Bronchial asthma is a chronic and inflammatory disease of the airways. Shortness of breath, fits of coughing and wheezing when breathing are characteristic. The bronchial tubes react to various stimuli such as pollen or animal hair, but cold or physical exertion can also trigger asthmatic symptoms.
Causes and risk factors
In bronchial asthma, the airways, i.e. the bronchi, react to various stimuli with inflammation. The mucous membrane of the bronchi swells, it narrows (bronchial obstruction). The lungs produce thick mucus and the bronchial muscles cramp. The used air can only be breathed out with great effort. The less used air that can be exhaled, the less fresh air gets into the lungs. There is shortness of breath.
The cause of the symptoms is hypersensitivity of the respiratory tract to various stimuli, which can have either an allergic (extrinsic) or a non-allergic (intrinsic or endogenous) origin. In most cases, asthma is a mixed form.
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Allergic asthma
In order to protect yourself effectively against allergic asthma, it is important to know its triggers (allergens). Only those who know the allergens to which their own body reacts can act themselves: avoid contact and possibly start hyposensitization. Allergic asthma triggers include animals (hair, skin, feathers), bee pollen, dust mites and mold, but also food, medicines and indoor pollutants. The latter in particular are becoming more and more of a problem for many of those affected, since houses, apartments and offices are very heavily insulated today. Not only is the exposure to in-house allergens increasing, but also the content of harmful substances from furniture, paints, seals, jointing compounds or adhesives.
Non-allergic asthma
Some of those affected react to stimuli that are not caused by allergic triggers. These include infections, cold air, dust, tobacco smoke, chemical irritants, exhaust fumes, stress and psychological influences, as well as medication for pain and physical exertion.
Risk factors
Children whose parents are also affected have a particular risk of developing bronchial asthma. The risk of developing asthma is hereditary. If both parents suffer or have suffered from asthma, seven to eight out of ten children can expect to develop asthma as well. Two to four out of ten children are likely to have the disease if only one parent has or has had asthma. If neither parent has asthma, the risk drops to an average of one in ten children. Risk factors for asthma also include smoking in adults and obesity in children.
Symptoms
Do you get coughing fits, especially at night?
Do your lungs whine when you exhale?
These symptoms are typical of bronchial asthma. Many sufferers suffer from coughing fits, especially at night. There are also whistling noises when breathing (wheezing). Symptoms also include shortness of breath, shortness of breath and tightness in the chest. Exhaling in particular is difficult for many of those affected.
An important hallmark of asthma is that the symptoms are not always the same. They can vary depending on the time of day, fluctuate or change from day to day - depending on whether it is summer or winter. Sometimes the symptoms have disappeared for months, only to suddenly reappear. Sometimes they appear individually, sometimes all at the same time. If the symptoms get worse, an asthma attack (status asthmaticus) can occur. Then, in addition to the symptoms already listed, the following will appear:
- Tachycardia
- Blue lips and skin
- Gasping
- Anxiety, confusion and restlessness
- Bloated chest with hunched shoulders
- Exhaustion to the point of being unable to speak
Call an ambulance immediately!
At the latest when the emergency medication prescribed by the doctor is no longer effective, an emergency doctor should definitely be called.
Allergic or non-allergic
The individual symptoms hardly differ, whether it is allergic (extrinsic) or non-allergic (intrinsic or endogenous) asthma. However, it can happen that an allergic reaction leads to two asthma attacks in a row (dual reaction). Immediately after contact with the allergen - for example when taking a walk when the grass is in bloom - the allergic immediate reaction follows with symptoms such as tightness in the chest, shortness of breath or shortness of breath. The second episode, the so-called late reaction, sets in about six to twelve hours later. The bronchi produce mucus that is difficult to cough up. At the same time, breathing becomes more difficult, "the lungs wheeze".
If the asthma is caused by allergies, those affected often suffer from allergic rhinitis (hay fever) or neurodermatitis in addition to the symptoms mentioned above.
Treatment
The earlier asthma is detected, the better it can be treated. Even if there is no cure for asthma today, the symptoms can usually be controlled well with current treatment options. A prerequisite for an effective therapy is a careful diagnosis by a pulmonologist (pulmonologist). It is also important to clarify to what extent allergies are responsible for the asthma.
Diagnosis
When discussing the medical history (anamnesis), the doctor wants to know: Are there family members with asthma or allergies? When do complaints arise? Do they depend on the season, do they vary throughout the day, disappear during the day and become very strong at night? Do the complaints vary by location? Where are they strongest: at home, at work, on a walk in the countryside? Are there pets in the apartment? Are those affected exposed to tobacco smoke? After the interview, the doctor will arrange for various tests. These include breath tests, allergy tests, blood tests and possibly a provocation test.
