Stinging nettle: Good for the bladder?

Brief overview

  • Description: Chronic inflammation of the bronchi with seizure-like constriction of the airways
  • Common triggers: allergic asthma: pollen, dust, animal dander, food; non-allergic asthma: respiratory infection, exertion, cold, tobacco smoke, stress, medications
  • Typical symptoms: Cough, shortness of breath, shortness of breath, chest tightness, breath sounds, labored exhalation, acute asthma attack
  • Treatment: medication (such as cortisone, beta-2-sympathomimetics) for permanent treatment and for attack therapy, avoid allergens, adjust lifestyle
  • Diagnostics: lung function test, X-ray of the lungs, blood test

What is asthma?

Asthma is a chronic disease of the respiratory tract. In asthmatics, the bronchial tubes become hypersensitive due to chronic inflammation.

The bronchi are a widely branched system of tubes that carry the air we breathe from the trachea to the small air sacs in the lungs (alveoli). It is in the alveoli that the actual gas exchange takes place: Oxygen is absorbed into the blood and carbon dioxide is released into the exhaled air.

Exhalation in particular is more difficult for those affected. This can sometimes be heard in whistling or humming breathing noises. In severe cases, some air remains in the lungs with each breath – a condition known as hyperinflation. Gas exchange then functions only to a limited extent, so that an oxygen deficiency can develop in the blood.

Asthma occurs in episodes. This means that in between, the symptoms improve again and again or disappear completely.

Asthma: Causes and triggers

Depending on the trigger, a distinction is made between allergic and non-allergic asthma. If the respiratory disease is caused by an allergy, certain allergens trigger an asthma attack, such as pollen, house dust, animal dander or mold. The disease often occurs together with other allergies and usually begins in childhood.

In non-allergic asthma, the stimulus comes from the body itself. This form of the disease usually develops in the course of life.

There are also mixed forms of allergic and non-allergic asthma.

Triggers for allergic asthma

The symptoms of allergic asthma occur mainly when patients are exposed to certain allergens. Typical triggers for allergic asthma are:

  • Pollen
  • Dust (dust mites)
  • Animal dander
  • Molds
  • Food
  • Medication

For more on the topic, read our article Allergic Asthma.

Common triggers for non-allergic asthma

In non-allergic asthma, non-specific stimuli cause the asthma attack. These include:

  • Respiratory infections caused by bacteria or viruses
  • Physical exertion (exertional asthma), especially when changing from relaxation to sudden exertion
  • Cold weather
  • Tobacco smoke (active and passive)
  • Perfume
  • Air pollutants (ozone, nitrogen dioxide and others)
  • Stress
  • Metal fumes or halogens (especially at work)
  • Medications that constrict the airways, for example, non-steroidal anti-inflammatory drugs (NSAIDs such as acetylsalicylic acid, diclofenac, ibuprofen, naproxen) or beta-blockers

Asthma: risk factors

Exactly how asthma develops has not yet been conclusively clarified. Both environmental factors and genetic influences probably play a role.

There is also an increased risk of asthma if the parents smoke during pregnancy. Long breastfeeding in infancy, on the other hand, reduces the risk of asthma in children, according to several studies.

Asthma: symptoms

Asthma is usually characterized by an alternation of largely asymptomatic phases and sudden, repetitive asthma attacks.

Typical asthma symptoms include:

  • Coughing, especially at night (because the bronchial tubes are then less dilated)
  • Shortness of breath, often at night or in the morning
  • Shortness of breath
  • chest tightness
  • wheezing audible with the naked ear – a dry, whistling sound when exhaling
  • labored, long exhalation

Asthma attack: symptoms

Sometimes it happens that asthma symptoms worsen acutely. This happens when asthma patients are exposed to substances to which they are allergic. It then occurs:

  • sudden onset of shortness of breath, even without physical exertion
  • agonizing cough with sometimes little viscous, clear or yellowish mucus
  • restlessness and anxiety

This is the course of the asthma attack:

The number of breaths they take per minute increases, and patients use their respiratory support muscles. This is the name given to a group of muscles in the upper body that can support the breathing work of the lungs – for example, the abdominal muscles. To make breathing easier, many patients also support themselves with their arms on their thighs or on a table. In addition, there is an audible wheezing and whistling when exhaling as part of the typical asthma bronchial symptoms.

