What is asthma?
The term asthma comes from the Greek and means oppression. It is a chronic (that is, long-lasting) and seizure-like, inflammatory disease of the respiratory tract, which is associated with increased sensitivity of the bronchi to various stimuli (so-called bronchial hyperresponsiveness ). Typical asthma symptoms are wheezing breathing, coughing, tightness in the chest, shortness of breath and shortness of breath. They often occur at night and early in the morning.
One hallmark of asthma is that the symptoms recede, at least in part, either spontaneously or after taking certain medications. Also, asthma sufferers often change the disease level: After a symptom-free period, for example, it can lead to temporary periods with coughing and dyspnoea or even to an acute asthma attack.
In the 70s to 90s, asthma has become more prevalent worldwide, affecting up to 30% of the population, depending on the region. It is estimated that around 100 million asthma patients in the world. Asthma is most common among New Zealanders and Australians of European descent, most rarely Southeast Asian and Pacific natives. Interestingly, there was less hay fever and asthma right after the fall of East Germany than in West Germany. Since 1996, this difference has diminished, probably because the living conditions (especially the type of air pollutants and nutrition) in the former GDR and the Federal Republic have converged.
Why the onset of asthma increased in the 70s to 90s cannot yet be conclusively explained. Although genetic factors play a key role in the development of the disease, only changes in living conditions are the cause of this increasing trend. Paradoxically, this includes increasing hygiene which leads to a completely new strain on the immune system. After all, over millions of years, humans were used to eating perishable food contaminated with bacteria and fungi. Also, its environment (for example the living environment) was previously contaminated with more germs than today. On the other hand, however, many more viral infections occur today, as contacts with foreign virus strains have exploded as a result of the increasing frequency of travel over the past 100 years. Although today’s improved hygienic conditions have contained the infectious diseases (for example, tuberculosis, plague, cholera, etc.), the immune system, However, this is virtually under-challenged, so that it can lead to an overvaluation of other foreign substances. Apparently, therefore, in recent decades, the tendency is that allergy-causing substances ( allergens ) play an increasingly important role in the home and work environment.
In Germany, about 10 to 15% of children and about 5-7% of adults suffer from asthma – that’s about 8 million people. Especially children are affected – bronchial asthma is the most common chronic childhood disease (see also asthma in children). About every 8th child under the age of 10 and every 10th child under the age of 15 suffers from asthma in Germany. Boys are twice as likely as girls. With increasing age of the children, however, this gender difference fades again.
In adulthood, the proportion of women who suffer from asthma prevails. About 6% of adults in Germany are affected. While in childhood asthma is predominantly allergic, adults (especially in the second half of life) are more likely to experience a non-allergic (intrinsic) form of the disease in 30-50% of adult asthmatics. Thus, a purely allergic cause can be detected from the age of 20 only in less than a fifth of cases.
Luckily, mortality is quite low: In Central Europe, 1-8 people out of every 100,000 people die of asthma each year. Despite advances in the treatment of asthma, these figures have not changed for 30 years. Although asthma deaths in Germany have fallen since the 1980s, the mortality rate in Germany is still relatively high by international comparison (4-8 people per 100,000 inhabitants and year – see also Impact & Forecast ). In addition to the increasing prevalence of asthma between the 1970s and 1990s, one of the possible reasons for this is that patients often underestimate the severity of their condition and are not reliable in following their doctor’s treatment instructions.
In recent years (as of 2015), according to the 2014 White Paper on Lung, both the frequency and severity of asthma have increased. There are many theories that could explain this. Pollen may have become more aggressive due to environmental factors, which can make allergic asthma worse. According to data from the Robert Koch Institute, the lifetime prevalence among adults between 2003 and 2009 increased from 6.0 to 10.1 percent for women and from 5.2 to 8.3 percent for men.
Different types of asthma
The exact reason why people develop asthma is not yet understood in every detail. However, it is known that both genes and environmental factors play a role. Thus, those people are more prone to asthma, which come from an allergic family and even react to certain substances allergic. Others develop asthma because of their job because they are exposed to certain substances there.
Depending on the trigger, a distinction is made between the following forms of asthma, which may be allergic or non-allergic, but also occur in combination with one another and are then referred to as mixed-form:
- Allergic (extrinsic) asthma
- Non-allergic (intrinsic) asthma
- Mixed asthma
- Occupational asthma
- Triggering of asthma by infections
- Triggering of asthma by drugs.
