Complications
May occur in poorly controlled disease or if exposed to a major trigger (e.g., non-steroidal anti-inflammatory drug-sensitive patient with asthma consuming aspirin).
Can occur in any asthmatic after an upper airway infection or a persistent allergen exposure.
Counsel the patient on allergen removal and treat any upper or lower airway infection as necessary.
Exacerbation can be treated in the outpatient setting with an oral corticosteroid, a continued inhaled corticosteroid regimen as per the patient's action plan, and use of a short-acting beta agonist on an as-needed basis.
Patients should be instructed to go to the nearest emergency department if symptoms worsen.
Pathological changes affecting lung tissues as a result of persistent inflammation, causing a persistent irreversible airway obstruction.[145] Fixed airflow obstruction resembles may progressively develop and worsen, limiting the activity of the patient.[146]
Those with more severe asthma may have a higher predilection for airway remodelling.
It is unknown what percentages have airway remodelling and, of those with remodelling, how many develop fixed airflow obstruction.
The most common complication of using inhaled corticosteroids is thrush. This can be prevented by appropriate inhaler technique, the use of a spacer tube with a metered dose inhaler (MDI), and rinsing, gargling, and spitting after inhaler use.
Another complication of using inhaled corticosteroids is dysphonia (i.e., laryngeal muscle spasm causing an abnormal voice), which can be prevented by ensuring appropriate inhaler technique, and using a spacer with a metered dose inhaler (MDI). If using a spacer is not possible, consider changing the type of inhaler.
On rare occasions, this may occur secondary to use of inhaled corticosteroids. Check inhaler technique and HIV serologies.
Treat with appropriate antifungal agents (e.g., fluconazole).
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