asthma

Asthma is a chronic inflammatory respiratory disease that can cause bouts of shortness of breath and coughing. Asthma can usually be treated well with medication

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Inhaling against shortness of breath: Asthmatics should always have their emergency medication with them

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Asthma - in a nutshell

Asthma is a chronic disease of the respiratory tract that can narrow the airways and lead to attacks of coughing and shortness of breath. Asthma is often allergic, especially in younger patients. In the case of complaints after the age of 30, however, it is more likely not. The doctor makes a diagnosis of asthma based on medical history, examination, and pulmonary function tests. The aim of treatment is that symptoms no longer occur, so that the asthma is controlled. For this you need anti-inflammatory drugs and drugs that dilate the bronchi. Fast-acting bronchodilator sprays for emergencies are also always included.

Definition: what is asthma?

Asthma is an umbrella term for various forms of chronic, inflammatory diseases of the airways. They lead to constriction of the bronchi, constriction in the chest, attacks of shortness of breath, coughing and wheezing noises. The symptoms change in their severity. Of the different types or forms of asthma, allergic and intrinsic (non-allergic) asthma are best known.

Allergic asthma, together with hay fever and neurodermatitis, is one of the atopic diseases. These are characterized by the fact that the immune system overreacts to certain external stimuli. The allergy triggers can, for example, be pollen, animal hair or house dust mites. In addition to allergic asthma, which often begins in childhood, there are also intrinsic forms of asthma, which often do not begin until the age of thirty to forty.

This is how the bronchi change in asthma

© W & B / Dr. Ulrike Möhle

TO THE PICTURE GALLERY

© W & B / Dr. Ulrike Möhle

Symptom-free airways and a cross-section of a bronchus: the mucous membrane on the inside, then the muscle layers dark red

© W & B / Dr. Ulrike Möhle

Changes in the bronchi in asthma symptoms: the mucous membrane swells, thick mucus forms, the bronchial muscles contract, which narrows the airways

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causes

In asthma, two things come together: firstly, a predisposition that makes the inflamed bronchial tubes particularly sensitive to certain stimuli, and secondly, external triggers, such as allergens, respiratory infections or cold air, which can cause the typical shortness of breath.

The asthmatic inflammation of the airways leads to

  • swelling of the lining
  • a spasm of the bronchial muscles and
  • an increased production of mucus in the bronchi.

This hinders breathing. Characteristically, the exhalation is affected and there are whistling and humming breath noises (so-called wheezing, in English "wheezing"). In severe cases, a little more air remains in the lungs than normal after each breath, the doctor speaks of overinflation.

Types or forms of asthma

Doctors differentiate between two main forms of asthma:

1) allergic asthma, also called extrinsic asthma and

2) intrinsic asthma, formerly also known as non-allergic asthma.

Important: Not all asthma diseases can be clearly assigned to one form or another - there are also mixed forms! Research is identifying more and more forms of asthma in which the degree and characteristics of inflammation and the patients affected differ. For example, women and men are often affected by different types of asthma at different ages.

1) Allergic asthma

As the name suggests, allergic asthma is caused by an allergic reaction. It is triggered by certain substances, the so-called allergens, such as pollen from plants, house dust mite excrement or animal hair. Allergic asthma is based on a hereditary predisposition. It often sets in in childhood or adolescence.

2) Intrinsic (non-allergic) and other special forms of asthma

Intrinsic asthma can have very different causes:

  • Eosinophilic asthma

Many asthma sufferers have inflammation, which is characterized by a special type of white blood cell.

  • Infection-related asthma

Infections, which are mostly viral, make the airways vulnerable and trigger airway inflammation, which leads to bronchial spasms, mucus, coughing and shortness of breath. Initially, asthma disappears after the cold has subsided, but it often becomes chronic over the years.

  • Drug-related asthma

Asthma sufferers often react to certain medications such as pain relievers (acetylsalicylic acid) or anti-inflammatory drugs (so-called non-steroidal anti-inflammatory drugs). This is not an allergy, but a genetically determined intolerance to certain drugs, which, however, proceeds like an allergic reaction to the observer.

  • Asthma as a reaction to chemical or toxic substances

Certain environmental irritants (smog, smoke, dust, vapors, ozone) can also cause asthma. If the person concerned comes into contact with it in the course of his work, one speaks of occupational asthma.

Some other forms of asthma:

  • A special type of asthma is the asthma of very overweight women, which usually occurs around the age of 30 and does not respond well to classic asthma treatment.
  • The asthma of smokers, which in turn has special characteristics, is also difficult to treat.
  • Exercise asthma is a form of asthma with few or no inflammatory changes and is now correctly called bronchial spasms under exercise (exercise bronchospasm). These asthma patients have no symptoms if they do not exert themselves too much. Swimming, cross-country skiing and ice skating are sports in which a large number of athletes suffer from stress-induced asthma. A distinction should be made here between asthma patients who have not been optimally treated and who have symptoms even at rest and who react to physical stress by increasing their dyspnoea. The bronchospasm can occur both during exercise and afterwards, when the patient has already stopped physical activity.