After a phase of intense and often perceived threatening shortness of breath, the asthma attack usually subsides on its own. During this phase, the patient begins to cough up yellow mucus. Doctors then speak of a productive cough. This is still accompanied by an audible wheezing sound when breathing.

During a (severe) asthma attack, the following additional symptoms may appear:

  • bluish discoloration of the lips and fingernails due to lack of oxygen in the blood (cyanosis)
  • accelerated heartbeat
  • distended chest
  • hunched shoulders
  • exhaustion
  • inability to speak
  • in case of severe respiratory distress: retractions on the chest (between the ribs, in the upper abdomen, in the area of the jugular fossa)

A severe asthma attack is a medical emergency! The affected person must receive medical treatment as soon as possible.

First aid for an asthma attack

You can read which first aid measures are important in an acute asthma attack in the article Asthma attack.

Asthma: Treatment

Asthma therapy is divided into basic therapy (long-term therapy), attack therapy (demand therapy) and prevention. The treatment methods are correspondingly diverse.

Asthma therapy: medication

There are five (adults) or six (children and adolescents) levels of asthma therapy. The higher the level, the more intensive the therapy. In this way, the treatment can be individually adapted to the severity of the disease.

Basic therapy (long-term therapy)

Basic therapy for asthma involves the use of permanent anti-inflammatory drugs called controllers. They reduce the inflammation of the airways. As a result, asthma attacks and asthma symptoms occur less frequently and are less severe. For this longer-term effect, however, patients must use the controllers permanently and regularly.

If cortisone alone is not effective enough, the doctor prescribes additional or alternative long-acting beta-2 sympathomimetics (LABA) such as formoterol and salmeterol. They relax the bronchial muscles and thus widen the airways. They, too, are usually administered by inhaler.

In certain cases, other permanent medications may also be considered for asthma therapy. These include the so-called leukotriene antagonists such as montelukast. Like cortisone, they have an anti-inflammatory effect, but less effective.

Even if the basic therapy is successful, you should never arbitrarily reduce the dose of your medication or stop taking it altogether! Instead, talk to your doctor first. A reduction in medication is only possible after you have been symptom-free for at least three months.

Seizure therapy (demand therapy)

In advanced asthma, the doctor may also prescribe a long-acting beta-2 sympathomimetic (LABA). Its bronchodilator effect lasts longer than that of SABA. However, LABA should only be used in combination with an inhaled cortisone preparation (ICS) for demand therapy. Fixed combination preparations are also available for this purpose, which allow the two agents to be inhaled simultaneously. This combination therapy is possible in adults as well as in children over 12 years of age.

In the event of severe asthma attacks, you must call the emergency physician. He can administer glucocorticoids intravenously. Severe and life-threatening asthma attacks are additionally treated by the doctor with ipratropium bromide. This active ingredient also causes the bronchial tubes to dilate. In addition, the patient should receive oxygen via a nasal tube or mask.

Patients with a very severe attack are taken to hospital by the emergency physician. In addition to inadequate breathing, life-threatening complications of the cardiovascular system may occur.

Application inhaler

Asthmatics often use a so-called turbohaler. Here, the active ingredient passes through a rotary mechanism onto a sieve inside the device, from where it is inhaled. If you use the turbohaler according to the following step-by-step instructions, you will use it correctly:

1. prepare inhalation: Unscrew the protective cap. Hold the Turbohaler UPRIGHT, otherwise incorrect dosing is possible, and turn the dosing ring back and forth once. If you hear a click, the filling has worked correctly.

2. exhale: Before you bring the inhaler to your mouth, you need to BREATHE OUT GRADUALLY and HOLD YOUR BREATH. Be careful not to exhale through the device.

3. Inhale: Firmly enclose the mouthpiece of the turbohaler with your lips. Now INHALATE QUICKLY AND DEEPLY. This will release the cloud of medication. You will not taste or feel anything, as very small amounts are sufficient for the Turbohaler to have an effect. Breathe consciously through the Turbohaler and not through your nose.

Screw the protective cap back onto the turbo inhaler. Make sure to inhale each stroke individually. Leave a few minutes between strokes. 6.

