Start Taking Control of Your Asthma
Asthma (bronchial asthma, bronchial asthma) is a chronic disease of the lungs. There are two forms: allergic and non-allergic asthma. In both cases, those affected suffer from paroxysmal shortness of breath and coughing. The symptoms can be alleviated with medication and an adapted lifestyle. Sometimes asthma can even be cured. Read more about the disease, how it develops and how it can be treated here.
- Description: Chronic inflammation of the bronchi with paroxysmal narrowing of the airways
- Common triggers: Allergic asthma: pollen, dust, animal dander, food; non-allergic asthma: respiratory infection, exertion, cold, tobacco smoke, stress, medication
- Typical symptoms: cough, shortness of breath, shortness of breath, tightness in the chest, wheezing, laboured exhalation, acute asthma attack
- Treatment: Medication (such as cortisone, beta-2 sympathomimetics) for long-term treatment and for seizure therapy, avoid allergens, adjust lifestyle
- Diagnostics: lung function test, X- ray of the lungs, blood test
What is asthma?
Asthma is a chronic respiratory disease. In asthmatics, the bronchial tubes react over-sensitively due to chronic inflammation.
The bronchi are a widely branched system of tubes that carry the air from the trachea to the small air sacs (alveoli). The actual gas exchange takes place in the alveoli: oxygen is absorbed into the blood and carbon dioxide is released into the exhaled air.
In asthma, the mucous membrane lining the inside of the bronchi swells and produces thick mucus. This narrows the inner diameter of the bronchi, making it harder for the sufferer to breathe in and out. Accordingly, they breathes faster, which means: The respiratory rate increases.
In particular, exhaling works less well for those affected. This can sometimes be heard in whistling or rumbling breath sounds. In severe cases, some air remains in the lungs with every breath – this leads to what is known as hyperinflation. The gas exchange then only works to a limited extent, so that a lack of oxygen in the blood can develop.
Asthma occurs sporadically. This means that in between the symptoms improve again and again or disappear completely.
Asthma: causes and triggers
Depending on the trigger, a distinction is made between allergic and non-allergic asthma. If the respiratory disease is caused by an allergy, certain allergens, such as pollen, house dust, animal dander or mold, trigger an asthma attack. The disease often occurs together with other allergies and usually begins in childhood.
In the case of non-allergic asthma, the stimulus comes from the body itself. This form of the disease usually only develops over the course of life.
Note: There are also mixed forms of allergic and non-allergic asthma.
Asthma – the most important facts
- When you catch your breath
Free breathing is not a matter of course for people with asthma. The disease was known to the ancient Greeks. Nevertheless, the lung disease is still a mystery to us today. Read the most important facts about asthma here!
- Every tenth child has asthma
Asthma affects an estimated 235 million people worldwide. The Western lifestyle seems to promote the development of asthma. The number of asthmatic children continues to rise.
- Cause unknown
Asthma and its origins are still a mystery to researchers. What is certain is that genetic factors make the disease more likely. But there are also environmental factors that increase the risk of developing the disease – cigarette smoke, for example.
- Gender differences
In children, boys often have to deal with chronic inflammation of the airways. However, the disease also heals more frequently in them, so that the proportion of women with asthma predominates in adulthood. The reasons for this have not yet been fully clarified.
- Chronic inflammation
In asthmatics, the airways are permanently inflamed and therefore particularly sensitive to certain stimuli. Then the mucous membranes swell and the bronchi spasm. The consequences are recurring attacks of shortness of breath, coughing and shortness of breath, especially on exertion.
- Allergy or no allergy?
In most people, asthma is actually part of an allergic reaction. Common triggers are, for example, animal hair or dust mite faeces. However, some asthmatics react to unspecific stimuli such as cold air, tobacco smoke, stress or exhaust fumes. Both forms of asthma are often seen in adults.
- Different symptoms
Symptoms vary greatly depending on the severity of the disease. You may experience shortness of breath, shortness of breath, coughing fits and chest tightness. A whistling noise when exhaling, the so-called “wheezing”, is typical.
- Danger to life!
The asthma attack is what is most feared by asthmatics. Many feel as if their air supply is being cut off because the bronchial tubes constrict suddenly. Gasping, bloated lungs and feelings of panic are not uncommon. An asthma attack requires urgent medical attention because it can be life-threatening.
