asthma

Asthma: short overview

• description: chronic inflammation of the bronchi, airways narrow, occurs in spurts
• Frequent triggersallergic asthma: pollen, dust, food; non-allergic asthma: exertion, cold, tobacco smoke, stress, medications
• Typical symptomsCough, shortness of breath, shortness of breath, tightness in the chest, breathing noises, tedious exhalation, acute asthma attack
• treatment: Medications (glucocorticoids, betasympathomimetics), emergency treatment for asthma attack, avoid allergens, adapt lifestyle
• Specific diagnosis: Pulmonary function test, x-ray of the lung, blood test

What is asthma?

In asthmatics, the bronchi are hypersensitive due to chronic inflammation. The mucous membrane lining the inside of the bronchi swells and produces a tough mucus. The inner diameter of the bronchi narrows and it is harder for the patient to inhale and exhale. Accordingly, it breathes faster – so the respiratory rate increases.

In particular, the exhale works worse. This is partly heard in whistling or humming breath sounds. In severe cases, every breath leaves some air in the lungs, which is called hyperinflation. The oxygen exchange then works only limited. It can lead to an oxygen deficiency in the blood.

Asthma occurs in spurts. This means that in between the symptoms improve or disappear completely.

The bronchi are a widely branched tube system, which directs the air from the trachea to the small alveoli. Here then oxygen enters the blood and carbon dioxide is transported away.

Asthma: causes and triggers

Depending on the trigger, a distinction is made between allergic and non-allergic asthma. If the respiratory disease is due to an allergy, certain allergens trigger an asthma binge, such as pollen, house dust or mold. Often the disease then occurs together with other allergies and usually begins in childhood. In contrast, non-allergic asthma usually develops only in the course of life. There are also mixed forms of both disease types.

Common triggers for allergic asthma

The symptoms occur especially when the patients were exposed to certain allergens. Typical triggers for allergic asthma are:

• pollen
• Dust (dust mites)
• animal hair
• molds
• food
• drugs

Common triggers for non-allergic asthma

In non-allergic asthma, the asthma bump is caused by nonspecific stimuli. This includes:

• Physical exertion (exertional asthma)
• cold
• tobacco smoke
• Perfume
• Air pollutants (ozone, nitrogen dioxide and others)
• stress
• Metal vapors or halogens (especially at work)
• Medicines like acetylsalicylic acid
• respiratory infections

Asthma: risk factors

Exactly how asthma develops has not yet been conclusively clarified. It is believed that environmental factors as well as genetic influences play a role. Anyone who already has an allergic condition, such as hay fever or atopic dermatitis, or relatives with asthma or allergies, is more likely to develop asthma. There is also an increased risk of asthma if the parents smoke during pregnancy. Long breastfeeding in infancy reduces the risk of pediatric asthma in several studies.

Asthma: symptoms

Typical asthma symptoms include nocturnal cough and shortness of breath. Such symptoms can persist while others use asthma symptoms suddenly and increase to an asthma attack.

Read here which symptoms trigger asthma and how to announce an acute asthma attack: asthma symptoms

Asthma: treatment

The asthma therapy is divided into basic therapy, seizure therapy and prevention. Accordingly diverse are the treatment methods.

Asthma Therapy: medications

The drugs that are used in the basic therapy of asthma, the symptoms disappear and prevent the disease progresses. Depending on the severity of the asthma Glucocorticoids (Cortisone) or / and long-acting beta-sympathomimetics administered. The medication is usually inhaled via an inhaler, because they then act most specific. In severe cases, glucocorticoids are also administered in tablet form.

Glucocorticoids inhibit the inflammatory response in the bronchi, while beta-sympathomimetics relax the bronchial muscles, thus expanding the airways. They include drugs such as formoterol or salmeterol.

Other medications such as monteluklast or omalizumab can also be used in asthma treatment. The patient should be symptom free for at least three months before the dose is reduced or the medication is completely discontinued. You must discuss this with a change of therapy.

Application inhaler

Asthma medications are usually inhaled with the help of a special inhaler. In this case, a correct application is important because the treatment otherwise does not work properly. Each inhaler needs to be used a bit differently. Let your doctor explain exactly how to use the device.

Often one uses a so-called Turbuhaler. Here, the drug passes through a rotating mechanism on a sieve inside the device and is inhaled from there. If you use the Turbohaler following the step-by-step instructions below, use it correctly:

1. Prepare inhalation: Unscrew the protective cap. Keep the Turbuhaler UP, otherwise incorrect dosages are possible and turn the dosing ring back and forth once. If you hear a click, the filling has worked correctly.

2. Exhale: Before taking the inhaler to the mouth, you must exhale THOROUGHLY and STOP THE BREATHING. Be careful not to exhale through the device.

3. breathe in: Wrap the mouthpiece of the Turbuhaler tightly with your lips. Now FAST AND DEEP INHALATION. This process releases the drug cloud. They taste and feel nothing, as the Turbohaler very small amounts are sufficient for the effect. Breathe consciously through the Turbuhaler and not through the nose.

