Bronchial asthma: What is asthma, why does a seizure occur and what helps with it?

Bronchial asthma (lat.asthma brochiale) , or bronchial asthma, also obsolete shortness of breath, is a chronic inflammatory disease, diffusely affecting the lower respiratory tract

It is primarily conditioned by an inflammatory process followed by a hyperreactive airway response to various non-specific stimuli .

The inflammatory process occurs as a "natural" reaction to an unknown substance, causing swelling on the surface of the bronchial mucosa .
Mast cells, eosinophils, neutrophils, T-lymphocytes, macrophages and epithelial cells are mainly involved.
By their action, the small mucous glands begin to produce an increased amount of mucus , which stimulates the already mentioned hyperreactive response. 

Hyperreactivity of the bronchi (bronchi) leads to their reversible spasm , ie narrowing.
Such narrowed bronchi represent obstruction in the airways

In susceptible individuals - asthmatics, this inflammation causes typical recurrent bouts of shortness of breath - asthma attack , in response to various stimuli.
Such stimuli include, for example, allergens , dusty environments, chemicals, stress , agitation, cold, or increased physical exertion.

There is spasm of the bronchi, and as a result there is a feeling of lack of air, respiratory disorders, whistling sounds, especially during exhalation, cough and oxygenation disorders.

The occurrence of an asthma attack in peace is also not uncommon, it often occurs during sleep, most often in the morning.

Occurrence of asthma in the population

Due to its high prevalence, asthma is classified as a disease of civilization .

It affects a total of more than 300 million people , with the highest incidence in Western Europe and Australia.

In Slovakia, 3 to 5% of adults and  6% to 7% of children suffer from it .

It occurs equally in men and women, although it is predominantly male in childhood, but the age equalizes with age in both sexes.

Up to 50% of cases of this disease in adults are triggered by other allergic diseases , and other viral respiratory diseases in children .
Genetics, regardless of age or gender, also plays an important role.

Several risk factors are likely to be involved in the development of the disease .

It is caused mainly by  disorders of the immune system , which are often caused by frequent respiratory diseases observed mainly in childhood, especially up to 2 years of age.
The most common are viral diseases, they can also be bacterial.

Table with the most common viruses that significantly affect the development of asthma:

In most patients with asthma, we observe the occurrence of this disease in the family, so genetic predisposition also plays a role here .
Not only asthma but also other allergies are often present in the family history, and the patient himself may also suffer from them.

Allergies , as well as asthma itself, are disorders of the immune system, in which the organism incorrectly evaluates a certain substance as undesirable, resp. harmful, and begins to fight it.  
It responds to it with a natural inflammatory response with the production of specific antibodies .

An important chapter in genetic predispositions are atopic diseases and eczema.
It is these that lead to the increased production of IgE antibodies that occurs upon contact with the allergen, and thus patients with atopy tend to be more prone to asthma.

The above factors, together with genetics, cause early sensitization leading to inflammation, which is manifested by hyperreactivity of the bronchus with subsequent reconstruction of the airways.

Risk factors involved in the development of an asthma attack

Asthma and its manifestations significantly affect the patient's quality of life .
The reason is asthma attacks , which are usually conditioned by risk factors.

These are negative factors , resp. Triggers of the inflammatory response , which are to some extent influenced by the patient's way of life, cannot be influenced by the other patient.

The most common allergic risk factors for asthma attacks:

• polluted environment / air
• dusty work / home environment
• natural allergens (pollen, grasses, mites, microorganisms, animal fur)
• bad habits (smoking, drugging)
• chemicals (paints, disinfectants, perfumes)
• pharmaceuticals
• food allergens

The most common non-allergic risk factors for asthma attacks:

• stressors
• agitation
• excessive physical activity
• physical factors (cold)
• weather changes

Manifestations of asthma and asthma attacks manifest on two basic levels.
The first level represents the symptoms specific to the respiratory system , the second level includes all other general symptoms .

As it is a disease of the respiratory system, it is mainly characterized by breathing problems .

Table with typical manifestations of bronchial asthma:

At the beginning of the disease, resp. in mild asthma, we observe dry cough attacks , which occur more and more often.
They are evoked by increased physical exertion , often arising from emotional strain .
Later the cough also comes in peace, most often it is late at night , cough attacks and shortness of breath in the morning are typical .

