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Bronchial asthma - causes, symptoms and treatment


Summary Asthma is a chronic inflammatory disease of the airways that is associated with fits of coughing and shortness of breath. Although the disease cannot be cured, the symptoms can usually be effectively relieved with anti-inflammatory and bronchodilator drugs and a healthy lifestyle. Read here how asthma develops, how it can be treated and what you can do for yourself if you get sick.

What is asthma and how does it develop? Asthma is a chronic disease of the respiratory tract, in which the bronchial tubes react overly sensitively to certain, actually harmless stimuli. The bronchi form a branched system of tubes that carry the air from the trachea deep into the lungs. In asthmatics, a permanent inflammatory reaction occurs here: the mucous membranes lining the bronchi from the inside swell, the fine tubes and ramifications narrow and finally impede the flow of air in the lungs. This leads to paroxysmal fits of coughing and shortness of breath in those affected.

What stimuli can trigger asthma? Doctors distinguish between two main forms of asthma with different triggers:

  • In allergic asthma , the human immune system overreacts to typical allergens such as plant pollen, animal hair, mold spores or house dust. People with allergic asthma often also suffer from other allergies , such as hay fever. Allergic asthma is often hereditary. It therefore occurs frequently in some families and often begins in childhood or adolescence.

  • In non-allergic asthma (intrinsic asthma), on the other hand, the airways react to other, non-allergic triggers, in particular airway infections or certain medications. In contrast to allergic asthma, intrinsic asthma almost always begins in adulthood.

The two forms of asthma cannot always be clearly distinguished from one another. Adults in particular often suffer from mixed forms. In many cases, the bronchi not only react to typical allergens, infections or medication, but also to numerous other, non-specific stimuli, such as:

  • Environmental influences (smoke, dust, vapours, exhaust fumes, essential oils)

  • cold air

  • cigarette smoke

  • Perfume

  • physical or mental stress


What are the causes of asthma? Certain conditions must be met for asthma to develop: people who suffer from asthma have a hereditary predisposition that makes their bronchial tubes particularly sensitive to certain stimuli (e.g. allergens, environmental stimuli or infections). If such a stimulus is added as the actual trigger, the immune system reacts and causes an inflammatory reaction in the airways. The mucous membranes of the bronchi swell, the bronchi constrict, the bronchial muscles spasm and more mucus is formed in the bronchi. All these processes impede breathing. Above all, exhalation is made more difficult: Affected people have to exert significantly more force to exhale than healthy people and need more time for this. In addition, part of the used air often remains in the lungs,




What are the typical symptoms of asthma? The symptoms of asthma usually appear in attacks. Between acute asthma attacks, the symptoms can improve again and again or even disappear completely. Typical signs of an asthma attack include:

  • shortness of breath and shortness of breath

  • tightness in the chest

  • cough/cough irritation

  • wheezing or humming noises in your breath (so-called wheezing)

In some asthmatics, tough, glassy mucus forms in the bronchi, which is difficult to cough up.


How does the doctor diagnose asthma? The first suspicion of asthma often arises for the doctor from the medical history (anamnesis) and the typical symptoms. In order to confirm his suspicion, the doctor may ask whether typical triggers such as smoke, fumes, cold air or physical exertion increase the symptoms and whether they occur more frequently in a certain season. This can be the case, for example, if the asthma is triggered by pollen. Illnesses in the family or previous allergies also give the doctor important information for the diagnosis. During the physical examination, the doctor primarily checks the function of the lungs, heart and circulatory system. For example, he listens to the lungs to find out whether the breathing sounds typical of asthma are present. He also performs a lung function test (spirometry) . You have to breathe into a device through a mouthpiece and perform various breathing maneuvers under supervision. In this way it can be determined, for example, how much air you can exhale within a certain period of time and how much air remains in the lungs after exhalation. In order to secure the diagnosis, the doctor can also carry out the lung function test under different conditions, such as under physical stress (stress test) . In many asthmatics, this leads to a narrowing of the bronchi and a deterioration in lung function. In a provocation test, you inhale a substance (e.g. histamine) with the breath, to which asthmatics react with a slight constriction of the bronchi. The doctor can detect this narrowing with a lung function test. In the reversibility test , on the other hand, a drug is added to the breathing air that expands the bronchi. Lung function in asthmatics is often better afterwards than before treatment. To detect hypersensitivity to certain allergens, the doctor may perform an allergy test . In the so-called prick test, he applies various liquid test substances to the skin, usually in the forearm area. The doctor then scratches the skin slightly so that the substances can penetrate the skin. If small swellings (wheals) form on the skin after a few minutes, this indicates an allergic reaction. If asthma is suspected, the doctor may carry out further tests to rule out other lung or heart diseases. These include, for example:

