Control of asthma in both adults and children has proven to be a challenge due to the complexity involved in managing the disease. According to the Global Initiative for Asthma (GINA 1), the term refers to a clinical syndrome of “intermittent respiratory symptoms triggered by viral upper respiratory tract infections, environmental allergens, or other stimuli and is characterized by nonspecific bronchial hyperreactivity and airway inflammation ”. The severity of the disease is measured by an individual's lung function (FEV1), the number of times a patient uses a bronchodilator, and the symptoms a patient experiences at night (GINA 1). The pathophysiology of asthma includes bronchoconstriction which is the first step; refers to the narrowing of the airways as an immediate response to exposure stimuli such as allergens, aerosols, or irritants. Acute allergen-induced bronchoconstriction occurs when an IgE-dependent initiates the release of mediators from mast cells including histamine, tryptase, leukotrienes, and prostaglandins that cause airway smooth muscle contraction (Busse and Lemanske 363). Other stimuli include cold air, irritants, and exercise. Additionally, stress can be an exacerbating factor for an asthma attack. The next step of the disease involves inflammation and edema of the airways as the attack progresses further. Other changes that occur include hypersecretion of mucus, the formation of “thickened mucus plugs,” and hypertrophy and hyperplasia of airway smooth muscle. An attack may also be characterized by airway hyperresponsiveness which is a severe bronchoconstriction response to multiple stimuli. In very severe cases, airway remodeling may occur leading to progressive lu...... middle of paper ......thma. Network. December 2012. 3 October 2013Holgate, Stephen and Riccardo Polosa. The mechanisms, diagnosis and management of severe asthma in adults. Lancet 368.9537 (2006): 780–93. Print.Jahdali Hamdan, Anwar Ahmed and Al-Harbi Abdullah et al. Improper inhaler technique is associated with poor asthma control and frequent emergency room visits. AACI 9.1 (2013):8. Print.Lenney, J., Innes, JA, and Crompton, GK Inappropriate inhaler use: evaluation of the use and patient preference of seven inhalation devices. EDICI Respiratory Medicine 94.5 (2000):496-500. Print.Melani, Andrea et al. Mismanagement of inhalers remains common in real life and is associated with reduced disease control. Respiratory Medicine 105.6 (2011): 930-8. Print. Dolvich Myrna et al. Device selection and outcomes of aerosol therapy: evidence-based guidelines. Chest 127.1 (2005): 335-371. Press.