[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Asthma [Conditions](https://durgical.com/en/conditions/) · [Chest](https://durgical.com/en/anatomy/region/chest/) # Asthma Asthma is a long-term inflammation of the airways that makes them narrow in episodes, causing wheezing, breathlessness, chest tightness and cough. Updated 2026-10-30 ## Structures involved Tap one to see what it is and open it in 3D. - [Segmental bronchi](https://durgical.com/en/anatomy/segmental-bronchus/) - [Lobar bronchi](https://durgical.com/en/anatomy/lobar-bronchus/) - [Main bronchi](https://durgical.com/en/anatomy/right-main-bronchus/) - [Trachea](https://durgical.com/en/anatomy/trachea/) - [Diaphragm](https://durgical.com/en/anatomy/diaphragm/) - [Scalenes](https://durgical.com/en/anatomy/scalenus-anterior-muscle/) - [External intercostals](https://durgical.com/en/anatomy/external-intercostal-muscles/) ## In biochemistry - [Prostaglandin and thromboxane synthesis: Step 3 · Peroxidase activity of COX-1/COX-2](https://durgical.com/en/biochemistry/pathways/prostaglandin-and-thromboxane-synthesis/#paso-3) - [Eicosanoids: prostaglandins, thromboxanes and leukotrienes](https://durgical.com/en/biochemistry/topics/eicosanoids-prostaglandins-thromboxanes-and-leukotrienes/) - [IP₃, DAG and calcium pathway](https://durgical.com/en/biochemistry/topics/ip-dag-and-calcium-pathway/) - [Cyclic AMP (cAMP)](https://durgical.com/en/biochemistry/molecules/cyclic-amp/) - [Arachidonic acid](https://durgical.com/en/biochemistry/molecules/arachidonic-acid/) ## In immunology - [Eosinophil](https://durgical.com/en/immunology/eosinophil/) - [Mast cell and basophil](https://durgical.com/en/immunology/mast-cell-and-basophil/) - [Type I hypersensitivity (immediate, IgE)](https://durgical.com/en/immunology/type-i-hypersensitivity/) - [Latex and drug allergy](https://durgical.com/en/immunology/latex-and-drug-allergy/) - [Th1, Th2, Th17, Tfh and Treg](https://durgical.com/en/immunology/th1-th2-th17-tfh-and-treg/) - [Antibody structure and isotypes (IgG, IgA, IgM, IgE, IgD)](https://durgical.com/en/immunology/antibody-structure-and-isotypes/) - [Cytokines: the table to know](https://durgical.com/en/immunology/cytokines-the-table-to-know/) - [IL-4, IL-5 and IL-13 (the Th2 cytokines)](https://durgical.com/en/immunology/il-4-il-5-and-il-13/) ## In histology - [Simple, stratified, pseudostratified and transitional epithelium](https://durgical.com/en/histology/simple-stratified-pseudostratified-and-transitional-epithelium/) - [Smooth muscle](https://durgical.com/en/histology/smooth-muscle/) - [The airway: from nose to bronchioles](https://durgical.com/en/histology/the-airway-from-nose-to-bronchioles/) ## In the clinical exam - [Chest inspection: shape, expansion, accessory muscles and retractions](https://durgical.com/en/clinical-exam/chest-inspection-shape-expansion-accessory-muscles-and-retractions/) - [Lung auscultation: normal breath sounds](https://durgical.com/en/clinical-exam/lung-auscultation-normal-breath-sounds/) - [Adventitious sounds: crackles, wheezes, rhonchi, stridor and pleural rub](https://durgical.com/en/clinical-exam/adventitious-sounds-crackles-wheezes-rhonchi-stridor-and-pleural-rub/) - [Respiratory symptoms: cough, sputum, hemoptysis and dyspnea](https://durgical.com/en/clinical-exam/respiratory-symptoms-cough-sputum-hemoptysis-and-dyspnea/) - [The pleuropulmonary syndromes: the comparison table to know](https://durgical.com/en/clinical-exam/the-pleuropulmonary-syndromes-the-comparison-table-to-know/) - [Bronchial obstruction syndrome](https://durgical.com/en/clinical-exam/bronchial-obstruction-syndrome/) - [Respiratory distress and respiratory failure: the signs](https://durgical.com/en/clinical-exam/respiratory-distress-and-respiratory-failure-the-signs/) - [Pulmonary hyperinflation syndrome (emphysema)](https://durgical.com/en/clinical-exam/pulmonary-hyperinflation-syndrome/) ## In physiology - [Smooth muscle contraction](https://durgical.com/en/physiology/smooth-muscle-contraction/) - [Sympathetic and parasympathetic effects on each organ](https://durgical.com/en/physiology/sympathetic-and-parasympathetic-effects-on-each-organ/) - [Respiratory acidosis and alkalosis](https://durgical.com/en/physiology/respiratory-acidosis-and-alkalosis/) - [Lung volumes, capacities and