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What is asthma?

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Asthma is a common chronic disease that affects 1-18% of the world's population and is estimated to be responsible for over 450,000 deaths per year.

It is characterised by inflammation of the bronchi, the tubes that carry air to the lungs. The inflammation leads to narrowing of the airways and contraction of the muscles around the small airways. This results in a restriction of the airflow within them.

When an asthma patient is exposed to an irritant-inducing agent from the environment, an exaggerated bronchial response is triggered with worsening inflammation, contraction of the smooth muscle fibres of the bronchi (bronchospasm) and eventually narrowing of the lumen.

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What are the types of asthma?

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Allergic (exogenous) asthma

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It is caused by allergens and affects about 90% of cases of childhood asthma. Most often it is part of the atopic course, so it is found in patients who have already developed another allergy (hay fever, food allergy, eczema). Allergens that affect the respiratory system can be pollen, animal dander, dust particles, mould, cleaning products, etc.

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Asthma with coughing only

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The patient has a dry persistent cough, without any of the other symptoms of asthma.

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Nocturnal asthma

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Patients experience symptoms during the night, after falling asleep.

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Endogenous asthma

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It is asthma caused not by allergens, but by non-specific stimuli, such as stress, air conditioning, smoke, strong odours, confined spaces.

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Occupational asthma

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Caused by dust, inhaled exhaust gases or other hazardous substances in the workplace.

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Asthma from exercise

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It occurs in cases of intensive physical exercise and, in particular, shortly after its start. This type affects almost all asthmatic people, but it can also occur in people who do not report symptoms of the condition under other circumstances.

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How is it caused?

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Asthma is caused by a combination of genetic and environmental factors. These factors interact with each other, resulting in the airways being more sensitive and reacting more strongly to certain stimuli than in healthy individuals.

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As far as genetic factors are concerned, most often the disease is part of the atopic course. Environmental factors associated with the development, but also the worsening of the disease, are air pollution, allergens, chemicals, various respiratory tract infections, gastroesophageal reflux disease or even psychological factors.

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What are the symptoms?

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The symptoms of asthma may include the following:

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Wheezing in the chest or noisy breathing

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Cough dry or with mucous discharge

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Tightness in the chest

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Dyspnea

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Symptoms may occur every day, every week or less frequently and range from mild to severe.

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How is the diagnosis made?

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The diagnosis of asthma is based on history taking, clinical examination and the identification of respiratory airflow limitation.

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The measurement of air flow is carried out by spirometry. It is a non-invasive test, which is performed in the doctor's office. In this test, the volume of air inhaled and exhaled is measured as a function of time. An increase in FEV1 (force expiratory volume 1 sec) of more than 12% or more than 200ml, after administration of a bronchodilator, indicates the degree of airway obstruction and establishes the diagnosis of asthma. In case of doubtful diagnosis, a bronchial challenge test with metacholine is additionally performed.

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What is the treatment?

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The symptoms of asthma usually subside with proper treatment. Resolution of symptoms does not mean complete disappearance of bronchial inflammation. Medication should be long-term, aimed at suppressing inflammation and preventing recurrence of symptoms. Premature discontinuation of treatment by the patient himself, without or against the advice of the doctor, is the most common error in the treatment of asthma.

Each patient needs individualized treatment, which includes:

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Avoiding the triggering - irritating agent that causes the symptoms

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Specific immunotherapy when the conditions are met

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Pharmaceutical treatment

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Drug treatment includes 3 classes of drugs:

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Relievers, which help in the immediate treatment of asthma symptoms (inhaled bronchodilators)

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Regulators, which help control bronchial inflammation and prevent asthma attacks (mainly inhaled cortisone and leukotriene antagonists)

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anti-seizure medications (mainly cortisone in pills or injected)

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About 10% of adults with asthma experience persistent symptoms and flare-ups that cannot be controlled despite adequate treatment. In these individuals, the administration of monoclonal antibody against IgE can be added.

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It is very important for the patient to take the medication exactly as prescribed by the doctor and with the correct technique. When this does not happen, symptoms may worsen or hospitalization may be needed.

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The side effects of the drugs used for asthma are mainly caused by corticosteroids. Therefore, modern asthma management aims to achieve the best possible control of symptoms with the lowest possible doses of corticosteroids. Good communication between doctor and patient is very important in order to identify and treat these side effects in time.

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Is there any prevention?

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Unfortunately, there is no test or medicine that can prevent the disease. The only way is early diagnosis and proper treatment of the disease so that sufferers can live a normal life. To achieve this, patients must:

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