ASTHMA and the updated GINA

Global initiative for asthma

2006

R. Louis

Department of Pneumology

CHU Sart-Tilman

Liege

Definition of AsthmaDefinition of Asthma

A chronic inflammatory disorder of the airways

Many cells and cellular elements play a role

Chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing

Widespread, variable, and often reversible airflow limitation

A chronic inflammatory disorder of the airways

Many cells and cellular elements play a role

Chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing

Widespread, variable, and often reversible airflow limitation

Asthma Prevalence and Mortality

SourceSource: Masoli M et al. Allergy 2004: Masoli M et al. Allergy 2004

Asthma Diagnosis

History and patterns of symptoms

Measurements of lung function

- Spirometry - Peak expiratory flow

Measurement of airway responsiveness

Measurements of allergic status to identify risk factors

Extra measures may be required to diagnose asthma in children 5 years and younger

History and patterns of symptoms

Measurements of lung function

- Spirometry - Peak expiratory flow

Measurement of airway responsiveness

Measurements of allergic status to identify risk factors

Extra measures may be required to diagnose asthma in children 5 years and younger

Is it Asthma?Is it Asthma?

Recurrent episodes of wheezing Troublesome cough at night Cough or wheeze after exercise Cough, wheeze or chest tightness after

exposure to airborne allergens or pollutants

Colds “go to the chest” or take more than 10 days to clear

Typical Spirometric (FEV1) Tracings Bronchodilating testTypical Spirometric (FEV1) Tracings Bronchodilating test

11Time (sec)Time (sec)22 33 44 55

FEV1FEV1

VolumeVolume

Normal SubjectNormal Subject

Asthmatic (After Bronchodilator)Asthmatic (After Bronchodilator)

Asthmatic (Before Bronchodilator)Asthmatic (Before Bronchodilator)

Note: Each FEV1 curve represents the highest of three repeat measurements

≥ 12%

Measuring Variability of Peak Expiratory Flow

Measuring Airway Responsiveness

Levels of Asthma Control

CharacteristicControlled

(All of the following)

Partly controlled(Any present in any

week)Uncontrolled

Daytime symptomsNone (2 or less / week)

More than twice / week

3 or more features of partly controlled asthma present in any week

Limitations of activities

None Any

Nocturnal symptoms / awakening

None Any

Need for rescue / “reliever” treatment

None (2 or less / week)

More than twice / week

Lung function (PEF or FEV1)

Normal< 80% predicted or

personal best (if known) on any day

Exacerbation None One or more / year 1 in any week

Clinical Control of Asthma

No (or minimal)* daytime symptoms

No limitations of activity

No nocturnal symptoms

No (or minimal) need for rescue medication

Normal lung function

No exacerbations_________* Minimal = twice or less per week

controlled

partly controlled

uncontrolled

exacerbation

LEVEL OF CONTROLLEVEL OF CONTROL

maintain and find lowest controlling step

consider stepping up to gain control

step up until controlled

treat as exacerbation

TREATMENT OF ACTIONTREATMENT OF ACTION

TREATMENT STEPSREDUCE INCREASE

STEP

1STEP

2STEP

3STEP

4STEP

5

RE

DU

CE

INC

RE

AS

E

Développer un partenariat avec le malade

Expliquer le caractère fluctuant de la maladie

Gina 2002

Expliquer le mode d’utilisation des aérosols

Expliquer les composantes de la maladie

Inflammation Bronchospasme