spirometry](https://durgical.com/en/physiology/lung-volumes-capacities-and-spirometry/) - [Obstructive and restrictive patterns, and flow–volume loops](https://durgical.com/en/physiology/obstructive-and-restrictive-patterns-and-flow-volume-loops/) - [Airway resistance](https://durgical.com/en/physiology/airway-resistance/) - [The work of breathing](https://durgical.com/en/physiology/the-work-of-breathing/) ## Why it happens - [Mediators of inflammation: the table to know](https://durgical.com/en/general-pathology/mediators-of-inflammation-the-table-to-know/) - [Arachidonic acid metabolites in inflammation, and the drugs that block them](https://durgical.com/en/general-pathology/arachidonic-acid-metabolites-in-inflammation-and-the-drugs-that-block-them/) - [Histamine, serotonin, bradykinin and the plasma protein cascades](https://durgical.com/en/general-pathology/histamine-serotonin-bradykinin-and-the-plasma-protein-cascades/) - [Multifactorial (complex) disorders](https://durgical.com/en/general-pathology/multifactorial-disorders/) - [Air pollution and occupational exposures](https://durgical.com/en/general-pathology/air-pollution-and-occupational-exposures/) - [Health effects of climate change](https://durgical.com/en/general-pathology/health-effects-of-climate-change/) ## What it is Chronic inflammatory disease of the airways with variable, largely reversible airflow obstruction and hyperresponsiveness, causing recurrent wheeze, breathlessness, chest tightness and cough. ## Who gets it One of the most common chronic diseases in children and young adults; in Colombia and Latin America it is often under-diagnosed or under-treated, causing avoidable emergency visits. In ISAAC phase 3 (2002–2003), 11.8% of adolescents in three Colombian centres had current asthma, and a national study found 6.3% of Colombian adults with a medical diagnosis. ## Causes - Allergic (atopic) airway inflammation, often type 2 - Triggers: dust mites, animal dander, pollen, moulds - Viral respiratory infections - Exercise and cold air - Smoke, air pollution and occupational exposures - Aspirin or NSAID sensitivity in some patients ## Risk factors - Personal or family history of atopy (eczema, allergic rhinitis) - Exposure to tobacco smoke, including in pregnancy - Obesity - Indoor and outdoor air pollution - Early-life viral infections - Occupational sensitisers ## Pathophysiology Airway inflammation with eosinophils, mast cells and Th2 cytokines makes bronchi hyperresponsive. Triggers cause smooth-muscle contraction, mucosal oedema and mucus plugging, which narrow the airway reversibly. Chronic disease can lead to airway remodelling with partly fixed obstruction. ## Classification - By control: well controlled, partly controlled, uncontrolled - By severity: defined by the treatment step needed for control - Phenotypes: allergic, non-allergic, eosinophilic, exercise-induced, occupational ## Symptoms and signs - Episodic wheeze - Shortness of breath - Chest tightness - Cough, often at night or early morning - Symptoms triggered by exercise, allergens, cold air or infections - Expiratory wheeze and prolonged expiration on examination ## Red flags - Inability to complete sentences - Use of accessory muscles, or exhaustion - Silent chest on auscultation - Low oxygen saturation, cyanosis - Confusion or drowsiness - Normal or rising CO2 in a breathless patient (impending respiratory failure) ## Diagnosis **Clinical** Typical variable symptoms with triggers; a history of atopy supports it. Examination may be normal between attacks. **Tests** Spirometry shows obstruction (reduced FEV1/FVC) with a significant bronchodilator response; peak-flow variability, bronchial challenge tests or FeNO help when spirometry is normal. Blood eosinophils and IgE for phenotype. **Imaging** [Chest](https://durgical.com/en/anatomy/region/chest/) X-ray is usually normal; it is used to exclude other causes or complications such as pneumothorax. ## Differential diagnosis - COPD - Vocal cord dysfunction - Heart failure (cardiac asthma) - Foreign body or airway tumour - Bronchiectasis - GERD-related cough ## Goal of treatment Achieve good symptom control, prevent exacerbations and loss of lung function, and minimise medication side effects with the lowest effective treatment step. ## Treatment **Medical** Controller therapy: inhaled corticosteroids as the