Bronchospasm is a contraction (medical term spasm) of the smooth portion of the muscles of the bronchi. Bronchospasm often develops in the context of airway irritation, such as allergies or ingestion of toxic substances. In addition, bronchospasm is often seen in so-called obstructive diseases of the lungs, for example, asthma or COPD.
What is bronchospasm?
In the context of bronchospasm, the muscles in the area of the bronchi tighten. These are primarily smooth muscles that surround the airways. Various causes lead to the occurrence of bronchospasm, for example, contact with special vapors or asthma disease. As a result of the spasm, the muscles located in the area of the bronchi narrow. As a result, the width of the airways decreases and breathing resistance increases. Consequently, airway obstruction develops. For this reason, there is also an association between bronchospasm and obstructive diseases of the lungs. Due to the increased resistance during breathing, the lungs are either not supplied with enough air or are overinflated. If bronchospasm persists too long, hypertrophy develops in the muscles of the bronchi.
Causes
Bronchospasm is triggered by several potential contributing factors. In the majority of cases, these are external factors. For example, chemical or physical irritants are possible triggers. Certain types of medical agents are also capable of provoking bronchospasm. These include primarily antibiotic agents that release the substance histamine, as well as opiates. In addition, certain patient groups suffer from bronchospasm particularly frequently. The increased susceptibility to the phenomenon is primarily seen in people with asthma, acute airway diseases, and smokers. People with COPD, certain allergies and allergic rhinitis are also particularly at risk. Bronchospasm also results in many cases, for example, when individuals inhale smoke or steam. In addition, bronchospasm may be triggered by surgery in the airway area. Sometimes the cause of bronchospasm is due to a procedure called endotracheal intubation, which is performed with inadequate anesthesia.
Symptoms, complaints, and signs
The symptoms of bronchospasm as well as their severity vary. Basically, bronchospasm causes the bronchial areas or the surrounding smooth muscle to constrict. As a result, a sufficient amount of air does not reach the lungs of the affected person. Thus, patients initially suffer from shortness of breath. The sudden onset of this phenomenon often causes the sufferer to panic, resulting in hyperventilation. This is because the narrowed airways necessitate an increase in breathing frequency in order to inhale the required air. If the air passes through the constricted area, a whistling sound is also produced during exhalation. In addition, affected patients suffer from an unquenchable cough. In conjunction with this, individuals frequently expel mucus. As a result, breathing becomes even more difficult because the mucus blocks the airways. Pain develops in the chest and airway area. In the process, many patients feel intense pressure or have the sensation of bruising in the chest area. The symptoms of bronchospasm usually worsen as the sufferer panics. Exercise and outbreaks of sweat often have a negative effect on the progression of bronchospasm. In addition to the actual bronchospasm, there is also a so-called feigned bronchospasm. This occurs, for example, when persons inhale foreign substances, suffer from pulmonary embolism or edema, or a ventilation tube is kinked.
Diagnosis and course
When bronchospasm is severe, some individuals call 911, who then makes the diagnosis. To determine the disease, the physician is guided by the typical symptoms of bronchospasm. Clues such as increased breathing resistance as well as characteristic sounds when exhaling indicate bronchospasm. In principle, rapid diagnosis and therapy of bronchospasm are of great importance.This is because prolonged bronchospasm carries the risk of so-called hypercapnia, in which the concentration of carbon dioxide in the blood is increased. In addition, hypoxia is possible, in which the tissue is no longer supplied with sufficient oxygen.
Complications
Bronchospasm results from a variety of causes, which can carry various complications. For example, those with allergies are particularly susceptible to airway constriction. Due to a certain substance, the airways swell strongly and become obstructed, the affected person can hardly breathe and is in danger of suffocating. Due to the anatomical proximity to the esophagus, the patient also experiences discomfort when swallowing. In addition, due to the allergic reaction, deeper layers of the skin can swell strongly, the Quincke’s edema develops, which can worsen the symptoms even more. In the worst cases, there is a sharp drop in blood pressure, as a result of which several organs are no longer supplied with sufficient blood, anaphylactic shock develops. The organs can fail as a result and present further problems for the sufferer. Similar complications can also occur with asthma. The most feared complication is status asthmaticus, in which even antiasthmatics are of no help and the person concerned is in danger of suffocating. In this case, an emergency physician should be notified immediately. Infection of the airways can also cause bronchial constriction. In some cases, the infection can spread to the lungs and cause inflammation there (pneumonia). In the worst cases, the inflammation may spread systemically, resulting in sepsis.
When should you go to the doctor?