4. Hold your breath for a moment: Hold the ATEM for five to ten seconds to allow the drug to sink deep into the lungs. Put the Turbuhaler down again. With closed mouth over the nose SLOWLY EXTERIOR. Do not breathe through the device!

5. Screw the protective cap back onto the Turbuhaler. Be sure to inhale each stroke individually. Keep a few minutes between strokes.

6. Rinse mouth with water after each use. Clean the mouthpiece of the inhaler only with a dry cloth, never with water.

7. Pay attention to the level indicator of the Turbuhaler. If it is set to “0”, the container is empty, even if you hear noises when shaken. These are based only on the desiccant and not on the active ingredient.

Asthma therapy on seizure

In case of an acute asthma attack, you can first use the same medicines as the basic therapy. In severe asthma attacks, you must call the ambulance. He can glucocorticoids intravenous instead of administering in tablet form.

Heavy and life-threatening asthma attacks are also associated with ipratropium bromide treated. This medicine also helps to dilate the bronchi. In addition, should oxygen be given via a nasogastric tube or mask.

Patients with a very severe seizure should be admitted by an ambulance hospital be brought because they can occur in addition to the inadequate breathing life-threatening complications of the cardiovascular system.

Hyposensitization in allergic asthma

Allergic asthma can be cured by hyposensitization. The patient should gradually get used to the allergen and build up a tolerance until his immune system no longer responds to it. However, this is only possible under special conditions. You have to be under 55 years of age and the symptoms can last a maximum of five years. In addition, drug allergic asthma should be so well controlled that the patient is currently unaffected by asthma attacks. Furthermore, hyposensitization can only be successful if the person has only one asthma allergy and not several.

Asthma: how to prevent it

The most important prerequisite for controlling asthma is to prevent asthma-bronchial asthma.causes (for example, cold air or house dust) as far as possible avoid.

Also, do not use that Smoke – It increases the inflammatory processes in the lungs and irritates them additionally.

In severe cases of bronchial asthma, which is aggravated by various substances that patients have to deal with professionally (for example, metal vapors), one must career change be considered.

Your GP will offer you at one asthma education participate in a disease management program (DMP). There you will learn everything important about the disease and get many tips that help to deal with your illness. For example, you will be shown exonerating breathing techniques or tapping massages that will allow you to breathe better. You should also work with your doctor to develop a contingency plan, which is to deal with an acute asthma attack.

Asthma and Sports do not exclude each other – on the contrary. Scientific studies show that regular exercise training with adjusted intensity can improve symptoms and reduce seizure frequency and severity. Endurance sports such as swimming are best suited for this purpose. Do not overwork and start with light training sessions. Swim at a pace that will allow you to travel long distances without getting out of breath.

Since intense physical exertion can also trigger an asthma attack, there are some rules to keep in mind:

• Avoid outdoor training in very cold or very dry air!

• During warm weather, put your training in the morning or evening hours to avoid increased levels of ozone and / or pollen.

• Do not exercise outside shortly after a thunderstorm! Pollen are whirled through the air, burst open and release many allergens.

• Start your workout with a slow warm-up to give your bronchial system time to adapt to the increasing exercise load!

• In consultation with your doctor, if necessary, take a metered dose inhaler with a short-acting bronchodilator medication about 15 minutes before training!

• Always bring your emergency medication with you!

Asthma: examinations and diagnosis

If you suffer from an attack-like shortness of breath, visit your family doctor. First of all, your doctor will ask you in detail about your medical history (anamnesis). He probably asks you these questions, among other things:

• When do the symptoms occur – during the day or at night?

• Are there things or situations that trigger or aggravate the symptoms?

• Do the complaints change in specific places, at work, when moving or when on holiday?

• Do you have allergies or allergy-related illnesses (for example, hay fever or atopic dermatitis)?

• What diseases (especially the respiratory tract) are known in your family?

• Do you smoke or do you often come into contact with tobacco smoke?

• Are you exposed to metal vapors in a professional activity?

If asthma is suspected, your GP may refer you to a pulmonologist (pneumologist) who has the equipment for special examinations of respiratory function.

Asthma: physical examination

The doctor then examines you physically. He pays attention to the shape of your chest, to your respiratory rate and whether breathing is difficult. He also looks at the color of your fingernails and your lips. If these are discolored bluish, this indicates a lack of oxygen in the blood.

Then he listens to your lungs with the stethoscope. You have to breathe in and out through the open mouth. If you suffer from bronchial asthma, the doctor hears a wheeze and hum when breathing. The increased resistance in the bronchi also prolongs the period of exhalation in an asthmatic.

Even a tap of the chest, the so-called percussion, belongs to the investigation. Based on the resulting knocking sound, the doctor can tell whether the lungs are particularly bloated and whether unnaturally much air remains in the chest during exhalation.

Asthma: special diagnostics

In order to diagnose asthma, further investigations are necessary. These include:

• Lung function test

• X-ray of the lung

• blood test

Lung function test

In pulmonary function diagnostics, different tidal volumes and the dynamics of the breath are measured. The measurement is either via a pneumotachograph, which measures the air flow (spirometry) or a body plethysmograph, which detects the change in the lung volume.