- Exertional asthma (stress asthma)
- Asthma with gastroesophageal reflux
- Brittle Asthma
- Variant Asthma
- Asthma forms with the transition to COPD
Allergic (extrinsic) asthma
This asthma form is triggered by allergens and leads to the so-called allergic early reaction with an increased formation of immunoglobulin E (and thus increased Ig E levels in the blood serum). This early reaction is often followed by the so-called late allergic reaction, which causes asthmatic symptoms. Allergic asthma often occurs in some families, is genetic and often begins in childhood or adolescence. The allergic type of asthma also includes seasonal asthma, which occurs as a result of an allergy to certain pollen and depends on the respective pollen count. This often affects hayfever patients, their pollen allergy has made a level change from the upper to the lower respiratory tract so that they also have asthmatic complaints in addition to hay fever. Outside the pollen season, however, there are no complaints and the lung function is back to normal.
Non-allergic (intrinsic) asthma
In non-allergic asthma defense reactions also occur in the body, but these are not evidenced by an allergen (but by another trigger ), because it is less likely to increase immunoglobulin E. That is, the allergic early reaction does not take place, but only the asthmatic late reaction. See also video clips (right) about granulocytes and mast cells.
This late reaction also puts the inflammatory cells in a long-lasting readiness to defend themselves and thus leads to the asthmatic symptoms. Typically, in non-allergic asthma, the paranasal sinuses are almost always chronically inflamed. Later, it comes to polyp-like mucosal proliferation (nasal polyposis), which can significantly hinder breathing through the nose.
In about 30 to 50% of adults with asthma, allergy (with the formation of Ig E antibodies to environmental allergens) is undetectable. Non-allergic asthma often does not begin until late in the fourth decade of life, typically following a respiratory viral infection. That is, this form of asthma is often triggered or aggravated (triggered) by respiratory infections. Variations in the severity of the disease are less pronounced than in allergic asthma. However, intrinsic asthma often shows a severe form right from the start.
In asthma, hybrids are often present between the allergic and non-allergic forms of the disease. Mostly, mixed-type asthma develops from originally allergic asthma. Over time, non-allergic (intrinsic) causes to gain the upper hand – often due to repeated infections. On the other hand, both types of asthma exhibit asthmatic reactions to nonspecific triggers, such as cold air, mist, smoke, cooking fumes, perfume, etc., but these irritants do not cause asthma, they just bump it.
Certain occupations that come into daily contact with potential allergens are associated with an increased risk of asthma. These include, for example, bakers (Mehlstauballergie), hairdresser (nickel and care allergy), carpenters (wood dust allergy) and printing workers (dyes and solvents). People with known allergies should consider their career choices accordingly.
Occupational asthma is not always the result of an allergy. Certain chemical substances can irritate the bronchial system to such an extent that asthma develops without any allergic reaction. For example, the inhalation of chlorine gas (for example, in accidents) or so-called isocyanates (which are used, inter alia, for the production of plastics, paints, and adhesives or as a hardener) can lead to inflammatory reactions.
First signs of illness in the workplace often occur only after years of contact with the trigger. Typical of occupational asthma is the increase in workplace discomfort, as they recover on weekends and on vacation.
Occupational asthma allergens
|amines||Shellac and paint processors|
|anhydrides||Processing of plastics and epoxy resins|
|Vapors by electric current||Electricians, soldering workers|
|enzymes||Baker, a detergent manufacturer|
|To dye||Textile workers, painters, painters|
|Fish, shellfish||Fish processor, seller|
|Formaldehyde, glutaraldehyde||Employees in the hospital|
|Grain||Müller, baker, farmer|
|wood dust||Forest workers, carpenters, carpenters, carpenters|
|isocyanates||Insulating materials, painters (spray paints),
manufacturers of plastic, foam and rubber
|adhesives||Pharmacists, carpet weavers|
|latex||Medical professions, laboratory technicians|
|drugs||Medical professions, pharmacists|
|Metals (platinum, vanadium)||Soldering machine, refiner|
|Pet hair, droppings, urine||Pet trader, veterinarian, veterinarian|
Triggering of asthma by infections
Triggering of asthma by drugs
About 10-20% of asthmatics – especially those with non-allergic form – are hypersensitive to certain medications. This is especially common in middle-aged women. Triggers are mainly analgesics (with the active ingredient acetylsalicylic acid) and anti-inflammatories (so-called non-steroidal anti-inflammatory drugs), but also chemically related anti-rheumatic drugs (so-called non-steroidal anti-inflammatory drugs) can trigger an asthma attack.
