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Bronchial asthma is a chronic, inflammatory disease of the respiratory tract. Asthma is a disease with a variable course, its symptoms are difficult to predict. Sometimes the symptoms appear several times a day, sometimes several times a month, and their intensity can also vary greatly. In patients with asthma, the bronchial tubes contract too easily and too much, and the bronchial tubes continue to become inflamed, eventually leading to unfavorable tissue remodeling. What are the causes and symptoms of asthma? What is asthma diagnosis and treatment?

Asthma(Latin asthma, otherwise also bronchial asthma) is a chronic, incurable inflammatory disease of the airways that leads to reduced airway efficiency as a result of uncontrolled bronchial contractions and accumulation of thick mucus in them.

The symptoms of bronchial asthma can come and go, but the inflammation in the bronchial tract continues.

Every year around 180,000 people die worldwide from asthma and its consequences (e.g. chronic obstructive pulmonary disease).

It is estimated that asthma affects - depending on the country - from 1% to 18% of the population. According to WHO - the World He alth Organization - there are over 235 million people globally who cannot breathe calmly and safely. Children constitute a large group.

In Poland, about 4 million people suffer from asthma. According to the ECAP study, about 11% of children aged 6-14 and about 9% of the adult population suffer from asthma in Poland. It is a disease that must not be underestimated - if left untreated or improperly treated, it can lead to many complications. An asthmatic may also have a harder time suffering from respiratory infections, including whooping cough.

Here you can read about the dangers of asthmatics infected with the coronavirus

Asthma - types

Due to the etiology, the following are distinguished:

  • allergic asthma- exogenous asthma in which allergy plays a major role. If immunoglobulin E has been shown to contribute to the pathogenesis of asthma, it is referred to as IgE-mediated asthma. In allergic asthma, as in other allergic diseases, the immune system reacts to a substance that theoretically should not cause it and in he althy people it does not.
  • nonallergic asthma-intrinsic, i.e. one in which it is impossible to detect the participation of known allergens and the participation of specific IgE in triggering the symptoms of the disease

Due to the etiology, one more form of asthma can be distinguished -occupational asthma . Among occupational diseases, asthma is the most common disease of the respiratory system. Nurses and people working in agriculture, painting and cleaning services are most exposed to her appearance.

Due to the severity of the disease, the following is distinguished:

  • sporadic asthma
  • mild chronic asthma
  • Moderate chronic asthma
  • severe chronic asthma

Due to the assessment of the response to treatment and the estimation of future risk, the following are distinguished:

  • fully controlled asthmawhen the patient has no symptoms of the disease on a daily basis or they are minimal and do not affect the daily activities, the patient does not need to use emergency medications, but lung function is normal
  • partially controlled asthmawhen symptoms appear more than twice a week, the patient with asthma wakes up at night, and takes rescue medication more than twice a week or has lung dysfunction in a functional test
  • uncontrolled asthma , when symptoms are frequent, appear even several times a day, also at night, there is an increased need for emergency medications, the results of respiratory function tests are poor, and the disease significantly hinders everyday functioning

A special form of uncontrolled asthma is the so-calleddifficult asthma (diffi cult-to-treat asthma) , diagnosed when disease control is not achieved despite the use of intensive standard care according to expert guidelines.

Asthma - causes and risk factors

Most often, bronchial asthma is allergic - it is a reaction of the respiratory system to contact with an allergen. Inhaled allergens are the most important here - particles inhaled with the air.

What allergens can most often trigger asthma?

- These are house dust mites, pollen, mold fungi, animal hair. They cause inflammation in the respiratory system - erythema, swelling of the bronchial mucosa, causing bronchospasm and excess discharge. This, in turn, causes shortness of breath and cough, because the patient is forced to cough up the excess mucus secreted by the inflamed bronchi - says Dr. n. med. Piotr Dąbrowiecki, allergologist from the Department of Infectious Diseases and Allergology of the Military Institute of Medicine, chairman of the Polish Federation of Sick Associationsfor Asthma, Allergy and COPD.

- Asthma is more common in people with atopy, more often in those whose parents or grandparents suffered from asthma or allergies - emphasizes Dr. Piotr Dąbrowiecki. - In addition, research shows that obesity can also increase the risk of developing the disease, because excess body fat is a place where large amounts of inflammatory molecules are formed, which support inflammatory processes in the lungs, he adds.

