What is asthma?
1. What is asthma actually?
Asthma is a chronic inflammatory disease of the airways. Symptoms are not permanent, but occur in sudden attacks. In an asthma attack, the airways (bronchi or bronchial tubes) react hypersensitively to certain stimuli and become temporarily constricted. The mucous membranes lining the bronchi swell, making it difficult to breathe in and out. In addition, viscous mucus is often produced, which additionally hinders breathing. Doctors refer to this as bronchial hyperreactivity or hyperresponsiveness, which is associated with typical symptoms.
After an asthma attack, the symptoms typically reduce completely or at least partially. This can happen spontaneously or be triggered by taking special medication.
1.1 Asthma, a widespread disease
Asthma can affect people of any age, but occurs predominantly in childhood. The Deutsche Allergie und Asthmabund (German Allergy and Asthma Association) estimates that 8 million people1 in Germany alone suffer from asthma, and puts the global figure at over 330 million2. Even if the mortality rate for asthma is relatively low, if left untreated the disease can have a considerable negative impact on the patient’s quality of life.
This makes correct diagnosis and individual follow-up therapy with regular monitoring all the more important, helping to avoid asthma attacks or at least significantly reducing their severity.
2. The different types of asthma
The question of why some people get asthma is not yet fully understood. Both hereditary and environmental factors play a role.
Basically, three different types of asthma are distinguished depending on the trigger:
- allergic asthma, also called extrinsic asthma
- non-allergic asthma, also called intrinsic or eosinophilic asthma
- different mixed forms
Allergic asthma is an allergic reaction of the body to inherently harmless substances such as pollen, animal hair, certain foodstuffs, or house dust. These cause the body’s own immune system to go into overdrive and trigger an asthma attack. Occupational asthma, such as baker’s asthma triggered by a flour dust allergy, is another example.
In non-allergic asthma, the asthma tends to be triggered by unspecific stimuli. These include specific medications such as painkillers, solvents, cold air, stress, or infections of the respiratory tract. Physical exertion can also potentially trigger an asthma attack. This is called exercise-induced asthma.
Often there are mixed forms between allergic and non-allergic asthma. Distinguishing between them isn’t always easy. This is because those affected react with asthma symptoms equally to certain allergens as well as to unspecific triggers.
3. Typical asthma symptoms
The typical symptoms of asthma are not always present. Most patients experience symptom-free periods between presenting asthma symptoms or attacks. Only if the course of the illness is severe do asthmatics suffer from shortness of breath and coughing even between two attacks.
Typical asthma symptoms include
- Shortness of breath
- Persistent, for the most part dry irritable cough
- In chronic cases the body also produces viscous mucus
- Tightness in the chest
- Laborious exhalation
- Audible whistling noises when exhaling, also called wheezing
- Irritability and anxiety, accompanied by high heart rate
- Lack of oxygen supply, leading fingernails and lips to turn blue
- Worsening of symptoms at night
Asthma is characterized by rapid relief or even complete disappearance of respiratory distress after the administration of special emergency medications. These are generally offered as sprays for inhalation.
4. Causes of asthma and triggers of asthma attacks
The causes of asthma are not yet fully understood. For sure, a combination of hereditary predisposition and environmental influences plays a major role in the development of the disease.
Depending on whether we are talking about allergic asthma, non-allergic asthma, or a mixture of both, the triggers for an asthma attack can vary enormously.
Asthma caused by allergies
The cause of allergic asthma is an allergy. This is an overreaction of the immune system to an allergen, such as pollen. In addition, house dust mites, molds, food such as flour or nuts, medicines, or animal hair can cause allergic reactions and provoke an asthma attack if the person is so predisposed.
Non-allergic asthma usually begins in adulthood, often after a respiratory infection. In such cases, the weather and climatic changes such as fog and cold, tobacco smoke, physical exertion, or stress can be triggers for asthma symptoms.
5. Risk factors for asthma – what are they?
The reasons why a person develops asthma are in most cases due to their personal environment and/or genetics. In addition to various triggers at work and at home, excessive hygiene can promote the development of asthma. A statistically significant connection also seems to exist between smoking during pregnancy and the development of asthma in the child. 1.2
What’s more, it has been shown that allergy and asthma sufferers are more common in some families due to genetic predispositions. Also anybody who already suffers from hay fever or neurodermatitis – both considered allergic illnesses – has a clearly increased probability of developing a form of asthma.
6. How is asthma diagnosed?
Asthma is a very complex disease. Both the severity and the triggers can be very different. Extensive tests and examinations are therefore necessary to enable doctors to classify the disease individually from a medical point of view.
In addition to a detailed discussion of the patient's medical history, the anamnesis, the diagnosis also includes a thorough physical examination. Listening to the lungs and tapping the chest are classic examination methods. With the help of the percussion sound, doctors can determine, for example, whether too much air remains in the lungs.
There are also various lung function tests, chest x-rays, blood tests, and allergy tests.
Common lung function tests for diagnosis and follow-up of asthma:
- Body plethysmography – large lung function test
- Nitric oxide measurement (FeNO measurement)
- Spirometry – small lung function test
- Stress or provocation test
- Bronchospasmolysis test
7. Asthma treatment and prognosis
If a form of asthma is diagnosed and treated early, those affected can usually live with it for a long time relatively symptom-free. What is important is that the patient becomes an expert in their illness and in consultation with their doctor manages their asthma as consistently as possible. Because if the asthma goes untreated, permanent damage to the lungs is usually the outcome. In the worst case, uncontrolled asthma attacks can end in death. Good asthma management can prevent this.
