Controlling asthma in adults and children has proven to be a challenge due to the complexity involved in disease management. 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 infections, environmental allergens, or other stimuli and is characterized by bronchial hyperresponsiveness without specific and inflammation of the respiratory tract. Disease severity is measured based on 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 triggers the release of mediators from mast cells, including histamine, tryptase, leukotrienes, and prostaglandins, which cause airway smooth muscle to contract (Busse and Lemanske 363). Other stimuli include cold air, irritants and exercise. In addition, stress can be an aggravating factor in an asthma attack. The next stage of the disease involves inflammation and swelling of the airways as the attack progresses. Other changes that occur include hypersecretion of mucus, formation of “inspissated mucus plugs,” hypertrophy and hyperplasia of airway smooth muscle. A seizure may also be characterized by airway hyperreactivity, which is a severe bronchoconstriction response in response to multiple stimuli. In very severe cases, airway remodeling may occur, leading to lu...... middle of paper ......thma. Internet. December 2012. October 3, 2013 Holgate, 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. Poor 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 use of inhalers: assessment of patient use and preferences for seven inhaler devices. Respiratory medicine EDICI 94.5 (2000): 496-500. Print.Melani, Andrea et al. Mishandling 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. Print.