Bronchial asthma can be defined in a number of ways, and these are summarized below.

Clinically, bronchial asthma is a disorder characterized by recurrent symptoms of wheezing, cough, dyspnea, and chest tightness, especially at night or early in the morning. The patient may have one or more of these symptoms. From a physiologic viewpoint, asthma has been defined as reversible airways obstruction, with demonstration of improvement in forced expiratory volume in 1 second (FEV₁) of at least 12% and more than 200 mL spontaneously or with therapy. Asthmatics often complain of hyper-responsiveness to a variety of immunologic and nonimmunologic triggers. This hyper-reactivity is documented in the laboratory by the methacholine challenge procedure. From an anatomic viewpoint, asthma is characterized as peribronchial inflammation, with infiltration by eosinophils, monocytes, lymphocytes, and basophils.

Asthma affects at least 15 million Americans and is the most common, chronic disease in children. Asthma is a major cause of physician and emergency department visits and hospitalizations, and morbidity statistics seem on the rise. In the United States, at least 5000 deaths are attributed annually to asthma. There is evidence that the impact of the disease is significantly more severe among young African-Americans.

Because of the national concern for these bleak statistics, an initial, expert panel was organized in 1990.<sup>15   Expert Panel Report 2: Guidelines for the diagnosis and management of asthma Washington, DC: National Institutes of Health publication (1997).  97–4051.

Cliccare qui per andare alla sezione Riferimenti</sup> The first Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma (EPR-1) was published in 1991. This document stimulated two international reports and additional documents on asthma management.<sup>33 Spector S.L., Nicklas R.A. Practice parameters for the diagnosis and treatment of asthma J Allergy Clin Immunol 1995 ;  96 : 707-870

Cliccare qui per andare alla sezione Riferimenti</sup> The Expert Panel Report 2 (EPR-2)<sup>15   Expert Panel Report 2: Guidelines for the diagnosis and management of asthma Washington, DC: National Institutes of Health publication (1997).  97–4051.

Cliccare qui per andare alla sezione Riferimenti</sup> was published in 1997. This article reviews the major points of this important new document. These clinical practice guidelines should be useful for both primary care and specialty physicians who manage patients with asthma. The EPR-2 is based on a thorough review of the literature as well as the consensus of a quite diverse committee. It is anticipated that the EPR-2 may increase the number of physician visits and use of drugs and devises; however, the overall health of asthma sufferers should be improved, and costs related to lost work and school days, hospitalizations and emergent visits, and premature mortality should be reduced.