How to get asthma under control and relieve it: in five points

Asthma is a worldwide problem, affecting approximately 3-5% of adults and up to 10% of children. Hypothetical estimates for the next 5 years almost double this figure.

The rising trend in asthma prevalence is also to some extent due to the increasing number of people from weaker social classes and, of course, the casus socialis.
The living conditions of these groups are also the perfect trigger or trigger for the disease.
At the same time, this is a group in which asthma is very poorly controlled.
Education of the middle and upper classes is not problematic.

Get asthma under control once and for all!

Despite sufficient knowledge about the causes and risk factors of asthma, the number of cases is increasing. This is because of the aforementioned groups of people who either do not take care of their health, do not have the means to do so, or belong to a high-risk group of patients.

Despite the frightening numbers in the global number of asthma patients, there has been a significant increase in knowledge about the disease, a change in the way it is viewed and, last but not least, more effective treatment and crisis intervention.

These medical advances give patients a wide range of options to bring asthma under control and live a full life with minimal restrictions.

Find out how to do this later in the article.

What is asthma, how does it manifest, what causes it?

Asthma bronchiale or also bronchial asthma is a chronic inflammatory disease of the airways, specifically the bronchi. The disease is caused by hyperactivity of the bronchial tree, which results in narrowing of the bronchi (bronchioles) and also overproduction of mucus.
Ultimately, the narrowing and simultaneous obstruction of the airways cause breathing difficulties.

Important:
An asthma attack is typically manifested by a whistling sound on exhalation, which we call stridor.
If you have an asthma attack (shortness of breath with other symptoms) without stridor and no pathological phenomena or breathing murmurs are audible by auscultation (phonendoscope), we speak of a 'silent chest'.
A 'silent chest' represents a progression of the condition and a serious risk. The patient is at immediate risk of death.

Typical symptoms of an asthma attack

An asthma attack is a progressive exacerbation of asthma, i.e. a state of breathlessness that occurs due to various factors. The frequency of attacks is not the same for every patient. For some people they occur several times a week, for others once a month.

Classification of asthma according to the frequency of symptoms:

1. intermittent form of asthma - symptoms are sporadic and lung function is not impaired.
2. persistent form of asthma - symptoms are frequent and lung function is impaired

Table with the basic symptomatology of bronchial asthma:

Am I a high-risk patient?

In addition to the above group of people, there are patients whose asthma is a little more difficult to control. In these cases, the patient should be educated not only about the disease but also about the sudden onset and possible consequences associated with it.

Patients at risk:

• Patients who have had to be sedated, intubated and placed on artificial lung ventilation in the past because of breathing difficulties.
• patients with a history of severe asthma exacerbation requiring intensive care unit admission
• patients who have had at least one acute hospital admission in the last year
• patients who have been treated repeatedly by the emergency medical services in the last year due to ineffectiveness of their treatment
• patients taking a low dose of corticosteroids
• patients who have had to have their medication doses repeatedly increased
• patients who are dependent on medication
• patients who do not have inhaled corticosteroids
• patients who are unruly (non-use of medication, intermittent use of medication, psychiatric patients - anxiety, depression)

Negative factors and triggers of bronchial asthma

Bronchial asthma can either be born with it or acquired in adulthood. It arises in a sensitized (hypersensitive) individual due to endogenous and exogenous factors. Such an individual is also called a susceptible individual.

Read also the magazine article.

The process of sensitization occurs during intrauterine development, but also during life. The interaction of heterogeneous genetic predisposition and environmental influences leads to its occurrence.

Factors influencing the development of asthma:

• genetic predisposition
• exposure to infectious agents (viruses, bacteria, fungi, parasites)
• living in a dusty environment (prolonged, repeated)
• regular inhalation of chemical fumes (working with disinfectants and other volatile substances)
• exposure to allergens

Factors influencing the occurrence of an attack in an asthmatic:

• Excessive physical activity (panting after sporting activity)
• psychological agitation, upset, stress, strong emotions (attack conditioned by rapid breathing)
• concomitant respiratory diseases (viral, bacterial, fungal, parasitic)
• cold air (winter, cold wind, work in freezers)
• inhalation of chemical fumes (acetone in degreaser, cleaning agents, disinfectants)
• active smoking, staying in a smoky environment
• living in dusty environments (dust from sweeping pavements, increased vehicle traffic)
• living in an environment with mites, parasites, moulds (old houses, cottages)
• living in an environment with animals (animal hair, feather blankets)
• pollen, grasses (frequent walks outside during pollen season, poor pollen control measures)
• consumption of foods that promote histamine release (aged cheese, dairy products, citrus fruits, wine)
• certain preservatives containing sulphites, metatasulphites, tartrazines (dried fruit, canned fish, shrimp)
• use of certain drugs (non-steroidal antiphlogistics - ibalgin, aspirin, beta-blockers - metoprolol)

Management of well-controlled bronchial asthma

It's not a rule, but most patients with poorly controlled asthma are self-inflicted.
They know woefully little about the disease, see a doctor only when their condition worsens significantly, don't take their medication, and completely avoid risk factors.

To get your asthma well controlled, first and foremost, you need a strong will. When you have it, just follow these five rules and you'll have the upper hand.