There are also respiratory disorders , shortness of breath , less physical performance , the need to stop some activity for shortness of breath .
Breathing is accelerated and objectively strenuous , subjectively the patient feels a lack of air and feels shortness of breath .

During labored breathing, wheezing sounds are present , which are audible at a distance, and typically occur upon exhalation.
Exhalation is a problem for asthmatics, because it is not easy to expel air from the lungs through the narrowed bronchi, and it is accompanied by an unpleasant feeling of suffocation.
The specific origin of this whistling in connection with difficulty exhaling is called expiratory stridor .

Whistling and whistling on the lungs are a common finding in auscultative listening to the chest.

Interesting:
Paradoxically, auscultation whispers and screams can be a good sign for a patient, because in a severe asthma attack, when he is unable to exhale all the air from his lungs, it accumulates and whistling sounds disappear.
We call this state the so-called silent chest , and signals to us a serious life-threatening condition .

Poorly compensated asthma and the accumulation of air in the lungs results in the inspiratory position of the chest , while using the inspiratory muscles.
Such a chest is permanently in a position of inspiration , as if the patient were still inhaled.
We can see it in a patient during an acute attack.

The intensity of asthma depends on the degree of the disease

It should be noted that the symptoms of each asthmatist may be different in intensity.
It depends on the degree of airway obstruction, that is, the degree of asthma.

Table with degrees of bronchial asthma:

The diagnosis of asthma is based on the presence of a positive history (familial occurrence of the disease, information on evoking factors), typical symptoms (shortness of breath, suffocating cough, expiratory stridor, presence of auxiliary muscle involvement during respiration, chest inspiration) , which is supported by mostly nocturnal and early morning with a typical seizure pattern.

However, the substantiated diagnosis is based on a functional examination of the lungs (evidence of airway obstruction and bronchial hyperresponsiveness). Spirometry and bronchomotor tests
are used for this .

Complementary examinations are allergological examinations (skin prick test, examination of specific IgE - antibodies), and increasingly used inflamometry (measurement of nitric oxide in exhaled air).

The course of asthma depends on the degree of the disease (degree of airway obstruction), the  patient's responsibility and education , but also on the body's response to the treatment given .

By informing the patient about his diagnosis and possible risks, observing preventive measures, and current treatment options, this disease can be kept under control, which increases the patient's quality of life.

Asthma usually results from an allergy , such as an allergy to pollen, grass, mites, animal fur, or another allergen.
It usually enters the body by inhalation into the lungs , but it can also be another way.
In the case of allergen inhalation, which is most common in asthmatics, an asthma attack occurs in a relatively short time.
For other causes, such as inhalation of pollutants - smoking, polluted air, it is a long-term process, and an asthma attack occurs more slowly over a longer period of time.

Acute conditions in asthmatics are also globally called exacerbations. Exacerbations , ie asthma attacks and acute asthma, are episodes of progressive worsening of the symptoms of the disease .

They are characterized not only by worsening of difficulties, but also by a decrease in expiratory (exhaled) air flow, a decrease in lung function, and sometimes by respiratory insufficiency (failure) .

Acute conditions occurring in asthmatics:

1. Thus, an asthma attack occurs on the basis of a certain stimulus, most often after inhalation of an allergen. The body defends itself against this allergen, which leads to inflammation and hyperresponsiveness of the lower respiratory tract with hypersecretion of mucus. This is manifested by an acute and sudden onset of bronchial narrowing, ie spasm of the bronchial muscles. Externally, the condition is manifested by a sudden onset of shortness of breath with the involvement of auxiliary respiratory muscles, cough, spastic sound phenomena and oxygenation disorder. Increased muscle activity of the auxiliary respiratory muscles is a compensatory mechanism that on the one hand helps the patient with exhalation, but on the other hand can paradoxically cause a reduction in tissue oxygenation, because working muscles consume much more oxygen than they supply.

2. The most serious condition that can occur in asthmatics is the so-called asthmatic status .It is a severe asthma attack that is either accompanied by severe bronchial obstruction from the beginning, or begins as a normal asthma attack, escalates within minutes, and does not respond to treatment. It directly endangers the patient's life, threatening death as a result of suffocation. In the worst cases, when even therapy given by a doctor in a medical facility does not work, artificial lung ventilation and subsequent therapy is necessary to maintain basic vital functions.

