and How to Use Them? Indian J Pediatr. 2018 Aug;85(8):651-657.
  2. Asthma Care Quick Reference  https://www.nhlbi.nih.gov/files/docs/guidelines/asthma_qrg.pdf

 

Pathology

Learning Objectives 
  1. Review phenotypes/ Endotypes
  • Allergic asthma
  • Non-allergic asthma
  • aspirin-exacerbated respiratory disease 
  • allergic bronchopulmonary mycosis

 

References 
  1. Lotvall et al. Asthma endotypes: A new approach to classification of disease entities within the asthma syndrome. J Allergy Clin Immunol 2011;127:355-60.

Treatment

Learning Objectives 
  1. Describe the pharmacotherapy algorithms for asthma based on severity of symptoms. 
  2. Explain the role of allergen desensitization in the treatment of asthma. 

 

References 
  1. Guidelines for the Diagnosis and Management of Asthma. Avalable: https://www.nhlbi.nih.gov/sites/default/files/media/docs/asthgdln_1.pdf
  2. Dhami S, et al. Allergen immunotherapy for allergic asthma: A systematic review and meta-analysis. Allergy. 2017 Dec;72(12):1825-1848. 

 

Review

Review Questions 
  1. What is the relationship between allergic rhinitis and asthma?
  2. What is the pathophysiology of asthma?
  3. What are the initial treatments for allergic asthma?
  4. How do you decide when to increase medication for poor asthma control?

 

Resources 

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  1. Annual Meeting Webcast (AMW):
  2. ENT for the PA-C:
  3. Patient Management Perspectives (Pmp):