title: [Adult asthma exacerbations in questions].
abstract: In this article a French working party critically review the international literature to revise the definition, pathophysiology, treatment and cost of exacerbations of adult asthma. The various guidelines do not always provide a consistent definition of exacerbations of asthma. An exacerbation can be defined as deterioration of clinical and/or functional parameters lasting more than 24 hours, without return to baseline, requiring a change of treatment. No single clinical or functional criterion can be used as an early marker of an exacerbation. Innate and acquired immune mechanisms, modified by contact with infectious, irritant or allergenic agents, participate in the pathogenesis of exacerbations, which are accompanied by bronchial inflammation. In 2010, mortality is related to progression of exacerbations, often occurring before the patient seeks medical attention. The objective of treatment is to control asthma and prevent exacerbations. However, many factors can trigger exacerbations and often cannot be controlled. The efficacy of inhaled corticosteroids has been demonstrated on reduction of the number of exacerbations and the number of asthma-related deaths. This treatment is cost-effective, especially in terms of reduction of exacerbations.
authors.affiliation: Service de Pneumologie et de Réanimation Respiratoire, Hôpital Antoine-Béclère, Université Paris-Sud 11, AP-HP, 157 Rue de la Porte-de-Trivaux, 92140 Clamart, France. david.montani@abc.aphp.fr
authors.forename: D
authors.initials: D
authors.lastname: Montani
authors.forename: A
authors.initials: A
authors.lastname: Cavailles
authors.forename: L
authors.initials: L
authors.lastname: Bertoletti
authors.forename: A
authors.initials: A
authors.lastname: Botelho
authors.forename: A
authors.initials: A
authors.lastname: Cortot
authors.forename: C
authors.initials: C
authors.lastname: Taillé
authors.forename: S
authors.initials: S
authors.lastname: Marchand-Adam
authors.forename: D
authors.initials: D
authors.lastname: Pinot
authors.forename: C
authors.initials: C
authors.lastname: Chouaid
authors.forename: B
authors.initials: B
authors.lastname: Crestani
authors.forename: G
authors.initials: G
authors.lastname: Garcia
authors.forename: M
authors.initials: M
authors.lastname: Humbert
authors.forename: J-P
authors.initials: JP
authors.lastname: L'huillier
authors.forename: A
authors.initials: A
authors.lastname: Magnan
authors.forename: I
authors.initials: I
authors.lastname: Tillie-Leblond
authors.forename: P
authors.initials: P
authors.lastname: Chanez
mesh_terms: D000305:Adrenal Cortex Hormones / Q000191:economics / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D000328:Adult; D000397:Air Pollution / Q000009:adverse effects; D018927:Anti-Asthmatic Agents / Q000191:economics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D001991:Bronchitis / Q000150:complications / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000627:therapeutic use; D019090:Case Management; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D006801:Humans; D007962:Leukocytes / Q000473:pathology; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D000069444:Omalizumab; D010102:Oxygen Inhalation Therapy; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology / Q000821:virology; D013224:Status Asthmaticus / Q000150:complications / Q000188:drug therapy / Q000191:economics / Q000401:mortality / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D018927:Anti-Asthmatic Agents; D000900:Anti-Bacterial Agents; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D001993:Bronchodilator Agents; D020024:Leukotriene Antagonists; D000069444:Omalizumab