Why do you have asthma
Asthma: Quick Reference
- description: chronic inflammation of the bronchi with seizure-like narrowing of the airways
- Common triggers: allergic asthma: pollen, dust, food; non-allergic asthma: exertion, cold, tobacco smoke, stress, medication
- Typical symptoms: Cough, shortness of breath, shortness of breath, tightness in the chest, breathing noises, labored exhalation, acute asthma attack
- treatment: Medication (such as cortisone, beta-2 sympathomimetics) for long-term treatment and for seizure therapy, avoid allergens, adapt lifestyle
- Diagnosis: Pulmonary function test, x-ray of the lungs, blood test
What is asthma?
In asthma sufferers, the bronchial tubes are hypersensitive to chronic inflammation. The bronchi are a widely branched system of tubes that guides the air from the windpipe into the small alveoli, where gas exchange takes place - oxygen is absorbed into the blood and carbon dioxide is released into the exhaled air.
In asthma, the mucous membrane that lines the inside of the bronchi swells and produces thick mucus. The inner diameter of the bronchi narrows, making it harder for the patient to inhale and exhale. Accordingly, he breathes faster - so the breathing rate increases.
Exhaling in particular works worse. This can partly be heard in whistling or humming breath noises. In severe cases, some air remains in the lungs with every breath - this leads to what is known as overinflation. The gas exchange then only works to a limited extent, so that an oxygen deficiency can develop in the blood.
Asthma comes on in flares. This means that in between the symptoms keep getting better or go away completely.
Asthma: causes and triggers
Depending on the trigger, a distinction is made between allergic and non-allergic asthma. If the respiratory disease is caused by an allergy, certain allergens trigger an asthma attack, such as pollen, house dust or mold. The disease often occurs together with other allergies and usually begins in childhood. Non-allergic asthma, on the other hand, usually only develops in the course of life. There are also mixed forms of both types of disease.
When the cold makes you sick
Osteoarthritis: grinding jointsIn people with osteoarthritis, the joints are worn - for example on the hips or knees. This can cause pain with every movement. Muscles contract in winter temperatures. The pressure on the joints increases: they swell and hurt even more. Alternating showers and saunas can bring relief. It is also important to keep moving in winter - for example in the swimming pool.
Neurodermatitis: Stressed body shellWhen it is cold, the skin produces less sebum than usual and, due to the greater temperature difference, also tends to dry out. This is particularly problematic for people with neurodermatitis: their symptoms worsen. On the other hand, only consistent application of cream helps. It also makes sense to use a humidifier in the living room and at the workplace, which enriches the dry heating air with moisture.
Asthma: When cold air takes your breath awayThe cold can literally take the air out of asthmatics or people with particularly irritable airways: the bronchi react to the cold stimulus with spasms. An asthma attack is often the result. This can often be avoided through consistent nasal breathing, during which the air is slightly preheated. A woolen scarf around your mouth and nose also helps. Asthma patients should avoid sudden and intense exposure to cold and move their work-out to heated rooms.
Cold goes to the heartWhen it is cold, the blood vessels contract. The heart has to pump harder to force the blood through the narrowed arteries. This additional burden can be too much for heart patients. It is then important to only exercise moderately in the cold. Heart patients should rather leave the snow shoveling to others! A walk can also strengthen the circulation in winter. Talk to your doctor about what you can expect from yourself.
Got my back coldWhen it's cold, we instinctively try to put ourselves down: we hunch our shoulders and assume a slightly bent position. This can cause tension and, as a result, back pain. This can be avoided very easily - by dressing warmly enough. In cold weather, the onion strategy in several layers, which can store warm air close to the body, is ideal.
Winter weather can get on your nervesNerves can be damaged by operations, pathogens and their toxins or metabolic diseases such as diabetes. It is not uncommon for neuralgia to occur, with pain in the nerves. They then react particularly sensitively to stimuli. Pressure, but also cold, intensify the pain or trigger it in the first place. Even a cold draft can cause extremely painful reactions. In cold weather, the only thing that helps is to protect the sensitive parts of the body very well.
A cool head is not always goodWhen it's cold, the blood vessels on the head also contract. Sensitive people respond with a headache. It helps to wrap yourself in a hat or scarf in winter. This protects the head and offers little free surface to the cold air.