This is not based on any causative allergy, but a (probably hereditary) drug intolerance. It is, therefore, a non-allergic (intrinsic) asthma form. Drug asthma often occurs in combination with other, mostly allergic, forms of asthma. This form of asthma often manifests with sneezing and watery nasal flow.
Another group of drugs, beta-blockers, are problematic for asthmatics because they often increase asthma. Some, especially sensitive patients even get a severe asthma attack after taking the tablet. But even if patients seem to tolerate these medications (usually used to treat high blood pressure or heart failure), the severity of asthma attacks, such as those caused by an infection, is exacerbated.
Especially at the beginning of and after physical exertion, most children affected by asthma and about every third asthmatic adult suffer from asthmatic complaints. In many children, asthma attacks occur predominantly only during exercise, while (as long as they do not get an infection) have no signs of the disease. The asthmatic inflammation is caused by cooling and dehydration of the bronchial mucous membranes (especially in cold air) due to the increased respiration during exercise.
Asthma with gastroesophageal reflux
Here it comes to the strengthening of asthma because gastric juice passes into the esophagus. It comes to reflex-like cramping of the bronchi. This type of asthma may be compounded by certain asthma medications (such as theophylline and other adrenalin-like drugs known as beta-2 sympathomimetics) because they may paralyze the movement of the esophagus.
This is a very rare form of recurrent, severe and life-threatening asthma attacks with no previous signs of worsening disease status. This asthma variant is apparently based on completely different inflammatory mechanisms than the other forms of asthma.
Not infrequently (about 20-30% of asthma-related illnesses) there are also forms that later develop transitions to chronic obstructive pulmonary disease (COPD). These transitional forms are characterized by the patients having coughing and expectoration not only during the asthma attack or infection.
What happens in the bronchi of an asthmatic?
In asthmatics, there is a constant inflammatory and defensive readiness in the lower respiratory tract (bronchi and bronchioles), which is reinforced by certain influences ( triggers ). Due to the frequent inflammation, the bronchi of an asthmatic are hypersensitive and react to actually harmless stimuli with a violent defense reaction: they contract convulsively, the mucous membranes in the bronchial walls swell and often form excessively tough mucus. This leads to wheezing and buzzing breathing sounds, dry cough with tough glassy mucus, which is difficult to cough up, tightness in the chest and shortness of breath.
As a result, the diameter of the bronchi becomes narrower and the respiratory air can no longer flow freely in and out (obstruction). This overloads the respiratory muscles, which is the main cause of respiratory distress. In addition, exhaling is difficult in asthmatics. Thus, after each breath, a little more air remains in the lungs than normal, until a new equilibrium is reached. As a result, the lungs inflate a little more with each breath (acute pulmonary emphysema ). This is also the further inhalation more difficult: the less the exhausted air, which would actually have to be exhaled, can flow out of the lungs, the less space there remains in the lungs to breathe fresh air. Although the lungs are inflated with air, this additional amount of air is not breathable, so to speak. This increases the shortness of breath.
You can feel well about what an asthmatic must feel during an asthma attack when trying to breathe through a straw for a few minutes. While it is still reasonably possible to inhale through the straw, it is almost impossible to breathe quickly enough through a straw. After a short while, you will stop as a result of shortness of breath.
Total prolonged exhalation occurs because of the narrowing of the lower respiratory tract To more friction and thus to an increase in the flow noise: whistling (the doctor calls the gills) and hum are clearly heard.
The constant inflammatory and defense readiness of the respiratory system do not cause asthmatic complaints. At times, they are little or not affected. The only contact with a trigger causes and amplifies the asthmatic symptoms and can also cause an asthma attack. When asthma so two things come together: A constant inflammatory readiness and an external influence (trigger), which amplifies the existing inflammation (triggers) and thus causes the asthmatic symptoms.
