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© 2005, D Behera

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First Edition: 2000

Second Edition: 2005

Typeset at JPBMP typesetting unit

Printed at Gopsons Paper s Ltd, A-14, Sector 60, Noida 201 301, India

The prevalence of bronchial asthma, a major public health problem is increasing worldwide. Several studies have demonstrated that there is an increase in morbidity and mortality from bronchial asthma. Over and under treatment of asthma may be responsible for high mortality rates. Until recently bronchospasm that results from hyperresponsiveness of the airways to multiplicity of stimuli has been regarded as the main cause of airway dysfunction in asthma. Bronchial asthma is now considered as a chronic inflammatory disease of the airways. This realization that inflammation is the key factor in the pathogenesis of asthma is reflected in the change in asthma therapy with emphasis on inhaled anti-inflammatory drugs. There are many controversies in the management of bronchial asthma especially the role of immunotherapy. Many new drugs are under development and yet there is no cure for asthma.

Bronchial asthma is a common respiratory disorder affecting approximately 3–5 percent of the population, although there is a wide variation in its prevalence in the world, even in the same country at different parts. Over the years our understanding about the disease has changed. One of the major changes in our thinking about the pathophysiology of the disease is that the disease is inflammatory in nature rather than the earlier simplistic view of it being a simple bronchospastic disorder. A number of cytokines and mediators take part in its causation. Accordingly the approach to management of asthma has also changed. A number of guidelines have come up in recent years and there is a constant renewal in some of the concepts. Although there is no guideline for adult Indian patients, the same is given for children. The chapter on bronchial asthma in children is not complete in all aspects, but it will give a brief account of the same for the pulmonary physician. This edition has brought out some of these changes. Further, the references are updated with Vancouver style.

Bronchial asthma is a common disease affecting nearly 3 to 5 percent of the population. Although incidence- and prevalence-wise the disease is not more common than tuberculosis in this country, the major difference is its recurring nature with periods of remissions and exacerbation. In some cases life long, and in many cases most of the times, medications with anti-asthma drugs will be required for symptom-free life. This is a major contrast to tuberculosis where treatment for 6 to 9 months will cure the disease. Earlier concepts about bronchial asthma, that it is a bronchospastic disease, have changed in recent years, wherein it is proved that it is an inflammatory disease. A wide array of cells with a number of cytokines take active role in the pathophysiology of the disease.