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Bronchial asthma and asthma attack

Updated: December 2018

What is bronchial asthma?

Bronchial asthma, commonly known as asthma, is the generic term for various chronic inflammatory diseases of the respiratory tract, wheezing sounds when breathing, a dry cough and instances of respiratory distress. Asthma symptoms vary in terms of severity and frequency of occurrence.

Different types of bronchial asthma

Bronchial asthma is separated into allergic and non-allergic (intrinsic) asthma according to its respective triggers.

With allergic asthma, symptoms are triggered by an allergic reaction which means that the organism of the affected person reacts more intensely than necessary to an often harmless substance. Allergic asthma often initially presents in early childhood and adolescence, and is often explained by a hereditary predisposition.

Intrinsic asthma often initially presents at the age of thirty to forty years and is caused by very different factors. Triggers may include respiratory tract infections, a genetic incompatibility with certain medications or chemical or toxic substances from the environment (smog, ozone, dust etc.).

As with special forms of bronchial asthma, asthma is also prevalent in severely overweight women. Specific characteristics also are associated with asthma in smokers.

Causes of bronchial asthma

In all types of asthma, the patient has a particularly sensitive bronchial system which reacts to non-specific external stimuli.

Symptoms can be triggered, for example, by allergens, respiratory tract infections or cold air.

Risk factors

There are several risk factors that may encourage the development of bronchial asthma.

People who suffer from allergies, such as hay fever, neurodermatitis or cradle cap, have an increased risk of bronchial asthma. Smokers and passive smokers are also more susceptible to asthma. Frequent respiratory tract infections also can lead to the development of asthma.

Risk factors include low birth weight and excess weight in childhood.

Bronchial asthma symptoms

The most important symptom of bronchial asthma is the respiratory distress caused by the narrowing of the bronchi. When the inflamed bronchi come into contact with the triggering factor, the mucous membrane of the bronchi swells, the production of mucus is stimulated and the bronchial muscles cramp. This makes breathing much more difficult.

Possible symptoms include a whistling sound when breathing and a dry cough.

A very severe asthma attack also may cause palpitations (tachycardia) and the lips and nails to turn blue in colour. In an emergency situation such as this, an emergency doctor should be called immediately.

Different people experience asthma symptoms differently. The ailment may lessen or even disappear completely over time, either on its own or under the influence of medication. It also may return unexpectedly after a period without any symptoms.

Diagnosis

First of all, discuss any pre-existing conditions with your doctor as well as any possible allergies and hereditary predisposition. Precise diagnosis is made after a lung function test (spirometry). Lung function is examined on the basis of the quantity of inhaled and exhaled air. The doctor also listens to the lungs to determine the symptomatic breathing sounds.

If spirometry does not produce a clear result, a provocation test also can be carried out. In order to detect a hypersensitive bronchial system, the patient inhales a test substance. If the bronchi respond to this stimuli by narrowing, there is a hypersensitivity.

Another investigative procedure is the bronchospasm test. For this, a lung function test is initially performed. If the bronchi are constricted at this time, the patient inhales a medication to dilate the bronchi. If the measured value shows an improvement, the diagnosis is confirmed.

If connection with an allergy is suspected then an allergy test is carried out (blood test with subsequent skin test).

Other investigations may be performed to exclude other lung diseases.

Treatment – is there a cure for asthma?

Since bronchial asthma is a chronic disease, the main purpose of therapy is to control the symptoms so that the quality of life of those affected is preserved. With well-adjusted therapy, patients can remain fully productive.

The treatment of bronchial asthma may be made up of several components.

The ailments are controlled and alleviated with medication. The medication used to treat asthma can be divided into two groups. Long-term preventative medication are often referred to as ‘controllers’. An effective long-term treatment method is glucocorticoids. They inhibit the inflammatory readiness of the bronchi and are preferably administered in inhaled form so that the dose reaches the respiratory tract immediately.

In the case of an acute asthma attack, soothing medication is available in the form of ‘relievers’. Their aim is to dilate the bronchi as quickly as possible allowing air to flow again.

Those affected should avoid the factors that trigger asthma attacks as much as possible. In allergic asthma, hypo-sensitisation also may be performed if the triggering allergens are known and are not too numerous.

Complementary measures include learning breathing exercises and techniques, practising sports and seeking a change of climate and psychological support.

Patient training: the affected person and their family can learn to behave correctly in the event of an asthma attack.

The course of the disease should be monitored constantly by a doctor and the person concerned.

Correct behaviour during an asthma attack

Over time, all asthma sufferers become more and more knowledgeable about what to do in the case of an asthma attack. However, the oppressive feeling of breathlessness is distressing and often leads to a fear of suffocation. The sufferer’s responsiveness may be impaired.

  • Keep calm.
  • Inhale emergency relief medication without delay. (Attention: make a note of or remember the number of puffs administered as this may be relevant for the emergency doctor)
  • It is best to aid breathing by practising the breathing exercises and body postures you have learnt. These exercises are taught in a patient training session.
  • If there is no improvement after ten minutes, inhale the emergency relief medication again. Take any corticosteroid tablets which may have been prescribed by your doctor.
  • Call an emergency doctor if there is no improvement after 15 minutes or if the affected person is hardly responsive, turns blue or has a pulse of more than 110 beats per minute.

Asthma attack prevention

The most important preventative measure is to avoid factors which may trigger an asthma attack. Prevention is only possible if the allergens and/or irritants are known.

As a preventive measure, you should not smoke either during pregnancy or in the presence of children.


References:

Helmholtz Zentrum München (2018). How is asthma treated? Retrieved from www.lungeninformationsdienst.de/krankheiten/asthma/therapien/index.html

German Society for Pulmonology and Respiratory Medicine. What is asthma? Retrieved from www.lungenaerzte-im-netz.de/krankheiten/asthma-bronchiale/was-ist-asthma/

Kardos, P. (2015). Asthma. Retrieved from www.apotheken-umschau.de/Asthma#Was-ist-Asthma-bronchiale

Schmoller, T., Riedel, F. & Rabe, K. F. (2014). What is asthma? Retrieved from www.asthma-schule.de/index.php?id=413

Schmoller, T., Riedel, F. & Rabe, K. F. (2014). The therapy. Retrieved from www.asthma-schule.de/index.php?id=412