Breath tests
Breath tests are an inventory of how well the lungs are functioning. It measures how much of the air they breathe in the affected person can exhale again. A relatively simple and small device for this is the peak flow meter. You blow into it with all your might and you can then read off the maximum flow rate. The so-called spirometer measures the airflow during exhalation. In the complex, large lung function test (whole-body plethysmography), the patient sits in a glass cabin and, following instructions, breathes vigorously into a measuring device. The results show the flow resistance and width of the airways, i.e. the speed at which the inhaled air flows out again or the amount of air left in the lungs after exhaling.
Allergy testing
Medical diagnostics to uncover allergens generally consists of four stages. After the first step, the doctor's consultation, skin tests such as prick tests for pollen or animal hair allergies follow. Allergen extracts are applied in drops to the forearm. A small lancet is then pricked a millimeter deep into the skin under the drop. After half an hour, the doctor checks whether wheals or pustules have formed. In the third step, the doctor takes a blood sample and has it tested in the laboratory for allergy-typical antibodies. In the provocation test, the doctor tries to provoke an allergic reaction under supervision in a practice or in a hospital.
Some symptoms of asthma are similar to those of chronic obstructive pulmonary disease (COPD). The clinical pictures can be distinguished from each other diagnostically, since COPD sufferers do not react to triggers such as allergens or irritants.
Therapy
The therapy is multi-pronged. This includes avoidance of the triggers, medication adapted to the severity and current condition, as well as personal supplementary measures. It is also the responsibility of those affected not to rely solely on the therapeutic measures of the doctor, but to become an expert on their own illness.
The goals of therapy for asthma are:
- Reduce the frequency of complaints, preferably achieve freedom from symptoms
- Prevent disease progression and emergencies
- Reduce drug consumption and side effects
- Achieve unrestricted performance in everyday physical and social activities
- In children and young people, prevent physical and mental development from being impaired
Drugs used in asthma therapy work on two levels. Response medication is provided for acute asthma symptoms (reliever). With long-term medication, long-term control of the symptoms should be achieved (controller).
- Response medications are mostly bronchodilators that are inhaled. So-called beta-2 sympathomimetics are usually used for this. Their duration of action is very different. Certain drugs from this group of active ingredients help immediately, but only for a short time. These short-acting remedies are designed to help with an acute attack when the bronchial tubes need to dilate immediately and quickly. With another part, the effect lasts up to twelve hours. Those affected can take medication as needed, e.g. before exercising, to prevent an asthma attack during physical exertion.
- With the long-term medication, asthma should be controlled to such an extent that no more attacks occur. For this purpose, agents are usually inhaled that reduce the susceptibility to inflammation in the bronchi. According to the current state of medical research, cortisone sprays or powder inhalers are the most effective drugs for this. They work locally, i.e. exactly where they are used. They are only absorbed by the organism in small doses, and these doses are immediately broken down again by the liver. If the dosage is set correctly, those affected are symptom-free after two to four weeks of therapy.
- Another option is combination therapy. Anti-inflammatory and long-acting bronchodilators are inhaled at the same time. So that two inhalers do not have to be used, there is the SMART principle (Single Inhaler for Maintenance and Reliever Therapy) with one inhaler for both active ingredients. This should allow asthma to be controlled much better with a lower dose of medication. There are fewer asthma attacks and the use of reliever medication can be reduced.
There are also a number of other medications available as alternatives to cortisone preparations or beta-2 sympathomimetics. They are usually prescribed in the event of intolerance or if the usual remedies are not effective enough. Examples are xanthines, anticholinergics or leukotriene antagonists. A new active ingredient (omalizumab) has been approved in Switzerland since 2006 and is mainly used in severe allergic asthma. It binds the allergy-triggering antibody immunoglobulin E (IgE).
Phased plan
In order to achieve the therapy goals, drug treatment depends on the severity of the asthma. This is divided into four stages:
- Stage 1: occasional asthma; Complaints occur less than once a week, nocturnal cough twice a month at most; Therapy with reliever drugs.
- Stage 2: mild asthma; Complaints occur more than once a week, but not daily; night cough more than twice a month, possibly interfering with sleep and performance; Therapy with low-dose long-term medication plus reliever medication.
- Stage 3: moderate asthma; daily discomfort and nocturnal cough more than once a week, sleep and performance are impaired; Therapy with long-term medication plus reliever medication, possibly combination therapy.
- Stage 4: severe asthma; daily discomfort occurs, often at night, physical activities are limited; Therapy with long-term medication plus reliever medication, possibly combination therapy, possibly corticosteroids in tablet form or omalizumab as an injection.