Common triggers for allergic asthma
The symptoms mainly occur when the patient has been exposed to certain allergens. Typical triggers for allergic asthma are:
- Dust (house dust mites)
- Animal hair
Common triggers for non-allergic asthma
In non-allergic asthma, unspecific stimuli cause the asthma attack. This includes:
- physical exertion (exertion asthma)
- Tobacco smoke
- Air pollutants (ozone, nitrogen dioxide and others)
- Metal fumes or halogens (especially at work)
- Medicines such as acetylsalicylic acid
- Respiratory infections
Asthma: "Strengthen your immune system!"
Three questions toDr. med Hermann Teutemacher,
Pulmonologist, allergist and sleep specialist
How can I help someone who is having an asthma attack?Dr. med Hermann Teutemacher
Asthma sufferers usually have their asthma spray with them and can use it to help themselves quickly. If not, you should get medical help as soon as possible, in case of severe breathlessness you should even call the emergency number 112. It is important for everyone involved to stay calm, because stress makes breathing worse!
What is good for the lungs in asthma?Dr. med Hermann Teutemacher
Asthma is an inflammation of the airways, which is why the consistent use of anti-inflammatory asthma sprays is the best care for the lungs. In addition, everything that strengthens the immune system helps, namely exercise, vegetables and fruit, few dairy products and sweets and a lot of time in the fresh air, even in winter.
Why is asthma often worse in winter?Dr. med Hermann Teutemacher
The alternation between warm, dry air inside and cold, moist air outside is a particular provocation for the bronchial tubes that are inflamed in asthma. This increases the asthma sufferer's susceptibility to colds, which in turn often worsen the asthma. For example, vitamin D or anything that is good for the intestines helps to prevent colds - because this is where the immune system is at home.
- Dr. med Hermann Teutemacher,
Pulmonologist, allergist and sleep specialist
In his private practice for pneumology, allergology and sleep medicine in Wuppertal, he has specialized primarily in holistic therapeutic approaches.
Asthma: Risk Factors
Exactly how asthma develops has not yet been conclusively clarified. Both environmental and genetic factors are likely to play a role. Anyone who already has an allergic disease, such as hay fever or neurodermatitis, or relatives with asthma or allergies, is also more likely to develop asthma. There is also an increased risk of asthma if the parents smoke during pregnancy. Breastfeeding for long periods of time in infancy has shown several studies to reduce the risk of developing asthma in children.
Asthma is usually characterized by an alternation of largely asymptomatic phases and sudden, repetitive asthma attacks. Some of the signs of asthma include:
- Cough, especially at night (because the bronchial tubes are then less distant)
- Difficulty breathing, often at night or in the morning
- wheezing audible to the bare ear - a dry, whistling sound on exhalation
- labored, long exhalation
Nocturnal coughs and shortness of breath may persist while other signs of asthma set in suddenly and escalate into an asthma attack.
Asthma attack: symptoms
Typical asthma attack symptoms are:
- Sudden shortness of breath, even without physical exertion
- excruciating cough with sometimes not very tough, clear or yellowish mucus
This is how the asthma attack works:
An asthma attack begins with a dry cough and a tightness in the chest. Above all, exhaling is made more difficult, the patients have the feeling that they can no longer get rid of their air and that they do not have enough space to breathe in. Most of them are then excited or feel anxious, which in turn increases the shortness of breath.
The number of breaths per minute increases and they use their auxiliary breathing muscles. This is the name given to a group of muscles in the upper body that can support the work of breathing in the lungs. This can be achieved, for example, by supporting your arms on your thighs or on a table. In addition, there is an audible wheezing and whistling when exhaling as part of the typical bronchial asthma symptoms.
After a phase of intense and often threatening shortness of breath, the asthma attack usually subsides on its own. At this stage, the patient begins to cough up yellow mucus. Doctors then speak of a productive cough. This is still accompanied by an audible wheezing when breathing.
