Definition of asthma
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Definition of Asthma
Core Definition
Asthma is a chronic inflammatory disorder of the airways characterized by marked temporal variability in airflow obstruction that is often reversible, either spontaneously or with treatment. This inflammation presents clinically in susceptible patients with recurrent symptoms of wheezing, chest tightness, cough, and occasionally dyspnea, and contributes to heightened airway hyperresponsiveness to specific and nonspecific stimuli - a pathognomonic feature of the disease.
- Fishman's Pulmonary Diseases and Disorders
The NAEPP Expert Panel Report 3 (2007) classic definition elaborates that the inflammation involves multiple cell types: mast cells, eosinophils, neutrophils, T lymphocytes, macrophages, and epithelial cells. These episodes are associated with widespread but variable airflow obstruction that is reversible either spontaneously or with treatment.
- Fishman's Pulmonary Diseases and Disorders, NAEPP EPR-3
Asthma as a Heterogeneous Disease
A key modern understanding is that asthma is not a single disease entity with a unique pathogenesis, but rather a clinical syndrome comprising multiple endotypes that share common symptoms but have distinct pathophysiologic and etiologic mechanisms - with interplay between genetic and environmental factors. This phenotypic heterogeneity is multidimensional, including variability in pathologic, clinical, and physiologic parameters among different patients.
From an immunologic perspective, asthma results from heterogeneous immune disorders of the airways, broadly divided into:
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T2-high subtype (allergic) - the dominant form, driven by aberrant T2 immune responses
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T2-low forms - non-allergic immune responses, found in smaller subsets
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Murray & Nadel's Textbook of Respiratory Medicine
Key Features of the Definition (Summary)
| Feature | Detail |
|---|---|
| Nature | Chronic inflammatory disorder |
| Site | Airways (bronchi, bronchioles) |
| Obstruction | Variable, reversible |
| Cells involved | Mast cells, eosinophils, neutrophils, T lymphocytes, macrophages, epithelial cells |
| Symptoms | Wheezing, breathlessness, chest tightness, cough |
| Hallmark | Airway hyperresponsiveness |
| Disease character | Heterogeneous syndrome / multiple endotypes |
Diagnostic Note
Because asthma is a clinical syndrome, there is no gold standard for its diagnosis. Physicians use a combination of clinical history (wheezing, parental history of asthma), evidence of obstruction on lung function testing (spirometry/PEFR), and a favorable response to bronchodilator to make the diagnosis. Age, sex, smoking status, and allergic sensitization all influence how the diagnosis is applied in practice.
- Fishman's Pulmonary Diseases and Disorders
Recent evidence note: A 2025 systematic review in Lancet Respiratory Medicine (PMID 39549709) addresses the emerging concept of clinical remission in severe asthma treated with biologics, reflecting a modern evolution beyond the classic definition toward treatment goals that include sustained absence of symptoms, exacerbations, and oral corticosteroid use.
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