Gå direkt till huvudinnehållet

Astma hos barn ≥12 år och vuxna

Senast reviderad:
Sakkunnig:
Definition:
En heterogen sjukdom som kännetecknas av en variabel luftvägsobstruktion som yttrar sig som återkommande, varierande luftvägssymtom såsom pip i bröstet, andnöd, trånghetskänsla i bröstet, hosta som varierar över tid.
Förekomst:
Prevalensen av astma är ungefär 10 %. 
Symtom:
Pip i bröstet, andnöd, trånghetskänsla i bröstet, hosta och allergiska symtom är vanligt förekommande symtom. I anamnesen är ärftlighet och uppgifter om utlösande faktorer viktiga delar.
Kliniska fynd:
Oftast inga särskilda fynd vid välkontrollerad sjukdom. Spridda, högfrekventa pipljud med olika tonhöjd och längd, nedsatt saturation och tecken på allergi kan förekomma under försämringar av astma – akut astma .
Diagnostik:
Astma är en klinisk diagnos men dynamisk spirometri  är en viktig del av diagnostiken. Fynd av reversibel och/eller variabel obstruktion stödjer diagnosen. PEF-mätningar  är ofta användbara vid normal spirometri.
Behandling:
Behandling består av icke-farmakologiska åtgärder såsom patientutbildning, undvikande av utlösande faktorer och rökavvänjning samt farmakologiska åtgärder med antiinflammatoriska och ibland luftrörsvidgande läkemedel.
  1. Global Strategy for Asthma Management and Prevention. 2022 (hämtad 2022-11-25). ginasthma.org  
  2. Läkemedelsverket. Astma hos barn och vuxna, behandlingsrekommendation mars 2023 (hämtad 2023-03-27). www.lakemedelsverket.se  
  3. Ekerljung L, Rönmark E, Larsson K, Sundblad BM, Bjerg A, Ahlstedt S et al. No further increase of incidence of asthma: incidence, remission and relapse of adult asthma in Sweden. Respir Med 2008;102(12):1730-6. PubMed  
  4. Baur X, Sigsgaard T, Aasen TB, et al.: Guidelines for the management of work-related astma. (Erratum appears in Eur Respir J. 2012 Jun;39(6):1553). Eur Respir J 2012; 39: 529-45. PubMed  
  5. Socialstyrelsen. Statistik om dödsorsaker. 2019-08-23 (Hämtad 2020-02-24). www.socialstyrelsen.se  
  6. Kuruvilla ME, Lee FE, Lee GB. Understanding Asthma Phenotypes, Endotypes, and Mechanisms of Disease. Clin Rev Allergy Immunol 2019; 56(2): 219-233. pmid:30206782 PubMed  
  7. Wenzel SE. Asthma phenotypes: the evolution from clinical to molecular approaches. Nat Med. 2012;18(5):716–725. PMID:22561835. PubMed  
  8. Toskala E, Kennedy DW. Asthma risk factors. Int Forum Allergy Rhinol. 2015;5 Suppl 1(Suppl 1):S11-S16. PMID:26335830. PubMed  
  9. Upton MN, McConnachie A, McSharry C, Hart CL, et al. Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring. BMJ 2000; 321:88-92. PMID: 10884260 PubMed  
  10. Currie GP, Devereux GS, Lee DKC, Ayres JG. Recent developments in asthma management. BMJ 2005; 330: 585-9. PMID: 15761000. PubMed  
  11. Eagan TM, Gulsvik A, Eide GE, et al. Occupational airborne exposure and the incidence of respiratory symptoms and asthma. Am J Respir Crit Care Med 2002; 166: 933-8. PubMed  
  12. Moscato G, Vandenplas O, van Gerth WR, et al. Occupational rhinitis. Allergy 2008; 63: 969-80. PubMed  
  13. Örtqvist AK, Lundholm C, Kieler H, et al. Antibiotics in fetal and early life and subsequent childhood asthma: nationwide population based study with sibling analysis. BMJ 2014; 349: g6979. dx.doi.org  