One distinguishes the following asthma trigger:
Trigger for Allergic Asthma
Allergic (or extrinsic) asthma is caused by actually harmless substances that an asthmatic person is allergic to ( allergens ), for example:
- Pet allergens (animal hair, bird feathers)
- Environmental allergens (tree and grass pollen)
- Domestic allergens (feces of house dust mites and spores of molds)
- Certain foods
- Certain medications
- Chemicals (allergic and non-allergic)
- Occupational Allergens (see also Occupational Asthma )
Trigger for non-allergic asthma
- virus infections
- Bacterial infections
- Certain, mostly occupational substances
Trigger for all types of asthma
All asthmatics respond to nonspecific stimuli in the sense of an increase in asthma or obstruction. Such stimuli include:
- Infections of the upper and lower respiratory tract
- Physical exertion (exertional asthma)
- Mental stress and stress as a result of the resulting increased respiration (hyperventilation). Mental conflicts that cause asthma, there are, in contrast to previous information not!
- Cold (fog, cold air)
- Air pollutants in the environment (exhaust gases such as nitrogen and sulfur dioxide, ozone, dust – also caused by stirring up at home)
- Tobacco smoke (active and passive smoking )
- Certain medications (aspirin, non-steroidal anti-inflammatory drugs, beta-blockers)
Asthma risk factors
Certain circumstances and conditions are particularly common in asthmatics and are therefore considered as risk factors, which are usually requested by the doctor. Most of the following risk factors are related to allergic asthma, only some (eg smoking ) apply to all asthmatics:
- Family Disease: Family members also have asthma and/or allergies (such as hay fever or atopic dermatitis )
- Underweight at birth: Children born underweight are a little more likely to develop asthma than children who are of normal weight at birth.
- Illnesses as a child: As a child, the person affected suffered from allergies, atopic dermatitis, cradle cap or eczema (recurring itchy skin)
- Smoking parents: Children of smoking parents (especially mothers) suffer much more frequently already as infants under whistling breathing (wheezing) and other breathing problems. They develop asthma more often than children from non-smoking parents.
- Excessive hygiene that promotes the occurrence of allergies
- Common infections by (unknown or novel) viruses
- Early Weaning
Allergic diseases such as hay fever, atopic dermatitis, and allergic asthma are considered atopic and are associated with the excessive formation of immunoglobulin (Ig E antibodies) against in itself harmless environmental allergens. The propensity to allergies is genetic and one of the strongest risk factors for asthma, especially in children. However, the exact interplay between inherited genetic allergy addiction and other factors (for example, frequent infections or stressors, nutrition), which can be added in the first years of life and can lead to inflammation of the respiratory tract and eventually to asthma, is only partially understood.
Asthma first symptoms
Breathlessness, pain behind a sternum and irritable cough are often at the onset of an asthma attack. Other first signs include difficulty in breathing and/or at rest, exhalation sounds, respiratory rate increases to 20 breaths per minute, and heart rate to more than 100 beats per minute.
Typical signs of asthma include:
- Shortness of breath occurs in fits and starts, often at night and in the early morning
- Especially the exhalation is difficult and takes longer than normal
- shortness of breath
- Whistling or humming breath sounds (wheezing)
- Tightness in the chest
- Seizure dry cough
- In mild cases often occurs only a dry, irritant cough (see variant asthma)
- An irritable cough with glassy-viscous mucus, which can hardly be coughed off, can – but need not always – be present. After acute worsening, a so-called productive cough with a lot of mucus may develop, especially in chronic asthma sufferers
- The complaints are caused and amplified by certain triggers
- The most symptom-free time between two seizures called the doctor as an interval. However, in a more advanced stage of the disease, dyspnoea and coughing are more likely to occur between attacks
- Disease symptoms are mostly only available in the meantime and vary in their severity and in their severity
- Accordingly, in asthmatics, the measurements of their lung function often vary. This so-called peak-flow variability is also a typical feature of asthma
- Characteristic of asthma is the (at least partial) reversibility of respiratory distress symptoms by certain asthma medications. This distinguishes asthma from other (obstructive, ie, narrowing the respiratory tract ) lung diseases, which also include respiratory distress, such as emphysema of the lungs and chronic obstructive bronchitis
- In allergic asthma, asthmatic symptoms typically occur within minutes of exposure to the substance causing an allergic reaction ( allergen ). After 6-10 hours, the second episode of discomfort occurs in half of the cases.
