Bronchial Asthma: Medical History

Medical history (history of illness) represents an important component in the diagnosis of bronchial asthma. Family history

  • What is the general health of your family members?
  • Are there any respiratory diseases in your family that are common?

Social history

  • What is your profession?
  • Are you exposed to harmful working substances in your profession?

Current medical history/systemic medical history (somatic and psychological complaints).

  • Do you suffer from the following symptoms:
    • Cough with and without sputum?
    • Wheezing?
    • Seizure-like, often nocturnal dyspnea? *
    • Tightness in the chest? *
  • Children: does the child have repeated episodes of labored breathing and shortness of breath, often accompanied by dry irritable cough and noisy exhalation especially during and after physical exertion (e.g., play)?
  • Do symptoms worsen during the night and/or early morning hours?
  • Do symptoms occur after:
    • Respiratory stimuli (e.g., exposure to allergens (e.g., pollen, pets, house dust), smoke, dust, etc.).
    • Viral infections of the respiratory tract?
    • Emotional stress?
    • Physical stress/sports?
    • Changes in the weather?
    • Active and passive tobacco exposure?
    • Other noxious agents (harmful substances)?
  • Are the symptoms also dependent on the season (eg, allergen exposure) Dependent on other factors?
  • Do you have a lot of stress?

Vegetative anamnesis including nutritional anamnesis.

  • Are you overweight? Please tell us your body weight (in kg) and height (in cm).
  • Do you smoke? If so, how many cigarettes, cigars or pipes per day?
  • Is there smoking in your neighborhood?
  • Do you live in the city or in the countryside (in terms of air pollution)?
  • Do you use drugs? If yes, which drugs and how often per day or per week?

Self history incl. medication history.

Medication history

  • Antidepressants – use of older antidepressants during pregnancy was associated with an increased risk of asthma
  • Asthma can also be triggered by the use of analgesics (painkillers) – analgesic-induced bronchial asthma (analgesic asthma). These include, for example, acetylsalicylic acid (ASA; aspirin exacerbated respiratory disease, AERD) and nonsteroidal anti-inflammatory drugs (NSAID; NSAID-exacerbated respiratory disease, NERD), which interfere with prostaglandin metabolism. This is a genetically determined pseudoallergic reaction.
  • The Norwegian Mother and Child Cohort Study was able to demonstrate with regard to paracetamol exposure that in:
    • Paracetamol intake before pregnancy, there was no association with the risk of asthma in the child.
    • Prenatal exposure, the adjusted asthma rate was 13% higher in three-year-olds and 27% higher in seven-year-olds than in unexposed children.
    • Exclusive exposure during the first six months of life, the adjusted asthma rate was 29% higher in three-year-olds and 24% higher in seven-year-olds.
  • A British-Swedish research team considers the association between the use of certain analgesics during pregnancy and a predisposition of the child to asthma as proven, but not causal. According to these authors, the association can probably be attributed to maternal influences such as anxiety, stress or chronic pain.
  • Paracetamol/acetaminophen (children who received paracetamol in the first years of life are more likely to develop bronchial asthma and allergic rhinitis later).
  • Beta blockers also often trigger asthma attacks!
  • H2 receptor antagonists/proton pump inhibitors (proton pump inhibitors, PPI; acid blockers) – Use during pregnancy for heartburn increases children’s risk by 40% (H2 receptor antagonists) or 30% (proton pump inhibitors) of developing bronchial asthma in the first years of life. Note: Pantoprazole and rabeprazole are contraindicated in pregnancy, and omeprazole should be used only after careful risk-benefit consideration, according to the guidelines.

* If this question has been answered with “Yes”, an immediate visit to the doctor is required! (Information without guarantee)

Environmental history

  • Allergens in allergic bronchial asthma (allergic asthma). These include:
    • Inhalant allergens:
      • Plant dust (pollen)
      • Animal allergens (house dust mite droppings, animal hair, feathers): most common causes of perennial (“year-round”) allergic asthma are house dust mite allergy and animal hair allergy
      • Mold spores
    • Food Allergens
    • Occupational allergens (see below)
  • Occupational exposure (occupational allergens): in some occupational groups, asthma occurs more frequently due to frequent contact with allergenic, irritant or toxic (poisonous) substances. These are e.g. metal salts – platinum, chromium, nickel -, wood and plant dusts, industrial chemicals. Also known is the so-called baker’s asthma, fungal asthma and also people who work with isocyanates often suffer from asthma.
  • Air pollutants: staying in an air and polluted environment (exhaust fumes, particulate matter, nitrous gases, smog, ozone, tobacco smoke).
    • Hazard ratio of 1.05 (1.03 to 1.07) for each 5 µg/m3 increase in particulate matter (PM2.5) concentration and of 1.04 (1.03 to 1.04) for a corresponding increase in PM10 concentration
  • Damp walls (mold; during the first year of life).
  • Phthalates (mainly as plasticizers for soft PVC) – could lead to permanent epigenetic changes in the genome of the child, which later promote the development of allergic asthma.Note: Phthalates belong to the endocrine disruptors (synonym: xenohormones), which even in the smallest amounts can damage health by altering the hormonal system.
  • Cold air and fog
  • Repeated exposure to the triggering allergens (e.g., chlorinated water in swimming pools) – e.g., baby swimmingChlorinated water in swimming pools increases the risk of allergic rhinitis (hay fever) and, if predisposed, may increase the frequency of attacks of bronchial asthma. The reason for this is probably that chlorine compounds damage the barrier of the lung epithelium, making it easier for allergens to penetrate. Since 1980, the water in swimming pools may contain a maximum of 0.3 to 0.6 mg / l free and 0.2 mg / l combined chlorine at a pH between 6.5 and 7.6 according to DIN standards.
  • Household sprays – clear dose-response relationship: in individuals who used household sprays at least once a week, the risk of asthma was half that of participants who refrained from doing so; four times a week use of household sprays already led to a doubling of the risk of asthma!
  • Cleaning products in the first years of life, especially if they contained fragrances: more often asthma-like respiratory symptoms (“wheezing”) and more often was diagnosed with asthma disease (versus households with a sparing use).

* If this question has been answered with “Yes”, an immediate visit to the doctor is required! (Data without guarantee)