Rinse the mouth with water after each use. Clean the mouthpiece of the inhaler only with a dry cloth, never with water.

Pay attention to the filling level indicator of the turbo inhaler. If it is at “0”, the container is empty, even if you still hear noises when shaking it. These are only due to the desiccant and not the active ingredient.

There are inhalation aids for children to use the inhaler correctly. The so-called spacer, for example, is a cylinder with a larger air chamber that can be placed on the inhaler. This attachment is designed to make it easier to inhale the medication.

Hyposensitization for allergic asthma

Among other things, allergic asthma should be controlled by medication to the extent that the patient does not currently suffer from asthma attacks. In addition, hyposensitization can only be successful if the affected person has only one asthma allergy and not several.

You can read about exactly how specific immunotherapy works and which allergies it helps with in our article Hyposensitization.

Asthma: What you can do yourself

There is only a chance of getting asthma under control if you avoid the asthma triggers as much as possible (for example, cold air or pollen). Typically, the course of the disease then improves and you need a lower dose of medication.

In the case of an animal hair allergy, for example, this can mean avoiding any contact with the animal or separating from your pet.

But it is not always possible to avoid the trigger completely. In the case of dust mite allergy (house dust allergy), it can help to wash bed linen regularly and to ban dust catchers such as carpets or cuddly toys from the sleeping quarters.

You should also refrain from smoking: It increases inflammatory processes in the lungs and further irritates the airways.

People with severe bronchial asthma that is aggravated by occupational contact with various substances (e.g., metal fumes) may need to consider a change of occupation. Adolescents with asthma should keep in mind that not all occupations are suitable for asthmatics before or in the course of choosing a career.

Your family doctor will offer you the opportunity to take part in asthma training as part of a disease management program (DMP). There you will learn everything important about the disease and receive many tips to help you manage your condition. For example, you will be shown relieving breathing techniques or tapping massages that enable you to breathe better.

You should also draw up an emergency plan together with your doctor on what to do in the event of an acute asthma attack.

However, since intense physical exertion can also trigger an asthma attack, you should follow some rules:

  • Avoid outdoor exercise in very cold or very dry air.
  • Move your exercise to the morning or evening hours in warm weather. This way you can avoid increased ozone or/and pollen concentration.
  • Do not exercise outside shortly after a thunderstorm. The storm swirls pollen through the air, which then bursts open and releases extra allergens.
  • Start your workout with a slow warm-up. This gives your bronchial system time to adjust to the increasing physical stress.
  • In consultation with your doctor, take a metered-dose inhaler of a short-acting bronchodilator medication about 15 minutes before your workout, if necessary.
  • Always carry your emergency medication with you!

Asthma: examinations and diagnosis

If you suffer from attacks of breathlessness, consult your family doctor. First, he or she will ask you about your medical history in detail. He will probably ask you these questions, among others:

  • When do the symptoms occur – during the day or at night?
  • Do the complaints change in special places, at work, when changing location or on vacation?
  • Do you have allergies or allergy-like diseases (for example hay fever or neurodermatitis)?
  • What diseases (especially of the respiratory tract) are known in your family?
  • Do you smoke or come into frequent contact with tobacco smoke?
  • Are you exposed to metal fumes in any occupational activity?

If asthma is suspected, your primary care physician may refer you to a pulmonologist (lung specialist) who has the equipment to perform specialized tests of respiratory function.

Asthma: physical examination

After the medical history interview, the doctor will examine you physically. He pays attention to the shape of your chest, your breathing rate, and whether you have trouble breathing. He also looks at the color of your fingernails and lips. If these are bluish in color, this indicates a lack of oxygen in the blood.

The examination also includes tapping the chest, known as percussion. Based on the resulting tapping sound, the doctor can detect whether the lungs are particularly distended and whether an unnatural amount of air remains in the chest during exhalation.

Asthma: Special diagnostics

In order to make a diagnosis of asthma, further examinations are necessary. These include:

  • Pulmonary function test
  • X-ray of the lungs
  • Blood test

Lung function test

In pulmonary function diagnostics, the physician measures whether the air breathed flows freely through the airways or whether the bronchi are constricted. The measurement is made using either a pneumotachograph, which measures airflow (spirometry), or a bodyplethysmograph, which measures changes in lung volume (bodyplethysmography).