- In children, respiratory arrhythmias occur in the chest (see also ” Children with asthma “)
Various forms of the disease
Depending on the symptoms that occur, one differentiates:
- Asthma attack: During the attack, the symptoms increase within a few hours. In doing so, they can rapidly or gradually lead to severe impairment of the patient (acute deterioration) and death without treatment.
- Status asthmaticus: This is an asthma attack that continues despite the use of all available drugs ( cortisone, beta-2-sympathomimetics and / theophylline ) and lasts more than 24 hours.
- Permanent asthma: sufferers suffer from chronic (ie lasting for weeks to years) symptoms of varying severity and severity.
- Most severe seizures: They cause unconsciousness within minutes, but luckily they are very rare (see Brittle Asthma).
Signs of a severe asthma attack and “status asthmaticus”
- shortness of breath
- fast but superficial breathing (more than 25x breaths per minute)
- additional use of the auxiliary respiratory muscles (which are parts of the thoracic, spinal and shoulder girdle musculature which the patient includes in addition to the normal respiratory muscles because of the increased respiratory effort)
- Inability to speak longer sentences
- heavily cramped bronchial tubes with missing or very attenuated breathing noise (“silent lung”)
- Pulsus paradoxus
- Consciousness disorders, restlessness
- Lack of oxygen (bluish discolored nail beds and lips)
Four disease stages
In order to assess the severity of asthma objectively, the doctors distinguish four disease stages – depending on how often and what symptoms occur in the patient. Recently, the current guidelines five different types of asthma therapy.
|step 1||Slight, occasional (intermittent) asthma :
Discomfort: short-term, maximum 1x per week
Nocturnal discomfort: less than 2x per month
Peak flow (PEF or FEV1 ): over 80% of the target value.
PEF values fluctuate less than 20% of the setpoint.
In the interval: symptom-free with normal lung function, no respiratory disability
|Level2||Slight, persistent (mildly persistent) asthma :
Discomfort: more often than once a week, but not daily.
Nocturnal complaints: more than twice a month.
The symptoms affect sleep and limit the performance.
Peak flow (PEF or FEV1): up to 80% of setpoint
PEF values fluctuate less than 20-30% of setpoint
In the interval: no respiratory disability
|level 3||Moderate, persistent (moderately persistent) asthma :
Nocturnal complaints: more often than once a week
Complaints affect physical activity and sleep.
Peak flow (PEF or FEV1): reduced to 60-80% of setpoint
PEF values fluctuate less than 20-30% of setpoint
|Level4||Severe, persistent (severe persistent asthma) :
Complaints: persistent, ie during the day and at night, permanent symptoms of
Deteriorations and nocturnal complaints are common.
Physical activities are clearly limited.
Peak flow (PEF or FEV1): less than 60% of the setpoint in the morning.
Significant daily fluctuations: PEF levels fluctuate by more than 30%.
Early detection of the disease in asthma is particularly important. However, the first signs are often misinterpreted by those affected and relatives. For example, exertional asthma in children often occurs only in physical education and is then simply excused as a poor condition. On average, five years pass before the disease is treated.
Although you can not cure asthma, the treatment options today are very good. The quality of life of a patient must therefore by no means be limited. When asthma is under control and treated well, it has full physical capacity. About 10% of Olympic athletes in athletics have asthma. At the same time, the patient can do his / her own bit for a favorable course of the disease by dealing with his illness correctly and reliably (see Prevention and asthma patient training ).
Asthma is a chronic, ie long-lasting or lifelong disease. An exception to this is the disease in some children: With early detection of the disease and good, reliable treatment, one in three children with asthma has the chance to be cured at the latest in adulthood. However, the body’s excessive preparedness remains alive for life.
In general, the prognosis of childhood asthma is very good. Most children have only mild discomfort. In 30 to 50% of cases, asthma disappears during puberty but can reappear in adulthood. The more severe asthma in childhood, the more likely it is that those affected will suffer as adults as well. But also from mild childhood asthma may develop in later life in 5-10% of cases. The lung function of an adult who had asthma as a child is often moderately limited.