Another type of asthma can be triggered by certain medicinal substances, for example acetylsalicylic acid (the so-called aspirin asthma) or beta-blockers used in the treatment of cardiovascular diseases.

A risk factor for the development of asthma in children is frequent respiratory infections. Bronchial asthma can also be the next stage of an allergic disease - in patients who previously suffered from allergic rhinitis or atopic dermatitis. And as in the case of allergic diseases - genetic susceptibility to the development of the disease can play a role.

Air pollution also contributes to the development of asthma. Children born in London during a significant increase in smog, the so-called "Great smog" had much higher childhood asthma incidence rates.

- There have been many scientific studies confirming this relationship - says Dr. Piotr Dąbrowiecki. Particles of dust, gases, pathogenic microorganisms that enter the respiratory system along with the air inhaled, damage it, cause chronic inflammation. And it is especially visible in the case of children, including those not yet born, because pregnancy is a period of particular sensitivity to toxins, allergens and all pathogens. It is because of environmental pollution that city dwellers are twice as likely to suffer from asthma, explains the expert.

According to an expertdr. n. med. Piotr Dąbrowiecki, allergologist from the Department of Infectious Diseases and Allergology of the Military Institute of Medicine, chairman of the Polish Federation of Asthma, Allergy and COPD Patients

Asthma can be diagnosed at any stage of life. It should be noted right away that there are two types of asthma: allergic and non-allergic. The latter may appear later, usually after the age of 40, and is often similar to COPD, a chronic obstructive pulmonary disease that is generally a consequence of smoking. Allergic asthma may present as early as infancy, but usually at school age. However, she too can be diagnosed late in adulthood.

Asthma - symptoms

Asthma symptoms are:

  • annoying feeling of breathlessness, related to bronchial contraction, which occurs most often at night and in the morning, and also a few minutes after strenuous exercise.
  • cough
  • wheezing
  • chest tightness

Ailments are most often paroxysmal. They can appear suddenly, at night, they can be caused by cold air, stress, strenuous exercise or an infection.

The cause of paroxysmal breathlessness may also be smog, i.e. high air pollution. Allergic asthma attacks are favored by contact with an allergen.

Without proper treatment, the symptoms worsen and the functioning of the respiratory tract is permanently impaired.

Not all patients have all symptoms. Sometimes coughing is the only symptom of bronchial asthma.

According to an expertdr. n. med. Piotr Dąbrowiecki, allergologist from the Department of Infectious Diseases and Allergology of the Military Institute of Medicine, chairman of the Polish Federation of Asthma, Allergy and COPD Patients

When, and in what situations can it be suspected that it is asthma and not a "common" allergy or COPD?

- If the patient says that he or she has attacks of breathlessness, especially at night or after exercise, if a cough appears in the second half of the night, especially in the morning, if even slight physical exertion in the fresh air causes coughing, and during you hear wheezing sounds, and after taking asthma medications, the above symptoms disappear, all of which are indicative of asthma. In contrast, asthma and COPD often overlap. Unfortunately, around 20% of asthma sufferers smoke tobacco, and smokers are the most recruited group for COPD patients.

Asthma - how to stop an attack?

Immediate help is often needed during an asthmatic attack, especially a severe attack.

Even very regular medication and careful asthma control will not prevent the patient from developing shortness of breath.

If bronchospasm does not resolve within 20 minutes, give a second dose of medication. If the attack persists this time, call an ambulance immediately!

Rapid bronchospasm causes a characteristic wheezing and prevents breathing. So what should be in such a situation?

First of all, stay calm, because panic can make your condition worse.

A fast-relaxing bronchodilator must be given and it takes effect immediately so that the patient can breathe more freely in a matter of minutes.

During an asthma attack, you should not lie down as it makes breathing difficult. It is best then to sit or stand with your elbows on the windowsill or the table.

Once the contraction has passed, the sick person must not be left unattended.Make him calm and wait until he completely returns to the state of respiratory equilibrium.

Asthma - diagnosis

The diagnosis of asthma is based on the assessment of the symptoms characteristic for this disease and a thorough medical history.

The confirmation is the result of a spirometric test assessing the functioning of the respiratory system or provocation tests, i.e. subjecting the patient to an agent that causes an asthma attack.

  • A simple asthma test. Measurement of nitric oxide (FeNO) in the exhaled air

The diagnosis of a small child, who is usually first suspected of having recurrent respiratory infections, may cause some problems.

However, an experienced doctor should deal with this as well, especially as the symptoms become more readable as the child grows.

