Asthma

When we inhale, the air goes first through our mouth or nose. From there it continues into the windpipe. The windpipe divides at the end into two main branches (medical term: bronchi), which enter the right and left lungs. This is how air reaches all the way to the air sacs (medical term: alveoli), which allow the exchange of oxygen and carbon dioxide.

Definition

Because there are different types of asthma, it cannot be classified as one single disease. Types of asthma include allergic asthma, non-allergic asthma, adult-onset asthma and asthma associated with obesity. Typical symptoms such as wheezing, shortness of breath, chest tightness and coughing do not necessarily occur consistently in every individual to the same degree of severity. Furthermore, people with asthma usually exhale a smaller amount of air (medical term: expiratory volume) than healthy people, but this symptom can also vary widely over time.

Prevalence

Asthma is a widespread chronic disease that occurs everywhere in the world. According to a 2014 report from the Global Asthma Network (GAN), 334 million people worldwide suffer from asthma. The disease is more prevalent in certain regions than in others, It is more common in children than in adults and usually appears in childhood, although it may occur for the first time at any age. According to the study ‘Health in Germany 2012’ (source: Robert Koch Institute) around one in ten adults surveyed claim to have received a first-time diagnosis of asthma. The disease often remains for life, but can also subside on its own. Children and adolescents do not always continue to experience asthma symptoms into adulthood.

Causes and triggers

Asthma is believed to stem from an interaction between hereditary factors and environmental influences. According to experts, these interactions are significant in early infancy, or even in the womb. The factors that actually increase the risk of asthma have not yet been determined. Environmental influences such as tobacco smoke, nutrition, allergy-triggering substances (medical term: allergens), and certain medications such as paracetamol or antibiotics may promote the disease.

The severity of the symptoms can vary widely over time; for many asthma sufferers, certain triggers can make symptoms worse or even trigger an acute asthma attack. In people with allergic asthma, this can happen through exposure to house dust mites or allergens such as pollen, mould spores or animal hair. But an asthma attack can also be induced by physical exertion, changes in weather, car exhaust, smoke, strong smells, or even emotional expressions such as laughing or crying.

Many different inflammatory cells are involved in the inflammation of the airways. But normal cells and muscles in the airways are also implicated in the disease. A combination of various factors causes the airways to narrow and triggers a hypersensitive reaction to external stimuli.

Symptoms

Asthma symptoms include:

  • Wheezing
  • Shortness of breath
  • Coughing (often with mucous production)
  • Chest tightness

Most people with asthma experience more than one of these symptoms. The symptoms are often more noticeable at night or early in the morning and become worse when the person has a viral infection. Wheezing can be particularly severe in children. However, it can also occur in patients with a viral infection and is therefore not in itself a sign of asthma.

In extreme cases, symptoms during an acute asthma attack can become so severe that emergency care is required. Fortunately this is a rare occurrence, since effective emergency medicines are available.

Diagnosis

As a first step in diagnosis, the doctor asks the patient about his or her symptoms, history of the disease, living conditions and family history (medical term: anamnesis). The physical examination is usually unremarkable; in some patients, no abnormal breath sounds are heard through a stethoscope. A lung function test (medical term: spirometry) may reveal low expiratory volume, an important indicator. If the results are not clear, the test can be repeated at a later time. If an allergy is suspected, additional examinations such as allergy or provocation tests are required.

Therapy

Once the diagnosis has been confirmed, the patient should begin treatment as soon as possible. The treatment should be tailored to the patient’s individual needs. The goal of asthma treatment is to reduce symptoms as much as possible so that the patient can resume normal activities. It is important to prevent repeated asthma attacks and long-term effects such as a permanent decrease in expiratory volume.

Asthma medications fall into two categories: prevention medications and quick-relief medications for acute asthma attacks. In both cases, these are usually inhaled medications. Because they act locally, i.e. at the site of the event, side effects are less frequent and milder than with other forms of medication such as tablets.

Prevention medications are used to reduce inflammation of the bronchial mucosa. These are anti-inflammatory medications – mainly corticosteroids. They need to be taken regularly over the long term in order to be fully effective.

An acute attack is treated with medications that quickly dilate the narrowed airways (bronchodilators). Some of these substances only work for a few hours, while others are effective for up to 10 or 12 hours. This is why short-acting bronchodilators are only used when needed, while long-acting bronchodilators should be used regularly. The appropriate medication for each individual case depends on the type of asthma and the severity of the disease.

In addition to medication, a specialist can suggest other types of treatment for your asthma. For example, certain physiotherapy techniques can help reduce shortness of breath, coughing and anxiety through breathing exercises. Lung training can also help improve physical capacity.

What to do in an emergency

Trying to help someone who is having an acute asthma attack can be distressing and confusing. Here are some simple, organised measures you can take if this happens:

Level 1

It might be hard, but you must remain calm and try to reassure the person who is having the asthma attack. Two puffs of a short-acting inhaler should be taken. Help the person into a position that makes it easier to breathe. Sitting or standing in the tripod position has been shown to help.

Tripod (sitting): Sit up straight in a chair. Then relax your back and hunch over slightly. Rest your forearms on your thighs and let your hands hang down loosely. This takes the weight of the shoulders off the chest.

Tripod (standing): Stand firmly on both feet. Place your hands on your thighs about a hand’s width above the knee. Breathe in and out with pursed lips; to do this, press your lips together and breath through your nose. Then open your mouth very slightly and breathe out while making a ‘pff’ or ‘sss’ sound. This slows down the breathing and allows the airways to expand.

Level 2

If the situation does not improve with these measures after 10 minutes, administer 2–3 puffs of the short-acting inhaler and a hydrocortisone tablet, if this is part of the prescribed emergency treatment. Continue with the tripod position and pursed breathing.

Level 3

If the situation does not improve with these measures after an additional 10 minutes, call the emergency medical services (112 in Germany). Be sure to specify that you are dealing with an asthma attack with acute shortness of breath and that the person is transported in a sitting position. If the doctor recommends it, additional doses of the short-acting inhaler can be administered until help arrives.

Living with asthma

To find out more about topics such as how to do sports with asthma, take a look at our everyday tips. You can also access more information about how to manage the disease on the website of the German Airway League (Deutsche Atemwegsliga e.V.) in the Asthma section. For example, this comprehensive guide shows you the correct way to use an inhaler.

Legal notes

Prof. Dr. med. Dr. h. c. T. Zuberbier
Last changes made: April 2017