Japanese Guideline for Adult Asthma 2014

  • Ohta Ken
    National Hospital Organization, Tokyo National Hospital
  • Ichinose Masakazu
    Department of Respiratory Disease, Tohoku University Graduate School of Medicine
  • Nagase Hiroyuki
    Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
  • Yamaguchi Masao
    Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine
  • Sugiura Hisatoshi
    Department of Respiratory Disease, Tohoku University Graduate School of Medicine
  • Tohda Yuji
    Department of Respiratory Medicine and Allergology, Kinki University School of Medicine
  • Yamauchi Kohei
    Division of Pulmonary Medicine, Allergy and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine
  • Adachi Mitsuru
    Department of Clinical Research Center, International University of Health and Welfare/Sanno Hospital
  • Akiyama Kazuo
    National Hospital Organization, Sagamihara National Hospital

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Abstract

Adult bronchial asthma (hereinafter, asthma) is characterized by chronic airway inflammation, reversible airway narrowing, and airway hyperresponsiveness. Long-standing asthma induces airway remodeling to cause intractable asthma. The number of patients with asthma has increased, and that of patients who die from asthma has decreased (1.5 per 100,000 patients in 2012). The aim of asthma treatment is to enable patients with asthma to lead a normal life without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management with antiasthmatic 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. Long-acting β2-agonists, leukotriene receptor antagonists, and sustained-release theophylline are recommended as concomitant drugs, while anti-immunoglobulin E antibody therapy has been recently developed for the most severe and persistent asthma involving allergic reactions. Inhaled β2-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and others are used as needed in acute exacerbations by choosing treatment steps for asthma exacerbations depending on the severity of attacks. Allergic rhinitis, chronic obstructive pulmonary disease, aspirin-induced asthma, pregnancy, asthma in athletes, and cough-variant asthma are also important issues that need to be considered.<br>

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