In spirometry, the patient breathes through a mouthpiece with the nose closed by a clamp. The device measures the volume of air inhaled and exhaled and how quickly the air is exhaled. An important value here is the FEV1 value. It indicates how much air is forcefully and rapidly exhaled in the first second after a deep inhalation. This value is often reduced in asthma patients.

If asthma is suspected after the initial examinations, further tests follow, such as the reversibility test: For this, the patient is given a fast-acting, airway dilating medication after the first spirometry and repeats the examination again a few minutes later. If the typical values are now better, this indicates an asthma disease. This is because asthma is characterized, among other things, by the fact that the narrowing of the airways can be reversed.

The doctor can also use a so-called provocation test to check whether non-allergic asthma exists. After the initial pulmonary function test, the patient inhales a non-specific, i.e., non-allergenic, irritant (metacholine) and repeats the test shortly thereafter. Metacholine irritates the bronchial muscles and causes them to contract. If the respiratory values are now worse, this indicates non-allergic asthma.

However, care must be taken with the provocation test, as it can lead to a severe asthma attack. The physician therefore always has a fast-acting antidote at hand.

Self-test with the peak flow meter

To do this, you use a so-called peak flow meter: When you blow into the mouthpiece, it measures the maximum air flow (peak flow) when you exhale. This is usually reduced in patients with asthma.

To check the effect of your treatment or to detect an impending worsening of your condition in good time, you should regularly determine your peak flow and keep a diary of it.

You can read more about this simple lung function test in the article Peak flow measurement.

X-ray

X-ray examination of the chest (chest X-ray) is used to rule out other diseases, some of which can cause similar symptoms to asthma. These include infectious diseases such as pneumonia or tuberculosis and certain heart diseases. Chronic bronchitis and COPD also sometimes resemble asthma in appearance.

During an asthma attack, an X-ray can also show overinflation of the lungs.

Blood test

In addition, the doctor can use a blood test to find out whether the asthma is allergic or non-allergic. In the first case, certain antibodies can be detected in the blood (immunoglobulin E, or IgE for short).

Allergy tests

If the suspicion of allergic asthma is confirmed, it is important to find the exact trigger. The prick test (a form of allergy test) is suitable for this:

The doctor lightly scores the upper layer of skin and then applies solutions containing substances suspected of causing the allergy (allergens). If the triggering allergen is present, the body reacts after five to 60 minutes with a local allergic reaction – the prick test is therefore positive if wheals form or the skin reddens.

Asthma: Similar clinical pictures

Asthma is easy to confuse with other diseases that have similar symptoms. Therefore, it is important for the doctor to rule out other possible causes of the symptoms. These include the following diseases:

  • chronic obstructive pulmonary disease (COPD)
  • sarcoidosis or exogenous allergic alveolitis
  • Heart failure (cardiac insufficiency)
  • inflammation or scarring of the airways after infections
  • mentally induced accelerated and deepened breathing (hyperventilation)
  • Tuberculosis
  • cystic fibrosis (cystic fibrosis)
  • Penetration of fluid or foreign bodies into the airways
  • Pneumonia

Asthma: disease course and prognosis

Bronchial asthma is a chronic disease, which means it lasts longer or throughout life.

In at least seven out of ten children with asthma, the first symptoms become noticeable before the age of five. About half of children still have symptoms after age seven. However, if bronchial asthma is detected early and treated consistently, it is cured in about 30 to 50 percent of children during adolescence.

Asthma can also be cured in around 20 percent of affected adults, and 40 percent experience a significant reduction in symptoms over the course of the disease.

Chronic asthma can lead to permanent heart and lung damage. Certain remodeling processes in the lung tissue put increased strain on the heart, which can lead to chronic heart failure (right heart failure).

In Germany, it is estimated that about 1,000 people die each year as a result of asthma. It is therefore important to consistently carry out the medically prescribed therapy for asthma and to avoid known lifestyle risk factors such as smoking.

Asthma: frequency

The number of asthmatics in Germany is increasing. Asthma is now one of the most significant chronic diseases. Asthma in children is particularly common: about ten percent of all children suffer from bronchial asthma, boys more often than girls.

By contrast, only about five percent of adults have asthma symptoms. If asthma does not develop until adulthood, women are more frequently affected than men.