Asthma in children, how to distinguish it?

Common respiratory infections in children are the reason for visiting a pediatrician in up to 50% of cases.
This number should not be underestimated, because respiratory diseases are the most common trigger of asthma in children , up to 85% . They are preferably caused by viruses.

The most common viruses that trigger asthma in children:

• respiratory syncytial virus - RSV
• human rhinovirus - hRV
• human metapneumovirus - hMPV
• human boca virus - hBoV
• adenoviruses
• influenza virus

Untreated, underestimated, or poorly treated viral infections in childhood are also closely associated with the occurrence of asthma in old age.
The remaining 15% belong to genetic predisposition , ie heredity in predisposed individuals and other factors.

The most common causes of asthma in children:

• 80% viral respiratory infections
• 15% genetic predisposition
• 5% other respiratory infections

It is very difficult to diagnose asthma in the youngest children , almost impossible within three years.

The reason is the above-mentioned and at the same time very common viral diseases of the respiratory tract, which cause clinical manifestations remarkably similar to bronchial asthma, as well as the problem with the implementation of some diagnostic methods .

At this age, almost every child has at least one episode of coughing with cough and distant audible wheezing in a row, but in most cases it is caused by the upper respiratory tract viruses that are typical of them.

However, if the child has a positive family history and at the same time has typical symptoms of asthma, which are often recurrent (difficult breathing and coughing attacks, especially at night and after exercise without fever, audible wheezing sounds), the necessary diagnostic tests should be performed. .

Bronchial asthma as a disease is first diagnosed at preschool age , around 5 to 6 years.

It is during this period that the number of viral diseases of the upper respiratory tract is halved, and thus frequent episodes of shortness of breath with stridor may or may not indicate asthma.

There are a large number of expiratory stridor phenotypes in children , and therefore differential diagnosis is necessary .The final diagnosis is made only by a doctor on the basis of other professional examinations, which really proves the pathophysiology of this disease.

In school-age children and  adolescents, asthma is as typical as in adults . By this time, most pediatric patients have already been diagnosed and are usually scheduled for treatment.

Is Bronchial Asthma a Problem in Pregnancy?

Pregnancy is a period during which the future mother must be extremely careful, not only because of herself, but mainly because of her baby.
Pregnant women have to change many things, such as eating habits, lifestyle, or forget about their bad habits.

The biggest problem is medication , the use of which is very limited during pregnancy, but often vital for the mother .Many drugs cross the placenta and damage the fetus.

However, in the treatment of asthma, the therapy is not significantly different compared to non-pregnant women.

The incidence of bronchial asthma in pregnant women represents 4-12% of the total number , while during pregnancy it may be different.
In one third the course is the same, in the other third it improves, and in the last third it may be worse.
The good news is that most of the drugs used to treat it seem safe for the baby.

If asthma is properly controlled and treated , there are usually no risks to the mother or fetus .
There were no evidence of fetal abnormalities or malformations in a woman with an asthma who was taking her medication during pregnancy.

It should be borne in mind that the doctor chooses drugs with longer clinical practice and positive results in pregnancy in female patients, especially in the fertile age (between 15 and 49 years of age).
If one drug is enough to manage the disease, it is not necessary to combine the drugs unnecessarily.

On the contrary, the problem may be due to uncontrolled ,  untreated , or poorly treated asthma .
Sometimes, with good intentions but poor information from mothers, they may stop taking prescribed medications arbitrarily, often leading to unwanted complications.

The main reason for these health complications is insufficient oxygenation caused by the primary disease, which also causes insufficient oxygenation of the placenta and  fetus .

What complications can occur after stopping treatment for asthma in a pregnant woman?

• worsening of the mother's clinical condition
• more frequent exacerbations of asthma attacks
• premature birth
• low birth weight of the baby
• higher risk of death of the baby during childbirth
• the need to give birth by section

In addition to asthma medications, expectant mothers should compensate for their illness non-pharmacologically, so that they do not unnecessarily expose themselves to the negative factors that trigger an asthma attack and force them to use short-term bronchodilators in the form of sprays.

Such triggers include, for example, stress, agitation, exertion, or allergens.