The following symptoms may also appear during a (severe) asthma attack:
- bluish discoloration of the lips and fingernails due to lack of oxygen in the blood (cyanosis)
- accelerated heartbeat
- distended chest
- hunched shoulders
- Inability to speak
- with severe shortness of breath: retraction on the chest (between the ribs, in the upper abdomen, in the area of the throttle pit)
A very severe asthma attack without treatment can be accompanied by low blood pressure, decreasing pulse pressure when inhaling (pulsus paradocus), drowsiness and exhaustion and can lead to a coma. The outer bronchi can close almost completely, the breathing noise can disappear completely ("silent lung").
A severe asthma attack is a medical emergency! The person concerned must be treated by a doctor as soon as possible.
First aid for an asthma attack
You can find out which first aid measures are important in the event of an acute asthma attack in the article Asthma attack.
Asthma therapy is divided into basic therapy (long-term therapy), seizure therapy (on-demand therapy) and prevention. The treatment methods are correspondingly diverse.
Asthma therapy: medication
There are five (adults) and six (children and adolescents) levels for asthma drug therapy. The higher the level, the more intensive the therapy. In this way, the treatment can be individually adapted to the severity of the disease.
Basic therapy (long-term therapy)
For the basic therapy of asthma, long-term anti-inflammatory drugs are used that Controller to be named. They reduce the susceptibility of the airways to inflammation. As a result, asthma attacks and asthma symptoms occur less often and less violently. For this long-term effect, however, patients have to use the controllers continuously and regularly.
The most important long-term drugs are glucocorticoids (cortisone). They inhibit the chronic inflammation of the bronchi and are mostly inhaled - doctors speak of inhaled cortisone preparations (ICS). In severe cases of asthma, some patients receive it Cortisone tablets - either in addition to or as an alternative to inhaled cortisone.
If cortisone alone does not work enough, the doctor will prescribe an additional or alternative long-acting beta-2 sympathomimetics (LABA) like formoterol and salmeterol. They relax the bronchial muscles and thus widen the airways. They are also usually given by inhaler.
In certain cases, other long-term drugs for asthma therapy can also be considered. These include the so-called Leukotriene antagonists like Montelukast. Like cortisone, they have anti-inflammatory effects, but less so.
Even if the basic therapy is successful, you should never reduce the dose of the medication yourself or stop taking the medication completely! Instead, talk to your doctor first. You can only reduce your medication if you have been symptom-free for at least three months.
Seizure therapy (reliever therapy)
The asthma treatment for acute attacks takes place with quickly acting reliever medication, which also Reliever be called. Most of the time it is short-acting beta-2 sympathomimetics (SABA) such as fenoterol, salbutamol, or terbutaline, which the patient inhales. Within a few minutes you can relax the bronchial muscles cramped during an asthma attack and thus quickly relieve acute asthma symptoms. However, they have no effect on the underlying inflammation of the bronchi.
If the asthma illness is advanced, the doctor may also ask long-acting beta-2 sympathomimetic (LABA) prescribe. Its bronchodilator effects last longer than that of SABA. However, LABA only in combination with an inhaled cortisone preparation (ICS) can be used for reliever therapy. Fixed combination preparations are also available for this purpose, with which the two active ingredients can be inhaled at the same time. This combination therapy is possible for adults and children from 12 years of age.
If you have severe asthma attacks, you must call the emergency doctor. He can administer glucocorticoids intravenously. The doctor also treats severe and life-threatening asthma attacks with ipratropium bromide. This active ingredient also dilates the bronchi. In addition, the patient should receive oxygen through a nasogastric tube or mask.
The emergency doctor takes patients with a very severe seizure to the hospital because, in addition to inadequate breathing, life-threatening complications of the cardiovascular system can occur.
Asthma medication is usually inhaled using a special inhaler. Correct application is important because otherwise the treatment will not work properly. Each inhaler is a bit different to use. Let your doctor explain exactly how to use your device correctly.
Asthmatics often use a so-called Turbohaler. Here the active ingredient reaches a sieve inside the device through a rotating mechanism, from where it is inhaled. If you use the Turbohaler according to the following step-by-step instructions, you are using it correctly:
1. Prepare for inhalation: Unscrew the protective cap. Hold the Turbohaler upright, otherwise incorrect dosing is possible, and turn the dosing ring back and forth once. If you hear a click, filling has worked correctly.