Asthma - treatment

Asthma cannot be cured, but it is possible to control it - ad hoc, i.e. prevent exacerbations - the occurrence of ailments or at least significantly reduce and alleviate them, and long-term - stop the disease progression and a permanent decrease in the respiratory system efficiency.

According to the World Initiative Against Asthma (GINA), the treatment of asthma is currently based on two groups of drugs

  • drugs that act ad hoc, quickly expand the bronchi and facilitate breathing (including short-acting beta2-agonists, the so-called SABA)
  • drugs with anti-inflammatory properties, i.e. drugs affecting chronic inflammation in the respiratory tract, which is the cause of ailments (mainly inhaled glucocorticosteroids).

Inhaled glucocorticosteroids (ICS) are the first-line anti-inflammatory drugs in all asthma cases, considered to be the most effective in asthma control today.

Inhaled glucocorticosteroids improve lung function and reduce the sensitivity of the respiratory system, preventing or significantly weakening flare-ups. Thus, they have a positive impact on the quality of life of patients.

  • INHALATOR - types. Pressurized, dry, pneumatic and ultrasonic inhaler

The second group of drugs are long-acting (for about 12 hours) inhaled beta2-agonists (LABA), which dilate the bronchi, reducing their tension and swelling of the mucosa.

They are not used alone, but usually in combination with ICS. In patients for whom this therapy does not bring the expected results, long-acting anticholinergic drugs, including bronchodilators, are sometimes started.

Anti-inflammatory drugs also include anti-leukotriene drugs, tooused in combination therapy. On an ad hoc basis - for quick relief of asthma symptoms, also drugs from the beta2-agonist but short-acting group (SABA) and from the group of anticholinergics - effective shorter (up to 46 hours) than long-acting drugs with an almost immediate effect.

Unfortunately, many patients forget the meaning of the word "emergency" and abuse SABA drugs without using long-lasting anti-inflammatory drugs. Doing so leads to the aggravation of the disease.

To improve this situation, after 50 years of treating beta2-agonists (SABAs) as their primary reliever medication to relieve symptoms, GINA published an update to its recommendations for asthma management on April 12, 2022.

According to them, out of concern for the safety of patients, GINA recommends the immediate use of small doses of inhaled GKS / FORMOTEROL in one inhaler as the preferred method of emergency treatment at all stages of the disease (GINA 1-5), and SABA used so far it only moves to the site of alternative treatment. GINA clearly emphasizes that no patient with diagnosed bronchial asthma can be treated without the use of an anti-inflammatory drug - an inhaled steroid.

There is, however, a group of patients for whom standard treatment does not bring relief. A group of international experts, including GINA, estimate that 3.7% of patients suffer from severe asthma. In Poland, this form of the disease affects several thousand people.

Meanwhile, the drug program, which provides free access to modern biological therapies with mepolizumab and omalizumab, covers only a few hundred patients. Currently, there are 50 severe asthma treatment centers financed by the National He alth Fund in Poland. Most often these are selected allergy and pulmonary departments located in each voivodeship.

Until recently, with the ineffectiveness of classical treatment, oral glucocorticosteroids have been implemented, which (unlike inhaled glucocorticosteroids) have many serious side effects, so the therapy must be as short as possible.

Currently, GINA recommends that in the case of severe asthma not amenable to inhalation treatment, you should immediately use biological drugs - which are not only effective, but also safe.

According to an expertdr. n. med. Piotr Dąbrowiecki, allergologist from the Department of Infectious Diseases and Allergology of the Military Institute of Medicine, chairman of the Polish Federation of Asthma, Allergy and COPD Patients

Can asthma be cured?

- Cured not, but it can be cured so much that it will have a practically asymptomatic course. Then we are talking about asthmacompletely controlled, i.e. effectively conducted. But for this to happen, the patient's awareness and cooperation with the doctor are necessary. Unfortunately, this is not good. More than half of those suffering from asthma in Poland do not know that they suffer from it. Many patients do not take their medications as prescribed, and many misuse the inhaler. Many discontinue medication as soon as there is slight improvement. And there are also those who cannot quit smoking, and tobacco reduces the effectiveness of steroids. And then you have to give more of them to achieve the desired therapeutic effect, which is associated with unfavorable side effects.