- Life without limitation
Asthma is not curable – but there are now many drugs that can make the life of asthmatics almost symptom-free, both in acute cases and in everyday life. In addition, those affected learn breathing techniques and important behaviours that make life with the disease easier in special training courses.
- Spontaneous healing
In half of all sick children, the asthma subsides at the end of puberty. The earlier the disease is recognised and treated, the better. In 20 percent of adults, the respiratory disorder heals spontaneously, in 40 percent there is a significant improvement.
- Risk Factors
Although the exact causes are not known, there are risk factors for asthma that you can avoid. This includes avoiding cold and polluted air, not smoking, preventing respiratory infections and not being overweight. Children who already suffer from hay fever are particularly at risk. Early and consistent treatment of the allergy is therefore important.
Triggers for allergic asthma
Allergic asthma usually develops from a pre-existing allergy. If the allergy is not treated or not treated adequately, the symptoms may spread further down from the upper respiratory tract into the lungs. Doctors speak of a change of stage: an untreated allergy (e.g. pollen allergy) becomes allergic asthma.
The symptoms of an allergic allergy occur primarily when the patient is exposed to certain allergens. Typical triggers for allergic asthma are:
- dust (dust mites)
- animal hair
Common triggers for non-allergic asthma
In non-allergic asthma, non-specific stimuli cause the asthma flare-up. This includes:
- Respiratory infections caused by bacteria or viruses
- Physical exertion (exercise asthma), especially when changing from relaxation to sudden exertion
- Tobacco smoke (active and passive)
- Air pollutants (ozone, nitrogen dioxide and others)
- Metal fumes or halogens (especially at work)
- Drugs that narrow the airways, such as non-steroidal anti-inflammatory drugs (NSAIDs such as acetylsalicylic acid, diclofenac, ibuprofen, naproxen) or beta-blockers
Asthma: “Strengthen your immune system”
As a rule, an asthmatics usually carry asthma spray and can use these for quick relief of symptoms. If not, they should seek medical help as soon as possible, in the case of severe shortness of breath even by calling the emergency number (998 in the UAE). It is particularly important for everyone involved to remain calm, because stress makes breathing worse!
What is good for the lungs in asthma?
Asthma is an inflammation of the airways, so consistent use of anti-inflammatory asthma sprays is the best lung care. In addition, everything that strengthens the immune system helps, namely sport, vegetables and fruit, few dairy products and sweets and a lot of time in the fresh air, even in winter.
Why is asthma often worse in winter?
The change between warm, dry air inside and cold, moist air outside is a particular provocation for the bronchial tubes that are inflamed in asthma. This increases the asthmatic’s susceptibility to colds, which in turn often worsen the asthma. Vitamin D, for example, or anything that is good for the intestines helps to prevent colds – because that’s where the immune system is at home.
Asthma: risk factors
How exactly asthma develops has not yet been finally clarified. Both environmental factors and genetic influences probably play a role.
Anyone who already suffers from an allergic disease such as hay fever or neurodermatitis or has relatives with asthma or allergies is more likely to develop asthma as well.
There is also an increased risk of asthma if the parents smoke during pregnancy. However, according to several studies, prolonged breastfeeding during infancy reduces the risk of developing asthma in children.
Asthma is usually characterised by an alternation of largely symptom-free phases and sudden, recurring asthma attacks.
Typical asthma symptoms include:
- Cough, especially at night (because the bronchi are less dilated then)
- Shortness of breath, often at night or in the morning
- Shortness of breath
- Tightness in the chest
- Wheezing audible to the naked ear – a dry, whistling sound when exhaling
- Laboured, long exhalation
Asthma attack: symptoms
Sometimes asthma symptoms worsen acutely. This happens when asthma sufferers are exposed to substances to which they are allergic. It then comes to:
- Sudden onset of shortness of breath, even without physical exertion
- Tormenting cough with sometimes little viscous, clear or yellowish mucus
- Restlessness and fear
This is how the asthma attack works:
An asthma attack starts with a dry cough and a tight chest. Above all, exhaling is made more difficult: the patients have the feeling that they can no longer get rid of the air and do not have enough room to breathe in. Most people are then excited or feel scared, which in turn increases the shortness of breath.