2. Exhale: Before bringing the inhaler to your mouth, EXHAUST THOROUGHLY and BREATHING. Be careful not to breathe out through the device.
3. breathe in: Put your lips around the mouthpiece of the Turbohaler tightly. Now BREATHE FAST AND DEEPLY. This releases the drug cloud. You taste and feel nothing, as very small amounts are sufficient for the Turbohaler to work. Breathe consciously through the Turbohaler and not through your nose.
4. Hold your breath briefly: Hold BREATH ON for five to ten seconds to allow the drug to sink deep into your lungs. Put the Turbohaler back down again. EXHAUST SLOWLY through your nose with your mouth closed. Do not breathe out through the device!
5. Screw the protective cap back onto the Turbohaler. Make sure to inhale each puff individually. Leave a few minutes between strokes.
6. Rinse your mouth with water after each use. Only clean the mouthpiece of the inhaler with a dry cloth, never with water.
7. Pay attention to the level indicator on the Turbohaler. If it is set to "0", the container is empty, even if you can still hear noises when shaking it. These are only due to the desiccant and not to the active ingredient.
Inhalation aids are available for children to use the inhaler properly. The so-called spacer, for example, is a cylinder with a larger air chamber that can be placed on the inhaler. The purpose of this attachment is to make it easier for you to inhale the medication.
Desensitization in allergic asthma
Allergic asthma can sometimes be treated with desensitization.The patient should gradually get used to the allergen so that he builds up a tolerance until his immune system no longer reacts to the allergy trigger. However, desensitization can only be attempted under certain conditions:
Among other things, the allergic asthma should be controlled by medication to such an extent that the patient is currently not suffering from asthma attacks. In addition, desensitization can only be successful if those affected have only one asthma allergy and not several.
Asthma: Here's How You Can Prevent It
There is only a chance of getting asthma under control if the bronchial asthmacauses Avoid (for example cold air or house dust) as far as possible.
Also, do without that Smoke - it intensifies the inflammatory processes in the lungs and also irritates them.
People with severe bronchial asthma that is aggravated by occupational contact with various substances (e.g. metal fumes) may need a Career change consider. Adolescents with asthma should be advised before or during the Career choice keep in mind that not all professions are suitable for asthmatics.
Your GP will offer you one at one Asthma education to participate in a so-called disease management program (DMP). There you will learn everything you need to know about the disease and receive many tips that will help you deal with your disease. For example, you will be shown relieving breathing techniques or tapping massages, which will enable you to get better air. You should also work with your doctor to develop an emergency plan for what to do in the event of an acute asthma attack.
Asthma and Sports are not mutually exclusive - on the contrary. Scientific studies show that regular exercise at an appropriate intensity can improve symptoms and reduce the frequency and severity of seizures. Endurance sports such as swimming are best suited for this. Do not overexert yourself and start with light workouts first. Move (e.g. swim) at a pace at which you could cover long distances without getting out of breath.
Since intense physical exertion can also trigger an asthma attack, you should follow a few rules:
- Avoid outdoor training in very cold or very dry air.
- In warm weather, postpone your training in the morning or evening hours to avoid increased ozone and / and pollen concentrations.
- Do not exercise outside shortly after a thunderstorm. The storm whirls pollen through the air, which then bursts and releases a particularly large number of allergens.
- Start your workout with a slow warm-up to give your bronchial system time to adjust to the increasing physical strain.
- In consultation with your doctor, take a metered dose inhaler with a short-acting, bronchodilator drug about 15 minutes before training.
- Always have your emergency medication with you!
Asthma: examinations and diagnosis
If you suffer from an attack of shortness of breath, consult your family doctor. First, your doctor will ask you in detail about your medical history (anamnesis). He's likely asking you these questions, among others:
- When do the symptoms occur - during the day or at night?
- Are there things or situations that trigger or worsen the symptoms?
- Do the complaints change in special places, at work, when changing location or on vacation?
- Do you have allergies or allergy-like diseases (for example hay fever or neurodermatitis)?
- What diseases (especially of the respiratory tract) are known in your family?
- Do you smoke or do you come into frequent contact with tobacco smoke?
- Are you exposed to metal fumes in a job?