  14. Etminan M, Sadatsafavi M, Jafari S, et al. Acetaminophen use and the risk of asthma in children and adults: a sytematic review and metaanalysis. Chest 2009; 136: 1316-23. www.ncbi.nlm.nih.gov  
  15. Lowe AJ, Carlin JB, Bennett CM, et al. Paracetamol use in early life and asthma: prospective birth cohort study. BMJ 2010; 341: c4616. dx.doi.org  
  16. Greenhawt M. Environmental exposure to peanut and the risk of an allergic reaction. Ann Allergy Asthma Immunol. 2018;120(5):476–481.e3. PMID:29555352. PubMed  
  17. Rajan P, Wineinger NE, Stevenson DD, White AA. Prevalence of aspirin-exacerbated respiratory disease among asthmatic patients: A meta-analysis of the literature. J Allergy Clin Immunol 2015; 135: 676-81. DOI: 10.1016/j.jaci.2014.08.020. DOI  
  18. Salpeter S, Ormiston T, Salpeter E. Cardioselective beta-blockers for reversible airway disease. Cochrane Database Syst Rev 2002; 4: CD002992. pmid:12519582 PubMed  
  19. McCreanor J, Cullinan P, Nieuwenhuijsen MJ, et al. Respiratory effects of exposure to diesel traffic in persons with asthma. N Engl J Med 2007; 357: 2348-58. PMID: 18057337 PubMed  
  20. DiMango E, Holbrook JT, Simpson E, et al. Effects of asymptomatic proximal and distal gastroesophageal reflux on asthma severity. Am J Respir Crit Care Med 2009; 180: 8090-16. pmid:19661245 PubMed  
  21. Läkemedelsbehandling vid astma - behandlingsrekommendation: Information från Läkemedelsverket 2015;26(3):26–43. lakemedelsverket.se  
  22. Global Initiative för Asthma. Pocket guide for asthma management and prevention. Updated 2021. (Hämtad 2021-05-19) ginasthma.org  
  23. Reddel H, Jenkins C, Woolcock A. Diurnal variability--time to change asthma guidelines?. BMJ. 1999;319(7201):45–47. PMID:10390464. PubMed  
  24. Löwhagen O. Diagnosis of asthma - new theories. J Asthma. 2015;52(6):538-44 PMID: 25478896 PubMed  
  25. Johansson H, Norlander K, Berglund L et al. Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population. Thorax 2015; 70: 57-63. pmid:25380758 PubMed  
  26. Fuhlbrigge AL, Adams RJ, Guilbert TW, Grant E, Lozano P, Janson SL, et al. The burden of asthma in the United States: level and distribution are dependent on interpretation of the National Asthma Education and Prevention Program guidelines. Am J Respir Crit Care Med 2002; 166: 1044-9. PubMed  
  27. Socialstyrelsen (2018). Nationella riktlinjer för vård vid astma och KOL. www.socialstyrelsen.se  
  28. Thomas M, Price D, Chrystyn H, Lloyd A, Williams AE, von Ziegenweidt J. Inhaled corticosteroids for asthma: impact of practice level device switching on asthma control. BMC Pulm Med 2009;9:1 PubMed  
  29. FYSS (2008). Astma. (Hämtad 2016-07-12) fyss.se  
  30. Carson KV, Chandratilleke MG, Picot J, et al. Physical training for asthma. Cochrane Database Syst Rev. 2013 Sep 30;9. PMID: 24085631. PubMed  
  31. Eichenberger PA, Diener SN, Kofmehl R, et al. Effects of exercise training on airway hyperreactivity in asthma: a systematic review and meta-analysis. Sports Med. 2013 Nov;43(11):1157-70. doi: 10.1007/s40279-013-0077-2. [url]http://dx.doi.org/10.1007/s40279-013-0077-2[/url] PMID: 23846823 PubMed  
  32. Toennesen LL, Meteran H, Hostrup M, et al. Effects of Exercise and Diet in Nonobese Asthma Patients-A Randomized Controlled Trial. J Allergy Clin Immunol Pract 2018; 6(3): 803-811. pmid:29133220 PubMed  