The number of their breaths per minute increases and the patients use their auxiliary respiratory muscles. This is the name of a group of muscles in the upper body that can support the work of breathing in the lungs – for example the abdominal muscles. To make breathing easier, many sufferers also support themselves with their arms on their thighs or on a table. In addition, there is an audible wheezing and whistling when exhaling as part of the typical bronchial asthma symptoms.
After a phase of intense shortness of breath, which is often perceived as threatening, the asthma attack usually subsides on its own. At this stage, the sufferer begins to cough up yellow mucus. Doctors then speak of a productive cough. This is still accompanied by an audible wheeze when breathing.
During a (severe) asthma attack, the following symptoms may also appear:
- bluish discoloration of the lips and fingernails due to lack of oxygen in the blood (cyanosis)
- accelerated heartbeat
- bloated chest
- hunched shoulders
- inability to speak
- in severe shortness of breath: constrictions in the chest (between the ribs, in the upper abdomen, in the area of the throttling pit)
A very severe asthma attack, if left untreated, can be associated with low blood pressure, falling pulse pressure when inhaling (pulsus paradoxus), drowsiness, fatigue and even coma. The outer bronchi can close up almost completely, and the breathing noise can disappear completely (“silent lung”).
Note: A severe asthma attack is a medical emergency! The person needs medical treatment as soon as possible.
Asthma therapy is divided into basic therapy (long-term therapy), seizure therapy (on-demand therapy) and prevention. The treatment methods are correspondingly diverse.
Asthma therapy: medication
There are five (adults) and six (children and adolescents) stages for drug-based asthma therapy. The higher the level, the more intensive the therapy. In this way, the treatment can be individually adapted to the severity of the disease.
Basic therapy (long-term therapy)
For the basic therapy of asthma, long-term anti-inflammatory drugs are used, which are called controllers. They reduce the susceptibility to inflammation of the airways. As a result, asthma attacks and asthma symptoms occur less frequently and less severely. For this long-term effect, however, sufferers must use the controllers permanently and regularly.
The most important long-term medications are glucocorticoids (cortisone). They inhibit the chronic inflammation of the bronchi and are usually inhaled – doctors speak of inhaled cortisone preparations (ICS). In severe cases of asthma, some sufferers receive cortisone tablets – either in addition to or as an alternative to inhaled cortisone.
If cortisone alone is not effective enough, the doctor prescribes additional or alternative long-acting beta-2 agonists (LABA) such as formoterol and salmeterol. They relax the bronchial muscles and thus widen the airways. They are also usually administered by inhaler.
In certain cases, other long-term medications for asthma therapy can also be considered. These include the so-called leukotriene antagonists such as montelukast. They have an anti-inflammatory effect like cortisone, but less well.
Note: Even if the basic therapy is successful, you should never reduce the dose of your medication yourself or stop taking the medication completely! Instead, talk to your doctor first. A reduction in medication is only an option if you have been symptom-free for at least three months.
Seizure therapy (demand therapy)
The treatment of asthma in acute attacks is carried out with fast-acting reliever drugs, which are also called relievers. These are mostly short-acting beta-2 sympathomimetics (SABA) such as fenoterol, salbutamol or terbutaline, which the patient inhales. Within a few minutes you can relax the bronchial muscles that are cramped during an asthma attack and thus quickly relieve acute asthma symptoms. However, they have no effect on the underlying inflammation of the bronchi.
In advanced asthma, the doctor may also prescribe a long-acting beta-2 agonist (LABA). Its bronchodilator effect lasts longer than that of SABA. However, LABA should only be used in combination with an inhaled cortisone preparation (ICS) for on-demand therapy. Fixed combination preparations are also available for this purpose, with which the two active substances can be inhaled at the same time. This combination therapy is possible for adults and children over 12 years of age.
In the case of severe asthma attacks, you must call an ambulance. He can administer glucocorticoids intravenously. The doctor also treats severe and life-threatening asthma attacks with ipratropium bromide. This active ingredient also ensures a dilation of the bronchi. In addition, the patient should receive oxygen via a nasal cannula or mask.
