Schend J, Rowane M, Sanan N, Hostoffer SR. An Osteopathic Modular Approach to Asthma: A Narrative Review. J Am Osteopath Assoc 2020;120(11):774–782. doi: https://doi.org/10.7556/jaoa.2020.121.
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Asthma is among of the first ailments documented in the existing academic literature as being successfully managed with osteopathic manipulative treatment (OMT) techniques. Time-efficient and well-tolerated OMT techniques have been gradually added to the literature to manage this increasingly prevalent disease. In this narrative review, the authors discuss previously-published literature describing the history, diagnosis, and management of asthma related to osteopathic principles and practices and OMT application. They also present current and newly-approved medical managements, including biologics and inhaled corticosteroids. This article also includes supplemental videos showcasing OMT techniques for asthma management, which were developed by the authors based on recommendations indicated in the literature.
Abbreviations: AERD, aspirin-exacerbated respiratory disease; CS, corticosteroids; IL, interleukin; IgE, immunoglobulin E; FEV1, forced expiratory volume in 1 second; OCS, oral corticosteroids; SBM, subepithelial basement membrane.
Adapted from Wenzel 20124 and Tabatabaian 2019.5
a off-label, data only with budesonide-formoterol (bud-form); b off-label, separate or combination ICS and SABA inhalers; c low-dose ICS-form is the reliever for patients prescribed bud-form or beclomethasone-diproprionate form maintenance and reliever therapy; d consider adding house dust mites sublingual immunotherapy for sensitized patients with allergic rhinitis and FEV1 >70% predicted; e consider side effects DPI.
*Refer to Table 2B for specific inhaled corticosteroid potencies and dosages.
Abbreviations: DPI, dry powder inhaler; ICS, inhaled corticosteroid; IgE, immunoglobulin E; IL, interleukin; LTRA, leukotriene-receptor antagonist; LABA, long-acting β2-agonist; OCS, oral corticosteroids; SABA, Short-acting β2-agonist.
Adapted from Tabatabaian 20195 and Global Initiative for Asthma (GINA) 2019.6
Abbreviations: DPI, dry powder inhaler; HFA, hydrofluoroalkane propellant.
*Refer to Table 2A for an outline of preferred controllers and relievers.
Abbreviations: FcεRI, high affinity receptor for the fragmented crystallizable region of immunoglobulin E; FeNO, fractional exhaled nitric oxide FEV1, forced expiratory volume in 1 second; IgE, immunoglobulin E; IL, interleukin. Adapted from information provided in Tabatabaian,5 Hanania et al,7 Humbert et al,8 Pavord et al,9 Haldar et al,10 Flood-Page et al,11 Ortega et al,12 Corren et al,13 Laviolette et al,14 Nowak et al,15 Wenzel et al,16 Castro et al,17 Busse et al18
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