basis, with long-acting beta-2 agonists added at higher steps; leukotriene receptor antagonists as alternatives. **Medical** Reliever therapy: short-acting beta-2 agonists or a low-dose inhaled corticosteroid–formoterol combination as needed, per current guidelines; biologics for severe eosinophilic or allergic asthma. **Acute** Severe exacerbation: oxygen, repeated inhaled bronchodilators (beta-2 agonists plus antimuscarinics), systemic corticosteroids and, in selected cases, intravenous magnesium. **Lifestyle** Trigger avoidance, smoke-free environment, inhaler technique education and a written action plan. **Follow-up** Regular review of control, exacerbations and lung function to step treatment up or down. ## Drugs for this condition - [Ketamine](https://durgical.com/en/pharmacology/ketamine/) - [Methacholine](https://durgical.com/en/pharmacology/methacholine/) - [Dexamethasone](https://durgical.com/en/pharmacology/dexamethasone/) - [Prednisone](https://durgical.com/en/pharmacology/prednisone/) - [Prednisolone](https://durgical.com/en/pharmacology/prednisolone/) - [Methylprednisolone](https://durgical.com/en/pharmacology/methylprednisolone/) - [Salbutamol](https://durgical.com/en/pharmacology/salbutamol/) - [Tiotropium bromide](https://durgical.com/en/pharmacology/tiotropium-bromide/) - [Budesonide](https://durgical.com/en/pharmacology/budesonide/) - [Budesonide + formoterol](https://durgical.com/en/pharmacology/budesonide-formoterol/) - [Beclometasone](https://durgical.com/en/pharmacology/beclometasone/) - [Fluticasone](https://durgical.com/en/pharmacology/fluticasone/) - [Montelukast](https://durgical.com/en/pharmacology/montelukast/) - [Formoterol](https://durgical.com/en/pharmacology/formoterol/) - [Salmeterol](https://durgical.com/en/pharmacology/salmeterol/) - [Terbutaline](https://durgical.com/en/pharmacology/terbutaline/) ## Complications - Life-threatening exacerbation and respiratory failure - Pneumothorax or pneumomediastinum - Airway remodelling with fixed obstruction - Side effects of repeated systemic corticosteroids ## Prognosis Most patients achieve good control with regular controller therapy and good inhaler technique. Childhood asthma often improves in adolescence; poor adherence and previous near-fatal attacks predict worse outcomes. ## Prevention - Avoidance of tobacco smoke and known triggers - Influenza vaccination - Adherence to controller therapy to prevent exacerbations ## Test yourself Think of the answer, then tap the question to see it. ## What spirometry finding supports a diagnosis of asthma? Airflow obstruction (low FEV1/FVC) with a significant improvement in FEV1 after a bronchodilator, showing reversibility. ## What is the cornerstone controller medication class in persistent asthma? Inhaled corticosteroids, which reduce airway inflammation and the risk of exacerbations. ## Why is a silent chest an ominous sign in an asthma attack? It means airflow is so reduced that no wheeze is heard: a sign of life-threatening obstruction and impending respiratory failure. ## How does asthma differ from COPD in its airflow obstruction? In asthma obstruction is variable and largely reversible; in COPD it is persistent and not fully reversible after a bronchodilator. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/asthma/) ## Related conditions - [Chronic obstructive pulmonary disease (COPD)](https://durgical.com/en/conditions/chronic-obstructive-pulmonary-disease/) - [Gastro-oesophageal reflux disease (GERD)](https://durgical.com/en/conditions/gastro-oesophageal-reflux-disease/) - [Obesity](https://durgical.com/en/conditions/obesity/) - [Heart failure](https://durgical.com/en/conditions/heart-failure/) - [Bronchiectasis](https://durgical.com/en/conditions/bronchiectasis/) - [Acute rhinosinusitis](https://durgical.com/en/conditions/acute-rhinosinusitis/) - [Allergic rhinitis](https://durgical.com/en/conditions/allergic-rhinitis/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Asthma](https://www.ncbi.nlm.nih.gov/books/NBK430901/) (StatPearls (NCBI Bookshelf), 2024); [Asthma: epidemiology of disease control in Latin America - short review](https://europepmc.org/article/PMC/PMC5427548) (Asthma research and practice, 2017) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/asthma/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/asthma/