  33. Beggs S, Foong YC, Le HC, et al. Swimming training for asthma in children and adolescents aged 18 years and under. Cochrane Database Syst Rev 2013; 4: CD009607. doi:10.1002/14651858.CD009607.pub2 DOI  
  34. Freitas DA, Holloway EA, Bruno SS, et al. Breathing exercises for adults with asthma. Cochrane Database Syst Rev. 2013 Oct 1;10:CD001277. doi: 10.1002/14651858.CD001277.pub3. PMID: 24085551 PubMed  
  35. Baishnab E, Karner C. Primary care based clinics for asthma. Cochrane Database Syst Rev 2012; 4: CD003533. pmid:22513914 PubMed  
  36. Lisspers K, Ställberg B, Hasselgren M, et al. Primary health care centres with asthma clinics: effects on patients knowledge and asthma control. Prim Care Respir J. 2010;19(1):37–44. PMID:19623471. PubMed  
  37. Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, Haywood P, et al. Self-management education and regular practitioner review for adults with asthma (Cochrane Review). In: The Cochrane Library, issue 1, 2004. PMID: 12535399 PubMed  
  38. Martineau AR, Cates CJ, Urashima M, Jensen M, Griffiths AP, Nurmatov U, Sheikh A, Griffiths CJ. Vitamin D for the management of asthma. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD011511. DOI: 10.1002/14651858.CD011511.pub2. PMID: 27595415 PubMed  
  39. Wolsk HM, Harshfield BJ, Carey VJ, et al. Vitamin D supplementation in pregnancy, prenatal 25(OH)D levels, race, and subsequent asthma or recurrent wheeze in offspring: Secondary analyses from the Vitamin D Antenatal Asthma Reduction Trial. J Allergy Clin Immunol 2017; 140(5): 1423-1429. pmid:28285844 PubMed  
  40. Mintz M. Asthma updage: Part II. Medical management. Am Fam Physicians 2004; 70: 1061-6. PubMed  
  41. Rodrigo GJ1, Castro-Rodríguez JA. Daily vs. intermittent inhaled corticosteroids for recurrent wheezing and mild persistent asthma: a systematic review with meta-analysis. Respir Med. 2013 Aug;107(8):1133-40. PMID: 23769720. PubMed  
  42. Stridh B, Romberg K, Ställberg B, et al. . Många överbehandlas med astmamedicin. Algoritm för nedtrappning av astmaläkemedel är ett hjälpmedel för att uppnå optimal behandling. Läkartidningen. 2018;115:EY3E lakartidningen.se  
  43. Hagan JB, Samant SA, Volcheck GW, et al. The risk of asthma exacerbation after reducing inhaled corticosteroids: a systematic review and meta-analysis of randomized controlled trials. Allergy. 2014 Apr;69(4):510-6. doi: 10.1111/all.12368. PMID: 24571355 PubMed  
  44. Boyle RJ, Pedroletti C, Wickman M, Bjermer L, Valovirta E, Dahl R et al. Nocturnal temperature controlled laminar airflow for treating atopic asthma: a randomised controlled trial. Thorax 2012;67(3):215-21 PubMed  
  45. Humbert M, Beasley R, Ayres J, et al. Benefits og omalizumab as add-on therapy in patients with severe pesistent asthma who are inadequately controlled despite best available therapy. Allergy 2005; 60: 309-16. PubMed  
  46. Norman G, Faria R, Paton F, et al. Omalizumab for the treatment of severe persistent allergic asthma: a systematic review and economic evaluation. Health Technol Assess 2013; 17: 1-342. pmid:24267198 PubMed  
  47. Walters EH, Gibson PG, Lasserson TJ, Walters JAE. Long-acting beta2-agonists for chronic asthma in adults and children where background therapy contains varied or no inhaled corticosteroid. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD001385 PMID: 17253458 PubMed  
