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It is also important not to over-treat the untreatable, such as fixed airflow obstruction.
These can all be determined using simple, non-invasive tests such as spirometry before and after acute administration of a bronchodilator (reversible airflow obstruction); peripheral blood eosinophil count, induced sputum, exhaled nitric oxide (airway eosinophilia); and sputum or cough swab culture (bacterial infection).
Furthermore, there are domains of risk, which also need to be considered in any discussion of pathophysiology: • Risk of acute asthma attacks, which may be fatal • Risk of impaired trajectories of lung growth, which may sometimes but not inevitably be associated with asthma attacks • (in pre-school children) risk of progressing from episodic wheeze to eosinophilic atopic school age asthma • A fourth risk, about which little is known and will not be discussed here, is the risk of failing to remit Clearly not all are relevant to all pediatric airways diseases: the hallmark of CF is the effects of the airway being too dry [“low volume hypothesis” (11)] and infection and neutrophilic inflammation, whereas some at least of the asthmas are dominated by eosinophilic airway inflammation.
What is also clear is that we need modern–omics or genetic tools to try to dissect out these components—and these are sadly lacking.
The National Asthma Council Australia expressly disclaims all responsibility (including for negligence) for any loss, damage or personal injury resulting from reliance on the information contained herein.
The recent Lancet commission has highlighted that “asthma” should be used to describe a clinical syndrome of wheeze, breathlessness, chest tightness, and sometimes cough.
These are: • Narrowing to cause fixed obstruction • Narrowing to cause variable obstruction which changes spontaneously over time, and with treatment • Inflammation with various cell types predominant; inflammation may be harmful or beneficial • The tube may become infected with combinations of bacterial, viral and fungal pathogens • There may be increased “twitchiness” of the tube—this is different from variable obstruction.
An increased reflex expulsive effort (cough) may not be accompanied by transient airflow obstruction • The tube contents may be abnormal: including being too wet, too many solids, or too dry.