Even adults can extend the seizure-free periods by good treatment and relieve their symptoms. A “good treatment” presupposes that the asthmatic concerned becomes an expert in his own illness and develops and consistently pursues a treatment strategy that is personally tailored to his doctor.
Only with untreated asthma, especially if no medication is taken against the inflammation of the airways, it is to be feared with increasing duration of the disease that the respiratory tract of the patient take permanent damage and then permanent complaints occur. Basically, deterioration bouts and asthma attacks can be severe and even death without proper treatment, no matter how fast they develop.
Of the approximately 30 million asthmatics in Europe, about 70% are able to live well with their treatment thanks to appropriate medication and treatment. However, 1.5 million Europeans suffer from severe asthma with at least one menacing attack per week. Especially in Western Europe, there are still some patients who die as a result of an asthma attack. At the top is Portugal, with more than 8 deaths per 100,000 population per year as a result of asthma. But in Germany too (with 4-8 out of 100,000 people per year) more patients die of asthma than in other European countries (such as France: 2-4, Spain: <2). Around 90% of these deaths could be avoided through improved education and better treatment.
With appropriate treatment, the outlook for a favorable disease outcome is good in the long run. The life expectancy of a well-treated asthmatic corresponds to that of a healthy person. Permanent damage to the lung tissue as a result of the development of chronic obstructive bronchitis (with or without emphysema ) is rare.
Although asthma has not healed yet, it is treatable in most cases. A variety of therapeutic aids are available for the treatment of asthma. Their goal is for asthma patients to participate as normally as possible in their daily lives.
In principle, a good treatment consists of four pillars:
- Asthma medications (see below) to alleviate the symptoms and manage asthma attacks, whereby the patient must learn to use his remedy reliably and properly so that it can take full effect.
- Avoiding asthma triggers (allergen avoidance and triggeravoidance).
- A good asthma patient training and the implementation of the learned in daily life.
- Control of the course of the disease by the doctor (depending on the severity, for example, every three months to check the symptoms, lung function, follow the treatment plan and then, if necessary, course-oriented adjustment of treatment).
Treatment should seek optimal or best possible control of asthma by reducing inflammation in the airways and have the following goals:
- Freedom from symptoms or as long as possible seizure-free phases
- undisturbed night sleep (without coughing or shortness of breath)
- as rare as possible deterioration bumps
- preferably no emergency treatments
- Lowest possible consumption of medicines (especially if possible no additional use of demand medicines such as the rapidly acting beta-2-sympathomimetics)
- normal lung function or best possible peak flow values, with readings of less than 20% (or as little as possible) varying over the day
- as unlimited as possible and participate in the activities of daily life
- also, allow physical activity or other physical stress
- as few side effects from medication as possible
- To ensure normal growth and normal (mental, physical and mental) development in children
As part of drug therapy, these topics are discussed in more detail below:
- Medications for inhalation
- Required medicines (Reliever)
- Side effects of relievers
- Long-term medication (controller)
- Side effects of controllers
- Other asthma medications
- Staging scheme in the treatment of asthma
- Acute asthma attack
Alternative Asthma therapy
The treatment of asthma is not limited to medication. Equally important are the additional measures:
- Asthma patient education
- Respiratory and physiotherapy, breathing gymnastics
- Normalization of body weight
- Regular sports
- relaxation techniques
- Avoid triggers
- Abstinence from nicotine, avoidance of secondhand smoke, possibly smoking cessation
- if necessary, rehabilitation
A prerequisite for the effective treatment of asthma and a favorable course of the disease is that you take part in the precautionary measures as an affected patient and actively do something for yourself. They should:
- Being well informed about causes, triggers, examination and treatment options
- Learn how to handle your illness
- master the handling of your inhaler
- can assess the respiratory reaction well
- Identify problems or difficulties and discuss with your family doctor.