  48. Loymans RJ, Gemperli A, Cohen J, et al. Comparative effectiveness of long term drug treatment strategies to prevent asthma exacerbations: network meta-analysis. BMJ. 2014 May 13;348:g3009. doi: 10.1136/bmj.g3009. PMID: 24919052 PubMed  
  49. Salpeter SR, Buckley NS, Ormiston TM, Salpeter EE. Meta-analysis: effect of long-acting beta-agonists on severe asthma exacerbations and asthma-related deaths. Ann Intern Med. 2006; 144: 904-12. PubMed  
  50. Cates CJ, Jaeschke R, Schmidt S, et al. Regular treatment with formoterol and inhaled steroids for chronic asthma: serious adverse events. Cochrane Database Syst Rev 2013; 6: CD006924. PMID:23744625. PubMed  
  51. Cates CJ, Jaeschke R, Schmidt S, Ferrer M. Regular treatment with salmeterol and inhaled steroids for chronic asthma: serious adverse events. Cochrane Database Syst Rev. 2013 Mar 28;3:CD006922. doi: 10.1002/14651858.CD006922.pub3. PMID: 23543548 PubMed  
  52. Salpeter SR, Wall AJ, Buckley NS. Long-acting beta-agonists with and without inhaled corticostreoids and catastrophic asthma events. Am J Med 2010; 123: 322-8. PubMed  
  53. Busse WW, Bateman ED, Caplan AL, et al.. Combined Analysis of Asthma Safety Trials of Long-Acting β2-Agonists. N Engl J Med 2018; 378(26): 2497-2505. pmid:29949492 www.ncbi.nlm.nih.gov  
  54. Chauhan BF, Ducharme FM. Addition to inhaled corticosteroids of long-acting beta2-agonists versus anti-leukotrienes for chronic asthma. Cochrane Database Syst Rev. 2014 Jan 24;1:CD003137. PMID: 24459050 PubMed  
  55. Kew KM, Karner C, Mindus SM, et al. Combination formoterol and budesonide as maintenance and reliever therapy versus combination inhaler maintenance for chronic asthma in adults and children. Cochrane Database Syst Rev. 2013 Dec 16;12:CD009019. doi: 10.1002/14651858.CD009019.pub2. PMID: 24343671 PubMed  
  56. Bansal V, Mangi MA, Johnson MM, et al. Inhaled corticosteroids and incident pneumonia in patients with asthma: Systematic review and meta-analysis. Acta Med Acad. 2015;44(2):135-58. pmid: 26702909 PubMed  
  57. Kew KM, Quinn M, Quon BS, et al. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children. Cochrane Database Syst Rev. 2016 Jun 7;6:CD007524. PMID: 27272563 PubMed  
  58. Loke YK, Gilbert D, Thavarajah M, et al. Bone mineral density and fracture risk with long-term use of inhaled corticosteroids in patients with asthma: systematic review and meta-analysis. BMJ Open. 2015 Nov 24;5(11):e008554. PMID: 26603243. PubMed  
  59. Miligkos M, Bannuru RR, Alkofide H, et al. Leukotriene-receptor antagonists versus placebo in the treatment of asthma in adults and adolescents: a systematic review and meta-analysis. Ann Intern Med. 2015 Nov 17;163(10):756-67. PMID: 26390230 PubMed  
  60. FDA. FDA requires Boxed Warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair); advises restricting use for allergic rhinitis. 2020-04-03 (Hämtad 2020-04-30). www.fda.gov  
  61. Tian JW, Chen JW, Chen R, et al. Tiotropium versus placebo for inadequately controlled asthma: a meta-analysis. Respir Care. 2014 May;59(5):654-66. doi: 10.4187/respcare.02703. [url]http://dx.doi.org/10.4187/respcare.02703[/url PMID: 24170916 PubMed  
  62. Rodrigo GJ, Castro-Rodríguez JA. What Is the Role of Tiotropium in Asthma?: A Systematic Review With Meta-analysis. Chest 2015; 147: 388-96. doi:10.1378/chest.14-1698. PMID: 25322075 PubMed  
