Pulmonology
Asthma
천식
Chronic airway inflammation with reversible bronchoconstriction
- How common
- Adults 5–10%, children 10%
- Typical age
- Often starts in childhood
What is it?
Th2-mediated allergic inflammation produces airway hyperresponsiveness and reversible obstruction.
Commonly affected: Medium and small bronchi
How it develops
- Allergen exposurePollen, dust mite, animal dander
- Th2 immune responseIL-4/5/13 elevate IgE and eosinophils
- Airway inflammationMucosal edema and mucus hypersecretion
- BronchoconstrictionSmooth muscle contraction → reversible obstruction
Symptoms
- WheezingExpiratory wheeze, bilateral
- Paroxysmal dyspneaWorse at night and early morning
- Exercise-induced dyspneaOnset 5–10 min after exercise
- Chronic coughOften dry cough
- Chest tightnessSensation of chest constriction
How it is examined
- SpirometryFEV1/FVC <0.7; ≥12% reversibility post-bronchodilator
- Bronchial provocationMethacholine challenge for hyperresponsiveness
- FeNO/eosinophilAssess eosinophilic inflammation
Imaging
Usually normal between attacks; hyperinflation in severe attack.
- Hyperinflation
- Flattened diaphragm
Chest CT only for complications or alternative diagnosis.
- Bronchial wall thickening
- Mucous plugs
Non-surgical care
- Short-acting β2-agonistAlbuterol (salbutamol) inhaler for acute relief
- Inhaled corticosteroidFluticasone/budesonide daily controller
- Long-acting β2-agonistSalmeterol/formoterol combined with ICS
- Leukotriene antagonistMontelukast (children, exercise-induced)
- Trigger avoidance/educationAvoid allergens/smoke/cold air; inhaler technique training
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Severe refractory asthma; medication failure
Procedures that may be discussed
- Omalizumab (anti-IgE)
- Mepolizumab/benralizumab (anti-IL-5)
- Dupilumab (anti-IL-4Rα)
- Bronchial thermoplasty
Outlook
Normal life with proper inhaler use; airway remodeling if untreated.