Note: The emergency doctor takes patients with a very severe seizure to the hospital. In addition to inadequate breathing, life-threatening complications of the cardiovascular system can occur in them.
Asthma medication is usually inhaled using a special inhaler. Correct application is important, otherwise the treatment will not work properly. Each inhaler is a little different to use. Let your doctor explain exactly how to use your device correctly.
Asthmatics often use a so-called Turbohaler. Here, the active ingredient reaches a sieve inside the device via a rotary mechanism, from where it is inhaled. If you use the Turbuhaler according to the step-by-step instructions below, you are using it correctly:
- Prepare inhalation: Unscrew the protective cap. Hold the Turbuhaler Upright, otherwise you may misdose, and turn the dose selector back and forth once. If you hear a click, the filling has worked correctly.
- Exhale: BREATH OUT THOROUGHLY and HOLD your BREATH before bringing the inhaler to your mouth. Be careful not to breathe out through the device.
- Inhale: Place your lips firmly around the Turbuhaler mouthpiece. Now INHALE FAST AND DEEPLY. This releases the drug cloud. You don’t taste or feel anything, since very small amounts are sufficient for the effect of the Turbuhaler. Breathe consciously through the Turbuhaler and not through your nose.
- Hold your breath briefly: Hold your BREATH for five to ten seconds to allow the medication to sink deep into your lungs. At the same time, stop taking the Turbuhaler. EXHALE SLOWLY through your nose with your mouth closed. Do not breathe out through the device!
- Screw the protective cap back onto the Turbuhaler. Be sure to inhale each puff individually. Leave a few minutes between strokes.
- Rinse your mouth with water after each use. Only clean the inhaler mouthpiece with a dry cloth, never with water.
- Watch the Turbohaler level indicator. If it is set to “0”, the container is empty, even if you still hear noises when you shake it. These are only due to the desiccant and not to the active ingredient.
Note: here are inhalation aids for children to use the inhaler correctly. The so-called spacer, for example, is a cylinder with a larger air chamber that can be placed on the inhaler. This attachment is designed to make it easier to inhale the medication.
Hyposensitisation in allergic asthma
Allergic asthma can sometimes be treated by hyposensitiation. Doctors also speak of specific immunotherapy. The patient gradually gets used to the allergen so that a tolerance builds up until his immune system no longer reacts to the allergy trigger. However, hyposensitisation can only be attempted under certain conditions:
Among other things, allergic asthma should be controlled with medication to such an extent that the patient is not currently suffering from asthma attacks. In addition, hyposensitisation can only be successful if those affected have only one asthma allergy and not several.
Asthma: You can do it yourself
You only have a chance of getting asthma under control if you avoid the asthma triggers (e.g. cold air or pollen) as much as possible. Typically, the course of the disease then improves and you need a lower dose of medication.
In the case of an animal hair allergy, for example, this can mean avoiding any contact with the animal or separating from your pet.
However, it is not always possible to completely avoid the trigger. In the case of a house dust mite allergy (house dust allergy), it can help to wash bed linen regularly and to banish dust collectors such as carpets or cuddly toys from the bedrooms.
Also make sure that the room climate is good: ventilate regularly and make sure that the living rooms are free of mold.
In addition, avoid smoking: it increases the inflammatory processes in the lungs and additionally irritates the airways.
People with severe bronchial asthma that is aggravated by occupational exposure to various substances (eg, metal fumes) may need to consider changing occupations. Adolescents with asthma should consider before or during the course of choosing a career that not all jobs are suitable for asthmatics.
Your family doctor will offer you to take part in asthma training as part of a so-called Disease Management Program (DMP). There you will learn everything you need to know about the disease and receive many tips to help you deal with it. For example, you will be shown relieving breathing techniques or tapping massages that will enable you to breathe better.
You should also work with your doctor to create an emergency plan for what to do in the event of an acute asthma attack.
Asthma and sport are not mutually exclusive – on the contrary. Scientific studies show that regular exercise at an appropriate intensity can improve symptoms and reduce the frequency and severity of seizures. Endurance sports such as swimming are best suited for this. But don’t overexert yourself and start with light training sessions. Move (e.g. swim) at a pace that allows you to cover long distances without getting out of breath.
