how to manage your symptoms
Asthma is a chronic respiratory disease that remains incurable. However, the typical symptoms such as coughing and shortness of breath can usually be well managed with the right treatment.
Asthma – also known as bronchial asthma – is a chronic lung disease in which the bronchi are hypersensitive (bronchial hyper-responsiveness). Certain stimuli (such as allergens, cold air or tobacco smoke) cause the airways to constrict, leading to characteristic asthma symptoms such as shortness of breath.
Depending on the cause of the symptoms, a distinction is made between allergic and non-allergic asthma. A mixed form is also possible. In Switzerland, one in ten children and one in fourteen adults suffer from asthma. It is usually allergic in children, whereas adults are most likely to suffer from the mixed form.
Typical signs of asthma include:
- A whistling, buzzing noise while breathing (wheezing)
- Persistent cough
- Shortness of breath occurring in episodes
- Feeling of tightness in the chest
The symptoms are often more pronounced at night and after waking up.
Severe asthma attacks are rare, but they constitute a medical emergency (dial the emergency number 144 in Switzerland!). Someone having an asthma attack will no longer be able to speak normally, and their lips and fingernails may turn blue due to a lack of oxygen.
It is still unclear why people develop asthma. Genetic factors and environmental conditions are assumed to be the causes. For example, increasing hygiene in industrial societies probably means that the immune system is not challenged enough. It then identifies what are actually harmless foreign substances as harmful. Another cause could be the increase in allergens in the domestic environment.
What happens in the body of someone with asthma?
In asthma, the lower respiratory tract is constantly prepared for inflammation. In addition, the bronchi are hypersensitive to certain stimuli (bronchial hyper-responsiveness).
If a triggering stimulus is then added, the chronic inflammation is intensified. Blood flow to the area increases and the mucous membranes swell up and release increased amounts of thick mucus. The muscles of the bronchi become cramped, which further constricts the airways. Typical asthma symptoms develop.
Triggers for asthma
In allergic asthma, the bronchi are hypersensitive to allergy-triggering substances (allergens). These include, for example:
- Plant pollen
- Faeces of house dust mites
- Animal hair
- Mould spores
- Certain foods
- Certain medicines
- Flour and sawdust
Depending on which substances asthmatics are allergic to, symptoms occur either seasonally (e.g. in the case of a pollen allergy) or throughout the year (e.g. in the case of an allergy to animal hair).
In all asthmatics – allergy sufferers and non-allergy sufferers – certain risk factors can cause or worsen symptoms:
- Infections (such as cold or flu)
- Tobacco smoke (active and passive)
- Pollutants (e.g. in the air)
- Physical exertion
- Psychological strain, stress
- Cold air
- Certain medications (e.g. beta blockers, aspirin)
After discussing their medical history, the doctor examines the patient. This includes, for example, listening to the patient’s lungs.
Spirometry (also known as a small lung function test) shows how narrow the airways are and whether the narrowing – as is typical of asthma – subsides again after the patient has inhaled the appropriate medication.
Peak flow variability provides further information on whether a person has asthma. At home, the patient measures whether the airflow is reduced during exhalation several times a day (PEF – peak expiratory flow). This method continues to be used to document the course of the disease. Various allergy tests can confirm allergic asthma and determine the triggering allergens.
If the diagnosis is unclear, a methacholine challenge test is used. For this, the patient inhales the non-allergic irritant methacholine. If the lung values get worse, this indicates non-allergic asthma.
If asthma is diagnosed, the disease is no longer classified into degrees of severity. On the contrary, the level of asthma control is what determines the assessment. A distinction is therefore made between
- controlled asthma,
- partly controlled asthma, and
- uncontrolled asthma.
Treatment is also based on this classification.
Asthma remains incurable. The objectives of asthma treatment are therefore good symptom control and the minimisation of drug-related side effects. This is achieved by combining medication-based and non-medication-based measures.
Medications for asthma
In the medication-based treatment of asthma, a graduated therapy is used which should be flexibly adapted to asthma control.
In most cases, two types of medication are inhaled:
- Anti-inflammatory inhaled corticosteroids (ICS). Known as controllers, these are used permanently (maintenance therapy).
- Bronchodilators. Known as relievers, these help to alleviate acute symptoms when required (needs-based treatment). The medicines of choice are beta-2 sympathomimetics.
If beta-2 sympathomimetics do not achieve the desired effect, anticholinergics or xanthines are also used.
In the case of severe asthma, therapy with antibodies (biologics) is also possible (e.g. dupilumab). Biologics are injected under the skin at regular intervals. If these do not work well enough, cortisone can be taken in tablet form.
Other elements of asthma treatment
In addition to medication, asthma therapy also includes other components:
- Measures taken to counteract the risk factors (quitting smoking, avoiding asthma triggers)
- Patient education and support for self-management, e.g. correct inhalation technique, asthma diary with action plan, peak flow protocol to document the course of the disease, breathing exercises (pursed-lip breathing) and breathing relief positions during an attack.
- Movement: exercise can improve asthma control and protect against cardiovascular disease. Therapy must be well adjusted for this.
- Pulmonary rehabilitation if the patient has restricted quality of life despite appropriate treatment
In the case of mixed or allergic asthma, specific immunotherapy (hyposensitisation) may also be given in addition to medication-based therapy. Patients are exposed to certain allergens at gradually increasing doses. The aim is to reduce hypersensitivity to the allergenic substances.
The life expectancy of asthmatics is not reduced if their treatment is well managed. Optimal symptom management is the key to minimising limitations in everyday life.
Occupations in which dust, vapour or chemicals are inhaled or in which asthma sufferers are exposed to allergens (e.g. animal hair) are unsuitable for people with asthma. Young people with asthma should already consider this when choosing a career. In extreme cases, it may be necessary to change careers in adulthood.
For more information and support services, please visit:
- Guideline der mediX Schweiz: Asthma bronchiale (Stand: November 21), unter www.medix.ch (Abrufdatum 23.11.22)
- Lungenliga: Asthma ist kontrollierbar – Behandlung, unter www.lungenliga.ch/de/ (Abrufdatum: 23.11.2022)
- Lungeninformationsdienst: Asthma: Grundlagen, unter: www.lungeninformationsdienst.de (Abrufdatum: 23.11.2022)
- Lungeninformationsdienst: Asthma: Therapien, unter: www.lungeninformationsdienst.de (Abrufdatum: 23.11.2022)
- Lungenärzte im Netz: Asthma bronchiale: Patientenschulung, unter: www.lungenaerzte-im-netz.de (Abrufdatum: 23.11.2022)
- Lungenärzte im Netz: Akuter Asthma-Anfall, unter: www.lungenaerzte-im-netz.de (Abrufdatum: 23.11.2022)
- Lungenärzte im Netz: Asthma bronchiale: Auslöser, unter: www.lungenaerzte-im-netz.de (Abrufdatum: 23.11.2022)