If you suspect asthma, your general practitioner can refer you to a pulmonologist (pulmonologist) who has the equipment for special examinations of the respiratory functions.
Asthma: physical examination
The doctor will then examine you physically. He pays attention to the shape of your chest, your breathing rate and whether you find it difficult to breathe. He'll also look at the color of your fingernails and lips. If these have a bluish discoloration, this indicates a lack of oxygen in the blood.
Then he will listen to your lungs with the stethoscope. You have to breathe deeply in and out through your open mouth. If you have bronchial asthma, the doctor will hear wheezing and humming when you breathe. Due to the increased resistance in the bronchi, the exhalation phase is also prolonged in an asthmatic.
Tapping the chest, the so-called percussion, is also part of the examination. Based on the resulting knocking noise, the doctor can tell whether the lungs are particularly bloated and whether an unnatural amount of air remains in the chest when you exhale.
Asthma: special diagnostics
Further examinations are necessary in order to be able to make a diagnosis of asthma. These include:
Pulmonary function test
In lung function diagnostics, the doctor measures different respiratory volumes and the respiratory dynamics. The measurement is made either via a pneumotachograph, which measures the air flow (spirometry), or a body plethysmograph, which records the change in lung volume (body plethysmography).
With the Pneumotachograph the patient is connected via a mouthpiece through which he inhales and exhales. The measurement by the Body plethysmograph takes place in a closed cabin in which sensors determine the various pressures during inhalation and exhalation. The device then converts this into the lung volume that has changed during breathing. Due to the narrowed airways, asthmatics have lower values, especially when exhaling. They also retain more air in their lungs after they exhale.
The diagnosis of asthma can be made by a Repeat the pulmonary function test hardening. For this purpose, after the first spirometry, the patient is given a fast-acting, airway-widening drug and repeats the examination a few minutes later. If the typical values are now better, this indicates an asthma illness. Because asthma is characterized, among other things, by the fact that the narrowing of the airways is reversible.
Likewise, the doctor can deal with a so-called Provocation test check for non-allergic asthma. After the first lung function test, the patient inhales a non-specific, i.e. non-allergenic irritant (metacholine) and then repeats the test shortly afterwards. Metacholine irritates the bronchial muscles and causes them to contract. If the respiratory values are now worse, this speaks for a non-allergic asthma. However, caution should be exercised with this test as it can lead to a severe asthma attack. The doctor therefore always has a fast-acting antidote on hand.
Self-test with the peak flow meter
You can also measure how forcefully you exhale at home. This is not for the initial diagnosis, but you can use it to monitor the course of the disease. To do this, you use a so-calledPeak flow meter. When you blow into the mouthpiece, it measures the maximum airflow (peak flow) when you exhale. This is usually reduced in patients with asthma. In order to check the effect of the treatment or to recognize an impending worsening of your illness in good time, you should regularly determine your peak flow and keep a diary about it.
The X-ray examination of the chest serves to rule out other diseases, some of which can cause symptoms similar to asthma. These include infectious diseases such as pneumonia or tuberculosis or certain heart diseases. Chronic bronchitis or COPD are also sometimes similar in appearance to asthma. During an asthma attack, an overinflation of the lungs can also be seen in an X-ray.
With the help of a blood test, the doctor can measure how well the lungs can enrich the blood with oxygen and remove carbon dioxide. In asthma sufferers, these values are usually changed during an asthma attack.
The doctor can also do a blood test to find out whether the asthma is allergic or non-allergic. In the first case, so-called IgE antibodies prove.
Once the suspicion of allergic asthma has been confirmed, it is important to find the exact trigger. That is what the Prick test: The doctor slightly scratches the top layer of skin and then applies solutions containing substances (allergens) that are suspicious of allergies. If the triggering allergen is present, the body reacts with a local allergic reaction after five to 60 minutes. A prick test is positive if wheals form or the skin turns red.
Asthma: Similar clinical pictures
Asthma is easy to confuse with other diseases that have similar symptoms. It is therefore important for the doctor to rule out other possible causes of the symptoms. These include the following diseases, among others:
- chronic obstructive pulmonary disease (COPD)
- Sarcoid or exogenous allergic alveolitis
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