In bronchial asthma (synonyms: Allergic bronchial asthma; Allergic bronchial asthma; Allergic hyperreactive bronchial system; Asthmoid bronchitis; Asthmoid spasms; Atopic asthma; Exercise-induced asthma; Bronchial asthma; Chronic asthma; Endogenous asthma; Endogenous nonallergic bronchial asthma; Exogenous allergic asthma; Extrinsic bronchial asthma; Bronchial hyperreactivity; ICD-10-GM J45. -: Bronchial asthma) is an attack of dyspnea. It is caused by a variable and reversible narrowing of the bronchial tubes (branches of the trachea), which is caused by inflammation and hyperreactivity (hypersensitivity). Bronchial asthma is the most common chronic disease in childhood and adolescence. The age of first manifestation is usually in the first five years of life (70% of cases). Forms of bronchial asthma:
- Extrinsic bronchial asthma – allergic bronchial asthma (allergy asthma), IgE-mediated; belongs to the polygenic inherited atopic diseases (atopy).
- Intrinsic bronchial asthma – non-allergic, not IgE-mediated.
- Infectious (viruses, bacteria) – typically occurs in winter after respiratory infections (infectious asthma).
- Drug-related – analgesics (painkillers; acetylsalicylic acid/asthma in aspirin intolerance (“aspirin-exacerbated airway disease: AERD”); prevalence (frequency of disease): 5.5-12.4% of asthma patients), beta blockers
- Triggered by physical exertion (exercise-induced asthma, Engl : “exercise-induced asthma”, EIA; in children and adolescents, the prevalence (disease frequency): 40-90%) or also emotional stress.
- Occupational or environmental – toxic, chemical-irritant substances (inhalation toxins).
- Mixed-form bronchial asthma For an extrinsic asthma – allergic asthma – the onset in younger adulthood, the first appearance at an older age speaks more for an intrinsic asthma or a mixed form.
Definition of asthma severity see below classification. Sex ratio: boys to girls is 2: 1. Among adult asthmatics, women are in the majority. Peak incidence: Allergic asthma predominantly begins in childhood. The maximum occurrence is between the 8th and 12th year of life. Non-allergic asthma does not appear until middle age (> 40 years). Infectious asthma is most common in those over 45 years of age. Seasonal accumulation of the disease: Allergic asthma occurs more frequently in early summer (pollen) and autumn (house dust). The prevalence (disease incidence) is 10-15% of children and approximately 5-7% of adults worldwide. Prevalence is highest in Scotland and New Zealand and lower in Eastern Europe and Asia. Approximately 30% of adult asthmatics have extrinsic or intrinsic asthma and the remainder have mixed forms of both.In general, asthma prevalence decreases with age, especially for allergic asthma. Here, the prevalence in the 18- to 29-year-old group is 9%. Course and prognosis: The disease is often chronic-persistent. In adolescence, spontaneous remission (improvement or freedom from symptoms) occurs in 40-80% of cases. In about 50% of children with severe asthma, the disease resolves at puberty: eosinophilia in the blood was a predictive factor for the loss of severe extent at puberty.With increasing age, however, the chances of spontaneous remission decrease. The airways of affected individuals remain susceptible throughout their lives. Bronchial asthma is associated with a high mortality rate (number of deaths in a given period, relative to the number of the population concerned): 1-8 people per 100,000 inhabitants die of asthma per year in Central Europe. Comorbidities (accompanying diseases): Common comorbidities are obesity (overweight), gastroesophageal reflux (GERD; heartburn), obstructive sleep apnea (breathing cessation during sleep) and upper respiratory tract diseases, as well as psychological comorbidities (anxiety disorders, depression). Asthmatics are particularly likely to suffer from allergic rhinitis (“common cold“), sinusitis (inflammation of the sinuses) or polyps. This is often accompanied by poorer asthma control, due to inflammation of the upper airways. Another comorbidity is psoriasis in the presence of childhood asthma.