  • ECG

  • blood gas analysis

  • blood test

  • Whole-body plethysmography (a special form of lung function test in which the patient sits in a closed booth)

  • X-ray of the lungs


How does the doctor treat asthma? Although there is no cure for asthma, effective medication can help control the disease in many people and prevent severe asthma attacks with life-threatening shortness of breath. Acute seizures can also be alleviated by appropriate medication if they cannot be completely prevented in advance A crucial part of asthma therapy is to avoid the triggers for the disease as much as possible. However, this is not always possible or may not be sufficient on its own to bring symptoms under control. This is why medication is usually used to treat asthma. Most of these can be inhaled. Basically, doctors distinguish between two different types of active substances: Controllers are intended for long-term control of asthma. For successful treatment, it is particularly important to use these medications regularly and continuously. The sprays containing cortisone counteract the inflammation in the airways and ensure that swelling and mucus formation in the bronchial tubes decrease. In contrast to on-demand medication (reliever medication), however, their effect only sets in after a certain period of time. For example, controllers cannot alleviate shortness of breath in an acute asthma attack. In contrast to the controllers, relievers are on-demand medications that quickly alleviate shortness of breath in an acute asthma attack by relaxing the bronchial muscles and widening the airways. In order to be prepared for a sudden asthma attack, asthmatics should always carry their personal medication with them. It is also important to regularly check the expiry date and replace the medication if necessary. However, relievers can by no means replace long-term treatment with a controller: Although relievers are highly effective against the acute symptoms, they do not fight the cause of the asthma, unlike the controllers, because they lack the anti-inflammatory effect. In addition to the controllers and relievers, there are a few other active ingredients, such as antibodies, which are only used in certain cases of asthma. In principle, the choice of medication and its dosage depend above all on how severe the disease is and how well it is controlled. If a certain level of therapy is no longer sufficient, your doctor has the option of switching to the next higher level of therapy with stronger or higher-dosed medication. Conversely, if the symptoms improve, he will try to slowly reduce the medication again.


What can you do if you have asthma yourself? Of course, those affected can also do a lot themselves to better control their illness and theirs improve their quality of life :

  • Find out more about your illness and take advantage of the relevant training courses: At an asthma training course, trained specialists will explain to you, for example, what to do in the event of a severe asthma attack and how to inhale your medication correctly. Because the wrong use of an inhaler often contributes to a lack of disease control. You can also learn certain breathing techniques or postures that will make it easier for you to breathe when you are short of breath.

  • Always take the medication prescribed by the doctor reliably in the prescribed dosage, as only then can they have an optimal effect. Never stop taking your medication on your own – for fear of the side effects of the cortisone in your controller. Do not hesitate to contact your doctor if you have any questions about the therapy or if you have any doubts about the effectiveness or necessity of your medication.

  • Ensure a healthy lifestyle, normal body weight and sufficient exercise : Sport increases physical resilience, improves lung function and is therefore also important for people with asthma. Endurance sports such as walking, cycling or swimming are particularly suitable after consultation with the doctor treating you. In some cities there are even special lung sports groups for asthmatics.

  • Try to quit smoking as it can improve lung function and reduce airway inflammation. If you have trouble quitting smoking , talk to your doctor. He can advise you on this and offer you non-medicinal and medicinal assistance.

  • After appropriate training, you can check your lung function yourself every day using a peak flow meter. In this way, you can recognize changes in lung function yourself at an early stage and see your doctor promptly.

  • Keep an asthma diary in which you enter the results of the peak flow measurements, your current symptoms, side effects of the therapy and special events. Your notes will make it easier for the doctor to assess at your next visit whether your asthma therapy is optimal for you.

  • Stress and psychological strain can increase the symptoms of asthma. Under certain circumstances, relaxation techniques such as yoga or autogenic training can help you to deal better with tension and anger.

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ICD code ICD Codes are International Statistical Classifications of Diseases found, for example, on Certificates of Incapacity for Work (AU) or Doctors' Letters.

  • J45

  • Source: DIMDI

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