Diseases associated with airway obstruction are among the common diseases. By far their most significant cause is smoking.
What is airway obstruction?
An obstruction occurs when the airway becomes narrowed or obstructed. This can happen as a result of external factors such as foreign bodies or tumors, but it is more often triggered by pathological processes that take place inside the bronchial system. These airway obstructions in a narrow sense cause the reduction of the lumen of the airways in different ways. It may be bronchial muscle spasm (bronchospasm), thickened bronchial mucosa, increased accumulation of viscous mucus, or a combination of these components. The constriction increases breathing resistance and initially makes exhalation difficult because it reduces chest and lung volume and puts pressure on the airways. During inspiration, the chest expands and pulls the lungs along. The bronchi are made wide and the increased resistance does not occur at first. This occurs only in advanced stages or during violent attacks.
Causes
The fundamental cause of airway obstruction is the tendency of the bronchial system to overreact to stimuli from the environment. This hyperreactivity is the basis on which chronic obstructive airway disease develops. In bronchial asthma, there is a non-specific hypersensitivity to external stimuli such as heat and cold and allergenic substances. These can trigger an asthma attack in which there is a spasmodic contraction of the bronchial muscles. In bronchitis, the bronchial mucosa is hypersensitive to toxins and pathogens that are inhaled. Smoking plays by far the most important role in the chronification of this disease. However, other noxae such as quartz or flour dust to which people are occupationally exposed can also drive this process. External influences initially represent a purely mechanical obstacle. On the one hand, these can be foreign bodies that are swallowed when eating or by children playing with small parts. On the other hand, tumors and metastases that compress or break through the bronchial walls from the outside and grow into the interior.
Symptoms, complaints, and signs
Large foreign bodies in the trachea or bronchial branches can lead to acute life-threatening choking or massive shortness of breath (dyspnea). Inhalation in particular is restricted. Constriction due to tumors and metastases and the resulting impairment of respiratory function develop slowly. Bronchial asthma occurs in attacks and is characterized in the acute stage by marked dyspnea, often accompanied by fear of suffocation. Severe asthma attacks can be a life-threatening situation. Chronic obstructive bronchitis develops from recurrent acute bronchitis. During the course, shortness of breath also develops and worsens as the disease progresses. Initially, it occurs only during exertion, later also at rest. In addition, the bronchial mucosa swells and produces more viscous mucus, which collects inside the bronchi. This triggers persistent coughing attacks with sputum. Chronic obstructive bronchitis can develop into emphysema, in which the alveoli are dilated. The gas exchange that takes place there is impeded by this and by decreased respiration. The lack of oxygen that develops in the blood and tissues causes a blue discoloration (cyanosis) visible especially on the lips and the tips of the fingers and toes. It also often leads to a reduction in performance.
Diagnosis and course
The clinical picture of chronic obstructive airway disease usually already provides sufficient evidence for a tentative diagnosis, which can be confirmed by various additional examination methods. Imaging techniques such as radiography and computed tomography can provide information about the extent and nature of the disease. Pulmonary function tests such as spirometry and whole-body plethysmography are used to check lung volumes, breathing resistances and lung capacities. Bronchial asthma has a typical attack-like course. Acute asthma attacks of varying severity are followed by periods of extensive or complete freedom from symptoms.In contrast, the progression from acute to chronic obstructive bronchitis and emphysema occurs in sequential stages.
Complications
Airway obstruction often leads to severe, sometimes life-threatening complications. Initially, airway obstruction increases the risk of pneumoconiosis and other specific lung diseases associated with shortness of breath, coughing attacks, and pain. In severe cases, obstruction causes respiratory failure, i.e., failure of the respiratory system. The consequences of this include shortness of breath, syncope, chest pain, and fatigue, as well as severe sequelae such as tachycardia and tachypnea. Long-term complications range from chronic shortness of breath to lung and organ failure. Another complication of anthracosis is pulmonary hypertension, which occurs during the course of the disease and leads to severe disability or even death in a large proportion of affected individuals. Less severe are typical initial symptoms such as irritable cough, yellow sputum, and difficulty breathing. In a chronic course, the initially mild complications sometimes develop into severe disease. If airway obstruction develops into pneumothorax, shoulder pain, dry cough with bloody sputum, asthma-like attacks, and acute COPD-like cough symptoms may occur. Because airway obstruction itself is already a serious disease, complications are usually severe and persist permanently if left untreated. With early and comprehensive treatment by a physician, complications usually do not occur.
When should you see a doctor?
Airway obstruction is common in the context of many respiratory and pulmonary diseases and also causes corresponding breathing problems. For example, airway obstruction always occurs in the regular course of COPD or asthma. These and other airway obstructions, always require a doctor’s opinion, because they can be very distressing to life-threatening. Pulmonary specialists or specialists in internal medicine should be consulted. This involves bronchial and pulmonary conditions affecting the lower respiratory tract. For people who have already been diagnosed with airway obstruction, it follows that they should also treat it if possible. In addition to regular examinations of the respiratory tract, the underlying disease, etc., it is also advisable to consult a doctor in case of acute deterioration of breathing, which is out of the usual range. It is possible for an obstruction to worsen, for the airway to shift or even collapse. All of these things are noticeable when breathing and may necessitate calling 911. People who suddenly experience breathing problems – especially if they feel they are breathing against resistance – should always see a doctor or have one come. Sudden breathing problems may be due to airway obstruction, which is caused by acute tissue damage. Upper airway obstruction occurs, for example, in fainting patients due to the tongue falling back. Tumors in the neck may also create a resistance to breathing. If acute shortness of breath occurs, an emergency physician should always be notified in such cases of airway obstruction.