About half of all asthmatic illnesses could be avoided if affected patients consistently implemented existing knowledge about the risk factors of asthma. This may include, for example, separating from a pet, treating a hay fever early with specific immunotherapy ( hyposensitization ) or giving up smoking. Prevention is about avoiding acute asthma attacks and limiting long-term damage to bronchial asthma. This includes:
- Avoid asthma triggers
- do not smoke
- Learn breathing techniques and do breathing exercises
- Learn relaxation techniques
- Play sports, to asthma sports groups, participate
- Attend patient education, inform yourself
- Exchange in self-help groups
For seizure prevention, a good medical treatment is a basic requirement. This includes ensuring that you are taking your asthma medication reliably and regularly, as well as regularly monitoring the success of the treatment and adjusting the therapy if necessary. Patients with problems should, for example, measure their respiratory function at home several times a day using the peak flow meter in order to independently control and control illness progression and therapy (see also patient training ). Here you can print a Peak-Flow-Protocol or Asthma-Diary (as pdf).
The most important measure is to avoid known and further possible triggers. Every patient should become an expert in his illness. This also includes finding out which triggers are problematic for him. For example, many asthmatics develop animal hair allergy when they live in close contact with animals. Therefore, pets (even avian) are conceivably unfavorable. If the triggers ( allergens ) cannot be avoided, specific immunotherapy (hyposensitization) may also be necessary.
Avoid triggers and triggers
Once you find out what is causing or exacerbating your asthma symptoms, you should avoid these triggers and triggers as much as possible. However, this is not always easy in everyday life: Environmental influences such as temperature fluctuations or ozone smog, pollen or house dust cannot simply be avoided. Nevertheless, you can do something yourself to make your life with allergic asthma as free of complaints as possible by following the tips below. However, before you renovate your apartment sometimes expensive, should definitely be one of the following mentioned Asthmaursachen. A skin or blood test is usually not enough. It is better to prove the suspicion of the allergen in question by means of provocation tests.
dust There are house dust mites in every home. They are probably the most common cause of allergic asthma his. The causative allergen is not the mite itself, but their excretions. Remove unnecessary “mite scavengers” from your bedroom such as woolen carpets, curtains, extra pillows and blankets, but plastic carpets are much less problematic than previously thought, with a smooth floor (tiles, cork, laminate, parquet, etc.) that is at least 3 Use a vacuum cleaner with a fine filter to keep the room cool and dry The effectiveness of mite sprays is controversial, but mite-proof mattress covers are safer and wash the sheets regularly at a minimum of 60 degrees Celsius. The top bed and pillows should also be made of washable material and should be completely washed 4 times a year at 60 ° C in the machine. If possible, these “bad neighbors” should be washed once a month at 60 ° C, or once a month for 12 hours in the freezer (kill the mites) and then be washed (removes the allergen).
Dandruff from hairy pets (cats, dogs, horses, etc.)
It is certainly hard to part with a beloved pet because of an allergy. But especially in children, there is a chance that allergic asthma subsides, as soon as the allergen no longer acts. In addition, allergies do not necessarily last a lifetime. Thus, the allergic reaction to a particular animal can decrease again and disappear completely. In the case of at-risk children (one parent is allergic), keeping cats and rodents should be avoided, although dogs are often less problematic. In the case of high-risk children (both parents are allergy sufferers), it is essential to refrain from any pet ownership.
Moist walls must be rehabilitated. Shower rooms and bathrooms should always be wiped with a dry, clean towel after use and well ventilated. Compostable waste should only be stored for a short time in a closed container in the kitchen. Do without plants in the bedroom.
Certain foods (eg cow’s milk, chicken eggs, soy nuts, etc.), additives (eg for preservation) or food components (eg gluten) can cause respiratory problems or asthma attacks in allergies. When avoiding certain staple foods that one is allergic react, a change of diet to a comparable nutritious substitute food is necessary (eg on dairy products of goat and sheep in case of intolerance of cow’s milk). Here you should be informed by your doctor and, if necessary, by a nutritionist specializing in allergies (addresses can be obtained from the DAAB, email: firstname.lastname@example.org). A versatile, balanced and vitamin-rich diet is not only important for children. Generally not recommended for asthmatics are non-targeted diets and expensive supplements.
A worsening of symptoms sometimes occurs in conjunction with the following drugs:
- Painkillers such as aspirin, novalgin, diclofenac or ibuprofen
- Naturopathic remedies such as Royal Jelly or Echinacea
- Beta-blockers (used against hypertension and heart failure, but are also included in some eye drops!)