New-onset bronchospasm should always be evaluated by a physician, as it is the symptom of many chronic and acute conditions. In addition, feigned bronchospasm may indicate damage to the lungs or air in the pleural cavity. In this case, the actions of the affected person are largely determined by the effects of the spasm. If it is a mild restriction with shortness of breath and cough that will pass, emergency medical attention is not necessary. Affected individuals should find a resting position in which they can cough and seek medical attention when the bronchospasm has subsided. Bronchospasm that results in pain and severe shortness of breath may necessitate calling an emergency physician. There are bronchospasms that are further exacerbated by the onset of hyperventilation, mucus production, and cramping, which may pose a risk of choking. People with chronic diseases that cause increased airway spasm will experience them more frequently. If they have an episode, they must assess for themselves whether calling 911 is necessary. However, if the general perceived condition of the respiratory tract worsens due to more frequent or more severe spasms, a medical evaluation by the attending physician is necessary.
Treatment and therapy
Options for treating bronchospasm vary, with the decision to use certain measures based particularly on the severity of the bronchospasm. For example, it is possible that affected patients will receive manual ventilation. In the course of this, they receive high concentrations of oxygen. If the bronchospasm occurs as part of a surgical procedure, it may be helpful to give the person more anesthesia. Anesthetic agents such as ketamine are suitable for this purpose. So-called beta-2 mimetics are able to dilate the bronchi and relieve the discomfort of bronchospasm.
Outlook and prognosis
Bronchospasm has a favorable prognosis with prompt medical care. With drug treatment, relief of symptoms sets in within a short time. The spasms of the muscles are relieved, allowing the affected person to breathe normally again. If there are no other underlying or secondary symptoms, the patient is free of symptoms. Bronchospasm can recur at any time. The more frequently it occurs, the higher the risk of suffering further damage. The prospect of recovery deteriorates considerably as soon as the patient is affected by chronic lung disease. In these cases, damage to the tissue has already occurred, leading to irreparable development. In addition to breathing difficulties, functional disorders may occur or organ failure is imminent. This is associated with a life-threatening condition of the patient.At this stage, the patient can only be helped by an organ transplant, which in turn is associated with side effects and risks. An anxiety disorder may develop due to the sudden onset of bronchospasm. The muscle spasm leads to unexpected shortness of breath. This triggers the fear of death by suffocation. In addition, a panic attack or panic disorder may develop. This has an immense influence on the general health feeling. The undersupply of the organism with oxygen can also trigger secondary diseases and thus negatively affect the chance of recovery.
Prevention
Bronchospasm can be prevented to a certain extent, although cases of disease are not entirely preventable even with preventive measures. Individuals at increased risk for bronchospasm receive certain preventive medications before surgical procedures. Beta-2 mimetics are used for this purpose. When possible, attending physicians anesthetize the area to be operated on only regionally during a surgical procedure.
Aftercare
After bronchospasm has occurred, there are usually no further symptoms. The patient can resume normal breathing and go about his or her life. In this case, rapid immediate relief proves beneficial to recovery. Follow-up care is unnecessary. However, immunity does not develop. A recurring illness for the same or another reason is possible at any time. Basically, a clustered occurrence necessitates continuous follow-up care because the likelihood of chronic damage increases. The physician identifies an acute condition by the typical respiratory symptoms. So far, there are hardly any possibilities to prevent bronchospasm. It often occurs in combination with other respiratory diseases. Patients at risk are informed about health-preserving behaviors as part of the initial therapy. This includes, above all, taking it easy. Strenuous activities should be avoided at all costs. A healthy and balanced diet is advisable. Nicotine consumption should be discontinued. Follow-up care also aims to rule out complications. Patients at risk include allergy sufferers and asthmatics. They can be helped by medication to prevent shortness of breath. Regular use reduces the likelihood of bronchial muscle spasm. Only minor restrictions have to be accepted at work and in private life.
What you can do yourself
If bronchospasm is suspected, the emergency medical services must be called immediately and informed of the situation using the W questions. First aid measures must be taken until the arrival of the emergency physician. The first thing to do is to calm the patient, provide him with warm blankets and loosen constricting clothing. The upper body must be positioned upwards and the legs positioned low. If the affected person is asthmatic, appropriate asthma medication should be used to treat the bronchospasm. If unconscious, the affected person must be placed in the stable lateral position. If possible, breathing and pulse should be checked regularly thereafter. If necessary, resuscitation measures must be taken. In addition to mouth-to-mouth resuscitation, cardiopulmonary resuscitation and – assuming appropriate expertise – a tracheotomy are recommended. The emergency physician must be informed about the measures taken and the health condition of the victim in order to ensure rapid treatment. After treatment in the hospital, the affected person must first rest in bed and take it easy. Accompanying this, the causes of the bronchospasm must be determined. This, along with consultation with a family physician, will prevent further attacks in most cases.
