title: Japanese guidelines for adult asthma 2017.
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.
authors.affiliation: Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: ichinose@rm.med.tohoku.ac.jp.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ichinose
authors.affiliation: Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Hisatoshi
authors.initials: H
authors.lastname: Sugiura
authors.affiliation: Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nagase
authors.affiliation: Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Yamaguchi
authors.affiliation: Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Inoue
authors.affiliation: Division of Allergology and Respiratory Medicine, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Sagara
authors.affiliation: First Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Tamaoki
authors.affiliation: Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tohda
authors.affiliation: Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Munakata
authors.affiliation: Division of Pulmonary Medicine, Allergy and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Yamauchi
authors.affiliation: National Hospital Organization, Tokyo National Hospital, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Ohta
mesh_terms: D000328:Adult; D000367:Age Factors; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D003937:Diagnosis, Differential; D019468:Disease Management; D018450:Disease Progression; D006801:Humans; D007564:Japan; D009026:Mortality; D010353:Patient Education as Topic; D010641:Phenotype; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012720:Severity of Illness Index
keywords: Definition of asthma; Diagnosis of asthma; Epidemiology of asthma; Long-term management of asthma; Management of asthma exacerbation