  63. Anderson DE, Kew KM, Boyter AC. Long-acting muscarinic antagonists (LAMA) added to inhaled corticosteroids (ICS) versus the same dose of ICS alone for adults with asthma. Cochrane Database Syst Rev. 2015 Aug 24;8:CD011397 PMID: 26301488 PubMed  
  64. SBU. Tilläggsbehandling av långverkande antikolinergika till kombinationsbehandling av medelsvår till svår astma. 2022-05-04. www.sbu.se  
  65. Gray S L, Anderson ML, Dublin S,et al. "Cumulative Use of Strong Anticholinergic Medications and Incident Dementia". JAMA Intern Med. 2015;175(3):401-407. PubMed. [url]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&db=PubMed&term=25621434%5Buid%5D[/url] PMID: 25621434 PubMed  
  66. Janusinfo (2016). Mepolizumab (Nucala). (Hämtad 2016-11-03) www.janusinfo.se  
  67. Deeks ED. Mepolizumab: A Review in Eosinophilic Asthma. BioDrugs. 2016 Aug;30(4):361-70. Pmid:27311938. PubMed  
  68. Janusinfo. 2017. Läkemedel som motverkar interleukin-5 för tilläggsbehandling vid svår eosinofil astma hos vuxna – ny rekommendation från NT-rådet. (Hämtad 2018-02-08) www.janusinfo.se  
  69. Regionernas samverkansmodell för läkemedel. Cinqaero (reslizumab), Fasenra (benralizumab), Nucala (mepolizumab) samt Dupixent (dupilumab) vid astma. 2020-02-07 (Hämtad 2020-10-22). medibas.se  
  70. Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database Syst Rev 2010; 8: CD001186. pmid:20687065 PubMed  
  71. Reid MJ, Lockey RF, Turkeltaub PC, Platts-Mills TA. Survey of fatalities from skin testing and immunotherapy 1985-1989. J Allergy Clin Immunol. 1993; 92: 6-15. PubMed  
  72. Hondras MA, Linde K, Jones AP. Manual therapy for asthma (Cochrane Review). In: The Cochrane Library, Issue 4 2002. Oxford: Update Software. PMID: 12519548 PubMed  
  73. McCarney RW, Brinkhaus BG, Lasserson TJ, Linde K. Acupuncture for chronic asthma. Cochrane Database of Systematic Reviews 2003; 3: CD000008. PMID: 14973944 PubMed  
  74. Gøtzsche PC, Johansen HK. House dust mite control measures for asthma. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD001187 PMID: 18425868 PubMed  
  75. Woodcock A, Forster L, Matthews E, et al. Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma. N Engl J Med 2003; 349: 225-36. PubMed  
  76. Porsbjerg CM, Backer V. Astma hos gravide. Ugeskr Læger 2003; 165: 4545-9. PubMed  
  77. Möller C, Derborg S, Ferdousi HA, et al. Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (the PAT-study). J ALlergy Clin Immunol 2002; 109: 251-6. PubMed  
  78. Petsky HL, Kew KM, Turner C, et al. Exhaled nitric oxide levels to guide treatment for adults with asthma. Cochrane Database Syst Rev. 2016 Sep 1;9:CD011440. PMID: 27580628. PubMed  
  79. Sokolow AG, Stallings AP, Kercsmar C, et al. Safety of live attenuated influenza vaccine in children with asthma. Pediatrics 2022. PMID: 35342923 PubMed  
  80. Sheikh A, Alves B, Dhami S. Pneumococcal vaccine for asthma (Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software. PMID: 11869626 PubMed  
  81. Karlsson CA, Isaksson M, Janson C. Inhalationssteroider kan ge sekundär binjurebarkssvikt. Läkartidningen. 2014;111:CTAZ. www.lakartidningen.se  
  • Hanna Sandelowsky, specialist i allmänmedicin, Med dr, Karolinska Institutet, Stockholm