Medication
- Glucocorticoids (e.g. cortisone) are active ingredients that are chemically derived from the hormones of the adrenal cortex. In asthma, they are used in inhalation sprays for long-term medication. They are considered to be the most effective drugs to reduce the susceptibility to inflammation of the bronchi.
- Beta-2 sympathomimetics (e.g. salbutamol, fenoterol, salmeterol) dilate the bronchi. They are contained in asthma sprays against acute attacks or in longer-acting agents for long-term therapy.
- Leukotriene antagonists (e.g. montelukast) suppress the activity of inflammatory substances (leukotrienes). They prevent the narrowing of the bronchi and act against inflammation of the airways. Leukotriene antagonists are taken as tablets or chewable tablets.
- Mast cell stabilizers (cromones, e.g. cromoglicic acid) prevent the mast cells from releasing histamine and other messenger substances. They thus prevent the bronchial tubes from contracting convulsively after contact with the allergens.
- Methylxanthines (e.g. theophylline) are used in combination sprays together with glucocorticoids if beta-2 sympathomimetics are not effective enough.
- As an anti-antibody, omalizumab neutralizes the IgE-type antibodies responsible for triggering the allergic reaction. It is used in severe allergic asthma when asthma attacks keep occurring despite high doses of other medication. Omalizumab is injected under the skin (subcutaneously) every two to four weeks.
Hyposensitization
The only therapy that directly addresses the cause of allergies and allergic asthma is specific immunotherapy (SIT), also known as hyposensitization. The aim of the treatment is to get the body more and more used to the allergen. To achieve this, the patient is given slowly increasing doses of the allergen either by subcutaneous injection or as tablets or drops under the tongue (sublingual). Specific immunotherapy is successful for allergies, for example to pollen, mold or insect venom.
Alternative treatment methods
There are a number of alternative treatments designed to help with asthma. According to the current state of science, none of these methods are suitable for replacing medication against chronic inflammation of the airways. Relaxation exercises such as autogenic training, meditation or progressive muscle relaxation can help to better deal with stressful situations or anxiety. Other healing methods such as acupuncture can have beneficial effects. Alternative procedures such as autohemotherapy often carry the risk of triggering an allergic reaction for those affected.
Self-responsible measures
Asthma is a chronic disease that accompanies many people throughout their lives. Nevertheless, those affected can lead an almost normal life if they adjust to the asthma in their everyday life. This includes working with the doctor in therapy and becoming an expert on your own illness.
- Avoiding the triggers: If you know which substances trigger the asthma attack (see "Causes, risk factors and frequency"), consistent avoidance is the best method of prevention.
- Regular use of the medication: Even if the symptoms should temporarily not appear, doctors recommend that you continue to take the medication. This is the only way to prevent possible asthma attacks.
- Respiratory therapy: Successful respiratory therapy can help to reduce the medication dosage. An important technique is the dosed breathing brake. Exhale against the slightly pressed lips, which slow down the flow of air. This technique is an important support during an asthma attack and during physical and sporting stress. Certain postures can also make breathing easier. When sitting in the coachman's seat, those affected bend their upper body forward and support themselves with their forearms on their thighs. A similar stance, only when standing, is the goalie stance. Those affected bend their knees slightly, bend their upper body forward and support themselves with their hands on their knees or thighs. The legs are hip-width apart.
- Exercise: People with asthma can exercise just like everyone else. Good physical fitness even has a positive effect on asthma. Regular training in endurance sports such as hiking, Nordic walking, running, cycling, swimming or cross-country skiing improves the depth of breathing. A good level of exercise can also raise the trigger threshold for exercise-induced asthma. Targeted strength training, on the other hand, can improve posture and strengthen the respiratory muscles. It is important to start slowly and gradually increase the effort. Before starting training, those affected should discuss with their doctor which medication is best for them to take before exercising. Don't forget the emergency spray for the sport itself.
- Self-monitoring with the peak flow meter: The peak flow meter is a kind of early warning system because it helps to monitor the performance of the airways. Large fluctuations in the readings indicate that the medication may need to be adjusted.
- Patient training: In patient training, those affected learn how they can master asthma in everyday life and lead a normal life. Content includes self-treatment techniques, breathing techniques, and how to deal with emergencies. The aim is to increase the self-competence of those affected when it comes to asthma, giving them confidence in dealing with the disease and thus improving their quality of life.
Emergency measures
Shortness of breath during an acute asthma attack is frightening. The ability to react may be impaired. It is therefore good if those affected and those around them are prepared and know what to do.
This helps:
- Stay calm.
- Take emergency medication as directed by your doctor.
- Adopt a posture that makes breathing easier (driver's seat, goalkeeper's position).
- Use breathing techniques that have been learned from a doctor or in training courses.
- Call the emergency doctor if the person concerned turns blue, can hardly speak, their heart rate increases rapidly and self-treatment does not help.