When using medication, it should be noted that antipyretic drugs with the active ingredient acetylsalicylic acid can cause asthma. Especially in older children, an intolerance of the drug is known. Therefore, they should better use paracetamol-containing preparations. Sometimes the following drugs of the same class can cause trouble: ibuprofen, diclofenac, indomethacin. Asthma sufferers should also not take antihypertensive agents (beta-blockers). Because beta-blockers are antagonists of bronchodilator asthma drugs (beta-2-sympathomimetics): they constrict the bronchi and should therefore not be taken by asthmatics.
, the smoke must necessarily be abandoned. If necessary, you can also take advantage of professional support (smoking cessation programs). Smoking aggravates the asthma symptoms, as it additionally irritates and damages the inflamed mucosa of the bronchi. This can increase both the frequency with which asthma occurs and the severity of the disease.
This also applies to passive smoking, because even passive smoking increases allergy readiness! Asthmatics should avoid rooms where smoking takes place . Especially in the presence of asthmatic children, smoking is prohibited (especially not in the home, in the car and generally indoors).
At home or in the workplace, vapors (eg paint vapors or fumes from household cleaners and sprays) and odorous substances (eg in cosmetics) can occur, which can be dangerous for asthmatics and may need to be avoided.
Air pollutants and fine dust irritate the respiratory tract and can also damage it. The suspicion that they are effective as triggers of asthma has not yet been confirmed. However, it appears that children living near a busy street have a slightly increased risk of asthma.
Asthma attacks and discomfort accumulate during summer ozone moguls. Therefore, it is particularly important for those asthmatics who are sensitive to ozone, the current evidence of ozone pollution (in radio, newspaper or Internet – for example, on the website of the Federal Environment Agency) to take seriously and in such phrases as possible not outdoors. This may be difficult to understand, especially for children, but should be consistently maintained for their benefit.
Track regional pollen forecasts via telephone services and radio or in the Internet. This will allow you to adapt to the main flight times of the pollen you are allergic to, with practical measures or medications. In addition, ventilate in the city only in the early morning or at night, in the country preferably in the evening – at this time, less pollen in the apartment. Meanwhile, there are also pollen filters for the windows, which catch at least 85% of the pollen. And remember to also install a pollen filter in your car!
Asthmatics who are hypersensitive to insect bites (eg wasps or bees) should always have an emergency medication and specific immunotherapy ( hyposensitization ) – because, with this allergy formula, the success rate is over 95%!
Since dry indoor air is a stimulatory factor for the bronchi, one should pay attention to a sufficient humidity in the room. The climatic irritability also differs individually and should be taken into account when choosing the resort. In general, there are fewer allergens in the air in high mountains and at sea. In the case of pollen allergy, it may be helpful to select the place of vacation after the expected pollen count (the sea and high mountains are particularly low in pollen).
Fast and pronounced temperature changes, especially the change from heat to cold (eg from heated rooms into the cold outside air in winter) or fog (cold and humidity) can cause breathing difficulties or asthma attacks in some people.
Pathogens of respiratory diseases
Bacteria and viruses that cause inflammation of the bronchi or lungs, but also a common cold, aggravate the symptoms of many asthmatics. Vaccination against pneumococcal and flu is therefore useful and appropriate in many asthmatics. However, if a bacterial inflammation of the sinuses or bronchitis caused by bacteria, rapid and consistent antibiotics should be taken.
Exertion Although physical exertion can trigger asthma, it is important for asthma patients to exercise. Four out of five asthmatics experience symptoms such as shortness of breath or coughing during or after exercise. In order to still be able to do sports, it is important to inhale bronchodilator drugs before exercise and to listen to warning signals from the body and to react if necessary. With a corresponding medical accompaniment, this is possible without danger. In some cities, there are also sports groups that are specially designed for asthma patients (pulmonary sports groups). Suitable are endurance sports such as walking, cycling, running and especially swimming. Since cold and dry air can cause seizures, swimming may be preferable.
Factors that play a major role in asthma are undoubtedly psychological factors: they influence how a patient copes with his illness and thus also determine the extent of the disease. Time pressure and stress, excitement and anxiety can lead to coughing and shortness of breath. Since anger and tension cannot always be avoided, learning special relaxation techniques such as Jakobson progressive muscle relaxation, autogenic training and yoga are helpful.