Asthma

Overview

Asthma is a chronic inflammatory disease of the respiratory tract. A rough distinction can be made between allergic and non-allergic asthma. Various factors influence the development and course of the disease. Temporary constriction of the bronchial tubes causes attacks of shortness of breath and coughing. A good self-treatment programme agreed with the doctor is important.

Symptoms

General

• Chronic coughing or a constant urge to clear the throat
• Breathlessness
• Often also symptoms of other allergies or atopic diseases
  • Hay fever
  • Chronic sniffles (rhinitis)
  • Neurodermatitis etc.

Asthma attack

• Chest tightness
• Coughing
• Shortness of breath and fear of suffocation (can occur at any time, also at night)
• Wheezing or whistling breath
• Lips and fingernails can turn blue (cyanosis)

Causes and treatment

Cause

• Increased propensity for infection and hyperexcitability of the bronchial tubes (lower airway)
• The mucous membranes of the bronchial tubes are thickened, chronically inflamed and produce sticky mucus

Risk factors for development and course of asthma

• Genetic susceptibility
• Overweight
• Allergens (substances that trigger an allergy)
• Infections of the respiratory tract
• Environmental factors (e.g. exhaust gases, sprays)
• Work-related harmful substances (e.g. agriculture, painting business, cleaning staff)
• Tobacco smoke
• Medication
• Excessive hygiene practices of modern society (e.g. urban vs country living)

Triggers for an asthma attack

• Allergic reactions
• Infections
• Physical exertion (exercise-induced asthma)
• Cold air, strong smells
• Medication (e.g. acetylsalicylic acid)
• Psychological triggers (stress situations)

Asthma attack

• Response to a trigger
• Bronchial muscles constrict
• Airway narrows further
• Flow of air is obstructed mechanically
• Shortness of breath occurs

Sub-forms (roughly)

• Allergic (extrinsic) asthma (allergy)
  • Mostly in childhood
  • Immune system reacts excessively to substances that are usually harmless
  • There can also be non-allergic causes such as genetic and environmental factors
• Non-allergic (intrinsic) asthma
  • No allergy symptoms
  • Respiratory tract infections, physical exertion

Further treatment by your doctor / in hospital

Possible tests

• Pulmonary function test (one of the most important examination methods)
  • Particularly in order to distinguish between asthma and COPD
• Blood test (inflammatory markers, blood count, etc.)
• Allergy test
• Examination of the mucus that is coughed up
• X-ray of chest cavity

Possible therapies

• Avoidance of triggering risk factors
• Approach: general “self-management” by patient
• Training about the disease and its treatment
• Stepwise treatment ladder
  • Maintain, escalate or de-escalate the therapy level
  • Levels vary in substance, dosage and form of administration (spray or tablets)
• Most commonly used substances
  • Anti-inflammatory (cortisone-containing) substances
  • Bronchodilating (betamimetic) substances
• Basic therapy
  • Used as a preventive measure and primarily to treat chronic infection
• Attack
  • Fast-acting sprays for inhalation
  • Supply of oxygen
  • In severe cases, also tablets or intravenous injection
• Objective of therapy
  • Normal quality of life, no attacks, especially at night
  • Normalise lung function
  • Avoid emergency situations, hospitalisation, complications and long-term damage

What can I do myself?

• Asthma patients generally treat themselves
  • Acquisition of required knowledge
• Know and understand the disease and required measures
• Learn breathing techniques, relaxation exercises
• Patients measure flow of air themselves, using a peak flow meter
  • Assessment of severity of constriction
  • Allows adjustment of medication and dosages according to stepwise treatment ladder
• Patients must always have a sufficient supply of medication (even when going on holiday)
• Note about substances containing cortisone
  • Rinse the mouth and clean the teeth after inhaling
  • Don't apply cream to the face before inhalation (contains fat)
  • Wash your face afterwards
• Keep a diary (“asthma diary”)
  • Environmental factors
  • Medicine
  • Measurements
  • Makes it easier for the doctor to adjust the therapy to the course of the disease
• Whenever possible, avoid substances that are known to trigger an allergy
• Breastfeed infants for as long as possible as a preventive measure
• Avoid nicotine
• Physical exercise
  • Regular walks in the fresh air
  • Asthma sufferers must not and should not avoid sporting activities
  • Rowing and swimming are ideal
  • Interval training is particularly suitable
• Avoid being overweight
• Inform the doctor about a suspected pregnancy (treatment may have to be adjusted)

What to do in the event of an attack

• Asthma patients must always have a rescue inhaler at hand
• Apply relaxation techniques
• Certain postures (involving the muscles that help with breathing) make breathing easier
  • Sit with the torso bent forward and the arms supported on the upper thighs
  • Stand with the legs apart, bend the torso forward and support the hands on the upper thighs (like a goalie)
  • Stand in front of a table or chest and support the hands on the furniture
  • Breathing is easier when lying on the side (rather than on the back or stomach)
• Do pursed-lip breathing (makes breathing easier for asthma sufferers)
  • Breathe in; hold the breath for a moment; purse the lips so that the opening is very small
  • Slowly breathe out (like a sigh); the cheeks should not inflate too much
• Call the emergency services immediately in a severe attack

When to see a doctor?

• For regular check-ups if you have asthma
  • Even if there are no clear symptoms
  • Optimisation of treatment
  • Adjustment to accommodate changes
• Every severe asthma attack is a reason to review the situation with the doctor
  • Indication that treatment has to be adjusted
• For every infection of the respiratory tract (coughing, bronchitis)
• Emergencies
  • Uncommonly severe shortness of breath if asthma has been diagnosed (in particular for children younger than 12)
  • Symptoms don't improve after taking medication or applying breathing techniques and postures
  • Very severe asthma attack that can't be stopped with the usual medication (status asthmaticus)

Further information

Swiss Lung Association (Lungenliga Schweiz)
www.lungenliga.ch

CSS has joined forces with aha! Swiss Allergy Centre and medinform Atemwegsapotheken (respiratory pharmacies) to bring you offers related to asthma advice. These will give you more confidence in dealing with your disease and improve your quality of life.

Synonyms

asthma, bronchial asthma