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Allergol Int. 2017 Apr;66(2):163-189. doi: 10.1016/j.alit.2016.12.005. Epub 2017 Feb 11.

Japanese guidelines for adult asthma 2017.

Author information

1
Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: ichinose@rm.med.tohoku.ac.jp.
2
Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
3
Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
4
Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
5
Division of Allergology and Respiratory Medicine, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
6
First Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
7
Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan.
8
Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan.
9
Division of Pulmonary Medicine, Allergy and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan.
10
National Hospital Organization, Tokyo National Hospital, Tokyo, Japan.

Abstract

Adult bronchial asthma is characterized by chronic airway inflammation, and presents clinically with variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma induces airway remodeling, leading to intractable asthma. The number of patients with asthma has increased; however, the number of patients who die of asthma has decreased (1.2 per 100,000 patients in 2015). The goal of asthma treatment is to enable patients with asthma to attain normal pulmonary function and lead a normal life, without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management by therapeutic agents and elimination of the causes and risk factors of asthma are fundamental to its treatment. Four steps in pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid, varying from low to high levels. Long-acting β2-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonist are recommended as add-on drugs, while anti-immunoglobulin E antibody and oral steroids are considered for the most severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β2-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by choosing treatment steps for asthma in accordance with the severity of exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-induced asthma, and pregnancy are also important issues that need to be considered in asthma therapy.

KEYWORDS:

Definition of asthma; Diagnosis of asthma; Epidemiology of asthma; Long-term management of asthma; Management of asthma exacerbation

PMID:
28196638
DOI:
10.1016/j.alit.2016.12.005
[Indexed for MEDLINE]
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