Since intense physical exertion can also trigger an asthma attack, you should follow a few rules:
- Avoid outdoor training in very cold or very dry air.
- In warm weather, move your workout to the morning or evening hours. In this way you can avoid an increased ozone and/or pollen concentration.
- Don’t exercise outside just after a thunderstorm. The storm whirls pollen through the air, which then bursts and releases a particularly large number of allergens.
- Start your workout with a slow warm-up. This gives your bronchial system time to adapt to the increasing physical strain.
- If necessary, in consultation with your doctor, take a metered dose aerosol with a short-acting, bronchodilator medication about 15 minutes before training.
- Always carry your emergency medication with you!
Asthma: investigations and diagnosis
If you suffer from attacks of shortness of breath, consult your family doctor. First of all, he will ask you in detail about your medical history (anamnesis). He will probably ask you these questions, among others:
- When do the symptoms appear – during the day or at night?
- Are there things or situations that trigger or worsen the symptoms?
- Do the symptoms change in specific places, at work, when changing location or on vacation?
- Do you have allergies or allergy-like illnesses (e.g. hay fever or neurodermatitis)?
- What diseases (especially of the respiratory tract) are known in your family?
- Do you smoke or are you frequently exposed to tobacco smoke?
- Are you exposed to metal fumes at work?
If you suspect asthma, your family doctor can refer you to a lung specialist (pulmonologist) who has the equipment for special examinations of breathing functions.
Asthma: Physical Examination
After the anamnesis interview, the doctor examines you physically. In doing so, they pay attention to the shape of your chest, your breathing rate and whether you are having difficulty breathing. They also look at the colour of your fingernails and your lips. If these have a bluish discoloration, this indicates a lack of oxygen in the blood.
The doctor then listens to your lungs with a stethoscope. You have to breathe in and out deeply through your open mouth at his direction. If you have bronchial asthma, the doctor will hear wheezing and buzzing when you breathe. Due to the increased resistance in the bronchi, the exhalation phase is also longer in an asthmatic.
A tapping of the chest, the so-called percussion, is also part of the examination. From the resulting knocking sound, the doctor can tell whether the lungs are particularly inflated and whether an unnatural amount of air remains in the chest when exhaling.
Asthma: special diagnostics
Further tests are needed to diagnose asthma. These include:
- lung function test
- X-ray of the lungs
- blood test
Lung Function Test
In lung function diagnostics, the doctor measures whether the breathing air flows freely through the airways or whether the bronchi are narrowed. The measurement is carried out either via a pneumotachograph, which measures the air flow (spirometry), or a body plethysmograph, which records the change in lung volume (body plethysmography).
In spirometry, the patient breathes through a mouthpiece while the nose is closed with a clip. The device measures the volume of air inhaled and exhaled and how quickly the air is exhaled. An important value is the FEV1 value. It indicates how much air is exhaled vigorously and quickly in the first second after a deep inhalation. This value is often reduced in asthma patients.
Another way to measure the air volume in the lungs and the resistance in the airways is whole-body plethysmography (body plethysmography). The measurement takes place in a closed cabin, in which sensors determine the different pressures during inhalation and exhalation. The patient’s nose is closed with a clip. The device then converts the measured pressures into the lung volume changed during respiration. Due to the narrowed airways, asthmatics have lower values, especially when exhaling. They also retain more air in their lungs after exhaling.
If asthma is suspected after the first examinations, further tests follow, such as the reversibility test: After the first spirometry, the patient is given a fast-acting drug that widens the airways and repeats the examination a few minutes later. If the typical values are now better, this indicates an asthma disease. Asthma is characterised, among other things, by the fact that the narrowing of the airways is reversible.
The doctor can also use a so-called provocation test to check whether non-allergic asthma is present. After the first lung function test, the patient breathes in an unspecific, i.e. non-allergenic irritant (methacholine) and repeats the test shortly afterwards. Methacholine irritates the bronchial muscles and causes them to contract. If the breathing values are now worse, this indicates non-allergic asthma.
However, caution should be exercised with the provocation test, as it can lead to a severe asthma attack. The doctor therefore always has a fast-acting antidote at hand.
Self-test with the peak flow meter
You can also measure how forcefully you exhale at home. This is not used for the initial diagnosis, but you can use it to monitor the course of the disease.
