Bonus Material-04_Khurana_Asthma_2025

Pdf Summary

This comprehensive Pulmonary Board Review on asthma by Dr. Sandhya Khurana covers the pathophysiology, diagnosis, phenotyping, updated management guidelines, and biologic therapies in asthma.<br /><br />Asthma is the most prevalent chronic respiratory disease globally, affecting over 262 million people with 8.2% prevalence in the U.S., where 62% of adults have uncontrolled asthma. It is a heterogeneous disease characterized by chronic airway inflammation, variable symptoms, and variable expiratory airflow limitation. Asthma immunology involves type 2 (T2) inflammation, mainly mediated by cytokines IL-4, IL-5, and IL-13, and non-T2 (T2-low) forms including neutrophilic and paucigranulocytic phenotypes.<br /><br />Diagnosis centers on demonstrating variable airflow obstruction via spirometry, bronchodilator response, peak flow variability, and bronchoprovocation tests such as methacholine and exercise challenges. Bronchoprovocation sensitivity varies, and inhaled corticosteroids (ICS) can affect test sensitivity.<br /><br />Phenotyping and biomarkers (IgE, blood/sputum eosinophils, FeNO) guide precision therapy. Asthma guidelines (GINA 2024, NAEPP 2020) emphasize ICS-formoterol use as both maintenance and reliever therapy in mild to moderate asthma, reducing exacerbations with lower steroid exposure compared to SABA relievers. LABA must not be used as monotherapy.<br /><br />Severe asthma is defined in fewer than 5% of adults with asthma and is often T2-high; biologics targeting IgE (omalizumab), IL-5 (mepolizumab, reslizumab, benralizumab), IL-4/IL-13 receptor (dupilumab), and TSLP (tezepelumab) reduce exacerbations and oral corticosteroid (OCS) dependence. Dupilumab and tezepelumab are effective in various phenotypes, including OCS-dependent and non-T2 asthma.<br /><br />Non-T2 asthma treatment includes tezepelumab and macrolides like azithromycin; bronchial thermoplasty is no longer widely recommended. Comorbidities such as chronic rhinosinusitis, GERD, obesity, and vocal cord dysfunction influence asthma control.<br /><br />Recent studies explore asthma remission and biologic de-escalation. Emerging therapies and better phenotyping offer personalized asthma management to improve control and reduce exacerbations.

Meta Tag

Concept Asthma

Concept Airflow Limitation

Concept Inhaled Corticosteroid

Concept Asthma Diagnosis

Concept Spirometry

Keywords

asthma

pulmonary board review

pathophysiology

diagnosis

phenotyping

biologic therapies

GINA 2024

inhaled corticosteroids

type 2 inflammation

severe asthma

Asthma

Airflow Limitation

Inhaled Corticosteroid

Asthma Diagnosis

Spirometry