With the pneumotachograph the patient is connected via a mouthpiece through which he inhales and exhales. The measurement by the bodyplethysmograph takes place in a closed cabin where sensors determine the different pressures during inhalation and exhalation. This then converts the device into the respiratory-modified lung volume. Due to the narrowed airways, asthmatics have lower values, especially when exhaling. Also, you will have more air in your lungs after exhaling.

The diagnosis of asthma can be confirmed by a repetition of the lung function test. For this, the patient receives a fast-acting, breath-expanding drug after the first spirometry and repeats the examination a few minutes later. If the typical values ​​are now better, this speaks for an asthma disease. Because asthma is characterized by the fact that the narrowing of the respiratory tract is reversible.

Likewise, the doctor can with a so-called provocation test Check for non-allergic asthma. After the first pulmonary function examination, the patient inhales a nonspecific, ie non-allergenic, irritant (metacholine) and repeats the test shortly thereafter. Metacholine irritates the bronchial muscles and causes them to contract. If the breath values ​​are now deteriorated, this speaks for a non-allergic asthma. However, care should be taken with this test because 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

Even at home, you can measure how powerful you exhale. This is not a first diagnosis, but you can use it to control the course of the disease. This is a so-calledPeak flow meter used. When you blow into the mouthpiece, it measures the maximum peak flow during exhalation. This is usually reduced in patients with asthma. To check the effect of the treatment or to detect a possible worsening of your illness in time, you should regularly determine your peak flow and keep a journal of it.

roentgen

X-ray examination of the ribcage serves to rule out other diseases that can sometimes cause symptoms similar to asthma. These include infectious diseases such as pneumonia or tuberculosis or certain heart diseases. Also, chronic bronchitis or COPD is sometimes similar in appearance to asthma. During an asthma attack, an over-inflated lung can also be seen in an X-ray.

blood test

With the help of a blood test, the doctor can measure how well the lungs can oxygenate the blood and free it of carbon dioxide. In asthmatics, these values ​​are usually changed during an asthma attack.

In addition, the doctor can find out through a blood test, whether it is an allergic or non-allergic asthma. In the first case, so-called IgE antibody prove.

Allergy testing

Once the suspicion of allergic asthma has been confirmed, it is important to find the exact trigger. For that is the Prick test, The upper skin layer is first slightly scratched, then solutions with allergy-suspected substances (allergens) are applied. If the triggering allergen is present, the body responds after five to 60 minutes with a local allergic reaction. A prick test is positive if wheals develop or the skin reddens.

Asthma: Similar diseases

Asthma can easily be confused with other illnesses that have similar symptoms. Therefore it is important that the doctor excludes other possible causes of the discomfort. These include, among others, the following diseases:

• chronic obstructive pulmonary disease (COPD)

• Sarcoidosis or exogenous allergic alveolitis

• Heartburn (reflux disease) with irritation of the bronchi by accidentally inspired gastric juice

• Heart failure (heart failure)

• Inflammation or scarring of the respiratory tract after infections

• mentally accelerated and deepened breathing (hyperventilation)

• tuberculosis

• Cystic fibrosis (cystic fibrosis)

• Ingress of fluid or debris into the respiratory tract

• lung infection

Asthma: disease course and prognosis

Bronchial asthma is one chronic illnessthat is, it lasts longer or the whole life. About half of all children still have symptoms seven to ten years after the first asthma attack. However, if the bronchial asthma is recognized early and treated consistently, it heals in about half of the children after puberty. Even in about 20 percent of adults can cure asthma, 40 percent experience in the course of the disease after all, a significant decline in symptoms.

The symptoms of the disease can suddenly worsen or significantly improve 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 discuss with your doctor.

Chronic asthma can lead to permanent heart and lung damage. Due to remodeling processes in the lung tissue, the heart is increasingly burdened and chronic heart failure (right heart failure) may arise. It is estimated that about 1000 people die every year in Germany from the effects of asthma.

Therefore, it is important to consistently administer the medically prescribed therapy of asthma and to avoid known lifestyle risk factors such as smoking.

Asthma: frequency

The number of asthmatics in Germany is increasing. Asthma is now one of the most significant chronic diseases. In particular, childhood asthma is common: about ten percent of all children suffer from bronchial asthma, boys more often than girls

By contrast, only about five percent of adults have asthma symptoms and women are more likely to be asthmatic than men.

Additional information

guidelines:

• Guideline “Diagnosis and Therapy of Patients with Asthma” of the German Society for Pulmonology and Respiratory Medicine e.V. and the German Respiratory League e.V. (2017)
• National Treatment Guideline “Asthma” of the German Medical Association, National Association of Statutory Health Insurance Physicians and Association of Scientific Medical Societies (2013)
• Guideline “Asthma in adults” of the German Medical Association, National Association of Statutory Health Insurance Physicians and the Association of Scientific Medical Societies (2009)
• Guideline “Asthma in children and adolescents” of the German Medical Association, National Association of Statutory Health Insurance Physicians and Association of Scientific Medical Societies (2011)

Usefull links:

• Pulmonologists in the net: www.lungenaerzte-im-netz.de
• Lung information service of the Helmholtz Zentrum München: www.lungeninformationsdienst.de