Important Warning:
Poorly controlled or uncontrolled asthma can lead to spontaneous pneumothorax.
Poorly controlled or uncontrolled asthma leads to exacerbation, respiratory and circulatory arrest!

Read also.

1. Know your disease perfectly

To be the master of your health, you must know your condition well. Knowing that asthma causes choking after smoking a cigarette or during pollen season is not enough. Every single asthma sufferer should know more than this.

A district doctor or a pneumologist usually does not have time to explain the whole pathophysiology of the disease to you in the outpatient clinic. We know from experience that these are full of patients. Therefore, the information your doctor gives you is only marginal.

Education should be taken seriously. It is important to know the risks and consequences that you may encounter.
Studying a book or specialist material with a specific issue on the internet does not take much time and can save your life!

2. Don't forget to visit your doctor regularly and get the necessary tests

In addition to preventive medical check-ups, asthmatics should not forget to be checked by a pulmonologist and to have regular lung examinations. The frequency of check-ups and examinations is individual according to the patient's condition. The date of the next one is always determined by the doctor based on the current condition and the results.

It is the patient's responsibility to respect this and, of course, to seek immediate medical attention if the condition worsens between check-ups.

We consider spirometry to be the basic examination. Spirometry is an examination of the lungs. On the basis of this, the doctor determines their functionality.

Spirometry focuses on:

• examination or determination of arterial blood oxygen saturation
• testing lung capacity, i.e. the volume of air the lungs can hold after inspiration
• examination of the amount of air flowing from the lungs on expiration

In addition to spirometry, patients also undergo other tests such as physical stress tests, whole-body plethysmography, bronchodilation tests or measurement of the gas diffusion capacity of the lungs.

3. Do not neglect prescribed treatment

Asthma treatment is to be adhered to. Prescribed medications are taken either regularly or as needed!
Pharmacological treatment includes a large number of anti-asthmatic drugs.

Antiasthmatics are divided into two basic groups:

1. drugs that relax the spasm with a short half-life - drugs that dilate the bronchi and increase their lumen
2. long-acting anti-inflammatory drugs - reduce inflammation in the bronchial mucosa

Spasm-relieving drugs (called bronchodilators) are not used regularly, but should be carried by every asthmatic at all times. These include betamimetics and anticholinergics. They are usually in the form of sprays (ventolin) or even syrups or tablets.
They are used in the event of an asthma attack when the bronchial tubes narrow. Inhaling the drug causes them to expand again and make breathing easier. They do not treat inflammation.

Anti-inflammatory drugs include inhaled but also systemic corticosteroids (dexamethasone), leukotrienes (montelukast), cromones (cromoglycate) and some long-acting bronchodilators (theophylline).

These drugs are also called asthma controllers. On the one hand they treat asthma, on the other hand they prevent allergen-induced bronchoconstriction.

Biological treatments can also help.

4. Avoid factors that aggravate asthma

Various endogenous and exogenous factors that trigger and aggravate bronchial asthma have already been described in the article. All these factors act as allergen in a susceptible individual.

Avoidance of these factors is crucial in its treatment. It is even considered as a non-pharmacological treatment for asthma.

What must an asthmatic avoid?

• Excessive physical exertion (marathon, running up stairs)
• psychological upset as a result of strong emotions (stress, crying, laughing fits)
• a source of possible infection (a sick person)
• cold air (long walks in the wind in winter)
• inhalation of chemical fumes (bleaching hair, cleaning with chemical and irritant agents)
• smoking, but also staying in excessively smoky environments (bars, pubs, nightclubs)
• staying in dusty environments (in city centres with increased vehicle traffic)
• living in an environment with mites, parasites, moulds (old houses, cottages)
• living in an environment with animals (visiting a friend who keeps dogs, cats or birds)
• pollen (should minimise walking during pollen season, follow pollen precautions)
• consumption of foods that promote histamine release (aged cheese, dairy products, citrus fruits, wine)
• consumption of certain preservatives containing sulphites, metatasulphites, tartrazines (dried fruit)
• taking certain medicines (non-steroidal antiphlogistics - ibalgin, aspirin, beta-blockers - metoprolol)

5. Monitor your condition yourself in the comfort of your own home - self-monitoring

A device called an expiratory flow meter is used to monitor the current status of asthma. This device measures the peak expiratory flow rate. It is an indicator of the rate at which air is exhaled from the patient's lungs.

It is of great importance in practice. It helps the patient to detect airway obstruction early and thus check the effectiveness of therapy.
To simplify home use by the layperson, the result is colour-coded in three basic colour zones.

Table with colour zones of the breathalyser with description

How to use the breathalyser?

Home monitoring is very simple. The device itself resembles a thermometer with a basic scale and a moving pointer. Using it is similar to blowing into a dreger.

The mouthpiece (included with the device) must be inserted into the device.

The pointer must always be in the initial position (zero position) before use.
The examination must only be carried out standing up!

The patient must take a deep breath (full lungs) and place the instrument in his/her mouth. He/she must wrap his/her lips around the instrument so that no air can escape. All air from the lungs must be exhaled into the instrument as far as possible.
Afterwards, the result must be read on the scale with coloured zones (table above).