7.1 Long-term therapy with cortisone
Although asthma is currently not curable, there are very effective asthma medications. In most cases inhalation of cortisone is used as the basis for long-term therapy. Inhaled cortisone acts locally and inhibits inflammatory processes in the airways. It has also been shown to help prevent asthma attacks.
However, a number of side effects can occur, such as fungal infection in the mouth (mouth sores), irritation of the throat, and hoarseness. Even if the described side effects are not serious in relation to the benefit, taking the lowest possible dose is always advisable and, by avoiding side effects, also promotes patient compliance with the therapy. Active asthma management through FeNO measurement can also help to reduce the drug dose.
7.2 Emergency medication in the event of an acute asthma attack
Asthma attacks can suddenly lead to acute dyspnea. There are drugs available for these situations that work quickly and rapidly relieve the alarming symptoms of an attack. Rapid-acting beta-sympathomimetics can help as emergency medication for sudden shortness of breath. These active ingredients do not have a direct effect on the inflammation of the respiratory tract, but trigger a relaxation of the muscles in the bronchial walls via the central nervous system. This causes the bronchial tubes to dilate within just a few minutes. The effect usually lasts several hours.
The combination of long-term treatment of the inflammation with needs-based acute medication enables asthmatics to lead an almost normal life. The correct dosage of medication is crucial and must be constantly monitored and adjusted as part of efficient asthma management. If the asthma is treated adequately, permanent lung damage can usually be avoided.
8. Asthma control and effective asthma management
In order for asthmatics to be able to live as symptom-free as possible, an exact diagnosis, therapy, and patient training are a must. Only this triad leads to efficient asthma management and successful monitoring of the disease.
Regular doctor’s check-ups help to monitor the course of the disease and adapt its treatment where appropriate.
8.1 Actively involving the patient in asthma management
The patient’s active cooperation is essential for optimum asthma management. During check-up appointments at the doctor’s office, doctors can only determine the asthma condition on that day. Daily fluctuations that occur at home can only be recorded by the patient with the help of an asthma diary. But this is only effective if lung function and other measured values that change during the course of the illness are documented regularly. Digital measuring devices and asthma apps make it much easier for asthmatics to record their values.
Ideally, the values are entered daily in a so-called asthma diary, allowing patients to monitor the development of their disease over a long period of time.
This gives doctors a good overview of the status of a patient’s asthma and how their asthma symptoms affect their everyday life, even outside of check-up appointments.
8.2 Measuring the FeNO value as part of optimum asthma management
Measurement of the so-called FeNO value has become an established method for determining the acute level of respiratory inflammation quickly and reliably. This involves measuring the concentration of nitric oxide (NO) in the exhaled breath. The FeNO value reflects the degree of inflammation in the lower airways. NO is therefore a reliable biomarker for determining the extent of inflammation in the airways: the higher the FeNO value, the more severe the inflammation. The main advantage of FeNO measurement on a day-to-day basis is that it can detect an aggravation of the inflammation even before noticeable and measurable asthma symptoms occur, so that effective counteraction can be taken early on.
Knowledge of the current FeNO value thus helps doctors to optimize individual drug dosage in the short and long term. Continuous monitoring and treatment of the inflammation with optimally controlled asthma can have a positive influence on the course of the disease.
Vivatmo me is an easy-to-use device for measuring the FeNO value. It is the world’s first FeNO measuring device for use at home and on the road. It determines the FeNO value in the exhaled air in a matter of seconds.
By monitoring the FeNO value closely, meds can be administered in consultation with primary care physicians according to the recognized principle: as much as necessary and as little as possible. Measurement with Vivatmo me helps asthmatics keep a check on how they are doing and plan their daily activities accordingly. Combined with the Vivatmo app, the device is the perfect electronic asthma diary.
8.3 Peak flow measurement
Peak flow measurement is done using the peak flow meter. This measures the rate at which air is exhaled from the lungs. The more inflamed and constricted the bronchial tubes are, the slower the air flows out of the lungs. By keeping a peak-flow log, the patient has an overview of the changes during the course of the day. Compared to FeNO measurement, the peak flow meter mainly measures the effects of the inflammation on the airways and is dependent on the correct use of the device. Peak flow measurement allows an indirect conclusion to be drawn about the inflammatory process.
8.4 A healthy lifestyle helps
Additionally, asthmatics can counteract the disease with a healthy lifestyle by taking sufficient exercise and sport, eating a healthy diet, getting enough sleep, and avoiding excessive stress. Special breathing techniques help asthmatics relax their breathing when they experience shortness of breath. Special breathing exercises help to strengthen the respiratory muscles. Apart from this, it is important to avoid all known triggers for an asthma attack as far as possible.
1 S2k-Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma (guideline for diagnosis and therapy of patients with asthma)
2 Dezateux C. Stocks J. Dundas I et al. Impaired airway function and wheezing in infancy: the influence of maternal smoking and a genetic predisposition to asthma. Am J Respir Crit Care Med 1999; 159: 403-410