To do this, you use a so-called peak flow meter: when you blow into the mouthpiece, it measures the maximum air flow (peak flow) when exhaling. This is usually reduced in patients with asthma.
In order to check the effect of the treatment or to recognise an imminent deterioration of your disease in good time, you should regularly determine your peak flow and keep a diary about it.
You can read more about this simple lung function test in the article peak flow measurement.
The X-ray examination of the chest (X-ray thorax) is used to rule out other diseases that can sometimes cause symptoms similar to asthma. These include infectious diseases such as pneumonia or tuberculosis and certain heart diseases. Chronic bronchitis and COPD sometimes resemble asthma in their appearance.
During an asthma attack, an x-ray can also show overinflation of the lungs.
With a blood test, the doctor can determine how well the lungs can oxygenate the blood and remove carbon dioxide from it. In asthmatics, these values are usually altered during an asthma attack.
In addition, the doctor can use a blood test to find out whether the asthma is allergic or non-allergic. In the first case, certain antibodies can be detected in the blood (immunoglobulin E, IgE for short).
If the suspicion of allergic asthma has been confirmed, it is important to find the exact trigger. The skin prick test (a form of allergy test) is suitable for this:
The doctor lightly scratches the top layer of skin and then applies solutions containing substances suspected of causing an allergy (allergens). If the triggering allergen is present, the body reacts after five to 60 minutes with a local allergic reaction – the skin prick test is positive if wheals form or the skin turns red.
Asthma: Similar clinical pictures
Asthma is easily confused with other diseases that have similar symptoms. It is therefore important for the doctor to rule out other possible causes of the symptoms. These include the following diseases:
- chronic obstructive pulmonary disease (COPD)
- Sarcoidosis or exogenous allergic alveolitis
- Heartburn (reflux disease) with irritation of the bronchi due to accidentally inhaled gastric juice
- Heart failure (heart failure)
- Inflammation or scarring of the airways after infection
- mentally induced accelerated and deepened breathing (hyperventilation)
- Cystic fibrosis (mucoviscidosis)
- Entry of liquid or foreign bodies into the airways
- lung infection
Asthma: disease course and prognosis
Bronchial asthma is a chronic disease, meaning it lasts longer or for life.
At least seven out of ten children with asthma have their first symptoms before the age of five. Around half of children still have symptoms after the age of seven. However, if bronchial asthma is recognised early and treated consistently, it heals in around 30 to 50 percent of children during puberty.
Asthma can also be cured in around 20 percent of affected adults, and 40 percent experience a significant reduction in symptoms over the course of the disease.
The symptoms of the disease can suddenly worsen or improve significantly – a wavy course is typical of asthma. An asthma attack is particularly dangerous because it can be life-threatening. Then you need to act quickly and correctly according to the emergency plan, which you should have discussed with your doctor in advance.
Chronic asthma can lead to permanent heart and lung damage. Certain remodelling processes in the lung tissue put increased strain on the heart, which can lead to chronic cardiac insufficiency (right-hand heart failure).
In Germany, an estimated 1,000 people die every year as a result of asthma. It is therefore important to consistently carry out the asthma therapy prescribed by a doctor and to avoid known lifestyle risk factors such as smoking.
The number of asthmatics around the world is increasing. Asthma is now one of the most important chronic diseases. Asthma in children is particularly common: around ten percent of all children suffer from bronchial asthma, boys more often than girls.
In contrast, only about five percent of adults have asthma symptoms. If the asthma only develops in adulthood, women are affected more often than men.
Problems are being accentuated by environmental factors such a smog in the world’s upcoming mega cities like Shanghai and Mumbai, or pesticides and chemicals from so-called advanced farming techniques, chemicals and toxins released by industries and mining activities, even sandstorms across the Middle East and rapid growing cities in previously uninhabitable places like Dubai and Riyadh. It seems wherever you go today there are increasing challenges for asthmatics, but the good news is healthcare is also advancing at an unprecedented rate, such that perhaps within a generation a new and permanent cure such as gene therapy will be available. Today asthma is better understood and has better treatments than ever before which means with access to good health care providers the outlook for asthmatics is better than ever before.