Risk factors

Certain circumstances and conditions can promote asthma:
• Allergic people who are or have suffered from hay fever, neurodermatitis or cradle cap have a higher risk of asthma. The same applies to people who have asthma or allergy sufferers in their relatives.
• Nicotine: Smoking is poison for the airways and makes them more susceptible. Passive smoking also increases the risk of respiratory diseases. In addition, smoking reduces the effectiveness of the most important asthma medications.
• Respiratory infections: Frequent respiratory infections leave the airways vulnerable and can prepare the ground for asthma.
• Light weight at birth: These children are more likely to have asthma later than normal-weight newborns.
• Obesity and lack of exercise in childhood also increase the risk of asthma.

Symptoms: what are the signs of asthma?

The term "asthma" comes from the Greek and means wheezing. This already indicates an important symptom: shortness of breath, which occurs like attacks and preferably at night. In addition, whistling or humming noises can mainly arise when exhaling. A chronic cough can also indicate asthma. Many patients do not have any shortness of breath at all, but rather complain of feelings of oppression in the chest or pain when inhaling cold air is the foreground. An acute attack can also lead to a palpitations of the heart (tachycardia) and, in the case of severe shortness of breath, a bluish discoloration of the lips and skin. Then you need to act as quickly as possible and the emergency doctor should definitely be alerted!
The symptoms mentioned vary in their severity and severity. Another typical feature of asthma is that the symptoms completely or at least partially subside, either by themselves or after taking certain medications. But you can reappear at any time. After a symptom-free period, there may be, for example, temporary periods with coughing and shortness of breath or an acute asthma attack.

Complications

A dreaded complication in asthma is the status asthmaticus, i.e. the life-threatening asthma attack that cannot be easily broken with medication and therefore lasts for 24 hours and longer. It can happen that the gas exchange in the lungs fails and the asthma patient is only insufficiently supplied with oxygen. If he is not helped, the patient can die in the worst case. A severe seizure can also lead to acute overinflation of the lungs.

In the event of a severe asthma attack with severe shortness of breath, which does not improve quickly with the emergency medication prescribed by the doctor according to the emergency plan, you should therefore call an emergency doctor.

A lung function test helps diagnose asthma

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diagnosis

At the beginning, the doctor asks the person concerned in order to get an exact picture of the symptoms. He will also discuss previous illnesses and illnesses in the family, inquire about allergies and the stimuli that trigger the complaints.
He then examines the patient and listens to the lungs to find out whether there are typical asthmatic breathing sounds. A lung function test is then absolutely necessary in order to be able to make the diagnosis of asthma. In addition, the doctor can order further examinations, for example to detect the triggers in allergic asthma or to rule out other diseases.

Pulmonary function test

In spirometry, the patient performs various breathing maneuvers under supervision while breathing into a device with the aid of a mouthpiece. In this way it is possible to measure different tidal volumes. What is particularly important in spirometry is the value of the so-called second air (FEV1). Because the more the bronchi are narrowed, the less air can be exhaled in one second. If you want to determine the airway resistance and also the residual volume (the amount of air that remains in the lungs after a maximum exhalation), the measurement is carried out in a closed glass cabin, the procedure is called whole-body plethysmography.

With peak flow measurement, which can also be carried out with smaller devices and for self-monitoring at home, the maximum flow rate of the exhaled air is determined (unit: liters per minute) - the so-called peak flow. It is not necessary to breathe out long, but as forcefully and quickly as possible.
Lung function tests are also used to check the course of the asthma. By comparing the values ​​from older and more recent measurements, possible changes in the airways can be tracked over a longer period of time. The lung function test helps the doctor to get a precise picture of the condition of the asthma patient under treatment and thus to control the therapy. "Controlled" asthma is when the patient has no symptoms and normal lung function.

• Provocation test
If the result of normal spirometry is normal and there is still a suspicion of asthma, a provocation test to detect a hypersensitive (hyperresponsive) bronchial system can help to confirm the diagnosis. The patient inhales a test substance which constricts the bronchi, if they are hypersensitive, even at a low dose. If the value of the second air (FEV1) is at least 20 percent lower than without artificial stimulation, this indicates an over-sensitive bronchial system. The narrowing of the bronchi can also be provoked by inhalation of cold air or by physical exertion
• Bronchospasmolysis test
A lung function test is carried out. If the bronchi are narrowed, the patient then inhales a drug to dilate them. If the FEV1 value measured 15 minutes after the extension is at least 15 percent better than without medication, the suspicion of asthma is justified and therapy is necessary.