Treatment and therapy
On the one hand, therapy is aimed at eliminating or avoiding the factors that cause airway narrowing. The most important component of this is smoking cessation. An already existing narrowing and inflammatory processes are treated with medication. Agents that dilate the bronchi (bronchodilators) can be administered orally or as a fast-acting spray, for example in the event of an acute asthma attack. Corticosteroids are often used as anti-inflammatory agents. Secretolytics are agents that mobilize mucus in the airways and promote its removal. They can be taken orally or introduced by inhalation. Respiratory therapy can assist this process. This involves the use of breathing techniques by physical therapists, which patients can learn and then continue on their own. For asthmatics, learning specific breathing exercises and breathing-easing postures is important to help them better survive an acute attack. Breathing devices that train exhalation and help loosen mucus can be used as a supplement.In particularly severe cases, when dyspnea is very severe and performance is significantly impaired, demand-based oxygen administration may be necessary, and in rare cases artificial respiration. In all conditions that lead to mucus accumulation, care should be taken to ensure sufficient fluid intake.
Outlook and prognosis
Decisively responsible for a prognosis is the cause of the airway narrowing. If it arose from smoking, there is a good chance of cure. With a complete renunciation of the stimulant, the organism gradually regenerates. Normally, after 5 years at the latest, all symptoms have disappeared and the respiratory tract is permanently freed from impairment. In the case of a chronic disease such as bronchitis or asthma, the prospects of permanent freedom from symptoms are less optimistic. As soon as the inflammatory process of the respiratory disease begins or an asthmatic attack is triggered, the complaints increase. Nevertheless, they can be treated well and quickly with today’s medical options. Within a few days or weeks, the bronchitis is usually cured and the airway constriction has disappeared. In asthmatics, the airways are cleared after only a few minutes of inhalation. Due to the recurring process, a routine in dealing with the diseases returns in everyday life, yet a complete cure is not achieved. If the airway obstruction is pronounced due to a genetic or acquired cause, relief can only be achieved through surgical intervention. If the airway disposition is mild, various breathing techniques are learned to experience as little discomfort as possible in daily life. In severe cases, changes to the vascular walls must be made.
Prevention
Prevention consists of avoiding the causative and triggering factors. First and foremost, of course, is smoking cessation. But it also includes respiratory protection measures in the workplace and avoidance of climatically unfavorable conditions. For asthmatics, stress reduction measures are important. These can be applied in isolation, such as with autogenic training, meditation and other relaxation methods. However, it is also possible to combine the aspects of exercise, breathing techniques, and relaxation with techniques such as yoga and tai chi.
Aftercare
One of the goals of follow-up care is to prevent recurrence of airway obstruction. This target can be achieved in many cases. Indeed, smoking in particular is considered the primary cause of airway obstruction or narrowing. It is scientifically proven that a cessation of nicotine addiction contributes to healing, insofar as the consumption is actually responsible for the typical complaints. Preventive measures, which the patient can take himself, are also effective in many other cases. Inhalation of certain substances and baths with essential oils can prevent disease under certain circumstances. A physician will provide information about suitable measures. In principle, immunity does not build up after a single illness. Affected individuals may therefore suffer from airway obstruction again for the same or a different reason after a period of improvement. In contrast, certain conditions such as genetic causes and asthma do not result in a cure. Follow-up care becomes an ongoing issue. Imaging procedures such as a CT scan or X-rays provide information about the progress of the airway obstruction. Sufferers obtain relief through certain inhalations or breathing techniques. The attending physician prescribes medication on an ongoing basis or orders therapies as needed. Complications are thus prevented.
What you can do yourself
It is important to distinguish between airway obstruction due to disease and obstruction due to an external influence when considering ways to help yourself in everyday life. In the case of airway obstruction due to an external influence (swallowed food, etc.), strong tapping on the back must be used to try to remove the object. The affected person may still be able to do this himself. For further measures other persons are necessary. Respiratory obstructions that are disease-related can be relieved in part by resorting to inhalation of certain substances and essential oils. Inhalation is done by adding the active ingredients to a few liters of hot water.Baths are also conceivable and at the same time still relax the chest area, which can also lead to freer breathing. All plants and oils whose ingredients have a relaxing (and possibly expectorant) effect are suitable. Ginger, which can be drunk slowly in teas and mixed drinks with honey, has proven to have a decongestant effect. The most important measure, however, is to avoid irritants that lead to the narrowing of the airways. Affected individuals can put on breathing masks of simple design whenever they feel they may be exposed to harmful substances. Especially cigarette smoke, dusty basements and places polluted by chemical gases should be avoided. Breathing techniques can also be learned. Various training courses are available for this purpose, which are also adapted to different diseases.