Asthma - biological drugs

There has been an alternative for several years - modern biological drugs that affect the mechanisms of asthma. They allow you to control your asthma and return to normal life. In Poland, there is a program for treating severe asthma with two biological drugs - omalizumab and mepolizumab. There are also other drugs registered in Europe - benralizumab and reslizumab, so far not reimbursed in Poland.

- It has been proven in many clinical trials that they significantly improve disease control: they reduce the severity of symptoms, doses of systemic steroids, the number of exacerbations, hospitalizations, ambulance calls or visits to the HED - says Dr. hab. n. med. Maciej Kupczyk, prof. extra Medical University of Lodz, from the Department of Internal Diseases, Asthma and Allergy, president-elect of the Polish Society of Allergology.

- In some patients, we see an improvement in the parameters of the respiratory system and a lower incidence of infections. In practice, this translates into a significant improvement in the quality of life of patients. And what is important - the results of these studies are confirmed in our clinical observations after introducing biological therapy into everyday practice. We have no doubts today that this is the optimal treatment method in the group of patients with severe asthma - says the specialist.

The drug program for free biological treatment of severe asthma is currently run by 50 centers located in each province, but the number of patients receiving treatment is still too small.

Patients' access to biological therapies is difficult due to the need to strictly adhere to the provisions of the program, the lack of cooperation between specialist doctors and those running the drug program, long distances to the centers, low awareness of the disease and, finally, excessive burden on doctors with medical documentation related to admission new patients.

According to specialists, many more people should use drug programs. GINA in its newestof the guidelines reminds that for patients with severe asthma, "there is a rapidly evolving set of biological therapies that can significantly reduce severe exacerbations and improve quality of life."

The therapy should be used by patients with severe asthma, resistant to conventional inhalation therapies. To speed up diagnosis, GINA plans to soon issue a pocket guide for physicians to assess and treat patients with difficult-to-treat and severe asthma.

According to an expertdr. n. med. Piotr Dąbrowiecki, allergologist from the Department of Infectious Diseases and Allergology of the Military Institute of Medicine, chairman of the Polish Federation of Asthma, Allergy and COPD Patients

What to do if the patients do not follow the doctors' recommendations?

- Lack of cooperation on the part of patients and non-compliance with medical recommendations is a problem that occurs especially in patients who do not know about the disease. Education, i.e. training patients in basic knowledge about asthma, enriched with the topic of aerosol therapy, i.e. how to properly use inhaled drugs, as well as a chronic treatment and exacerbation therapy plan is the basis on which we can base proper disease management at home. Patients after such training have half as much disease exacerbations, their degree of asthma control improves significantly.

The best education is with your own doctor in the office, but there is not always time for a longer conversation. An asthmatic person can take advantage of training for patients with asthma, which is organized in departments dealing with asthma therapy.

Asthma, diet and sport

Every chronic disease requires a proper diet. Research shows that people who consume more vitamin C and E, beta-carotene, flavonoids, magnesium, selenium and omega-3 fatty acids control their asthma more easily and are less likely to have attacks of shortness of breath.

A diet low in these substances has a negative effect on the condition of the lungs. It also contributes to the weakening of the body, and thus promotes viral diseases that are dangerous for asthmatics.

Therefore, the plate should contain fresh fruit and green vegetables, fatty fish (salmon, mackerel), olive oil, garlic and onion.

Avoid preservatives and artificial colors, as they can exacerbate the symptoms of the disease.

If the disease is not severe, and only occasionally you have trouble breathing, do not give up sports.

Even people with exercise-induced asthma (triggered by exercise) should exercise. If you are afraid of an attack of breathlessness, take a bronchodilator before strenuous exercise.

Systematic exercises, especially aerobic ones (performed in a steady, rhythmic exercisepace), have a positive effect on the cardiovascular system.

Strong emotions can exacerbate asthma. This is confirmed by research: a stressful event increases the risk of a dyspnea attack even 5 times.

Therefore, you need to develop your own ways of fighting excessive stress. It is also important to master the constant fear of the attack of breathlessness.

People suffering from asthma do yoga and meditation well. But it does not matter which technique you choose, it is important that it is effective and allows you to shake off everyday problems in a short time.

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Where to go for help

The Organization of Patients and Supporters of Patients with Severe Asthma "Recover the Breath" (www.odbezpieczacoddech.pl) was established to help people who are most severely affected by asthma and educate patients suffering from asthma, as well as people completely he althy. The stories of the members of the Association are proof of how quickly an improperly treated or neglected disease can take over the whole life of a person.

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Respiratory system