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The following will attempt to provide insights into an illness that still spreads fear and terror today and sometimes results in social isolation. However, it should also be made clear that bronchial asthma can be treated very well with today’s medication options and, in most cases, can be associated with a good quality of life for those affected. However, the prerequisite is that those affected acquire knowledge about the disease, its cause and its treatment. Particular attention is paid to timely treatment with inhalation cortisone. Current developments of CFC-free metered dose inhalers and the advantages of certain types of application are presented in detail
What is bronchial asthma (bronchial asthma)?
Bronchial asthma is an inflammatory disease of the airways (=bronchi). The mucous membrane of the respiratory tract is primarily affected. Secondarily, the bronchial muscles are also involved, which tend to spasm due to the inflammatory stimulus. This cramping leads to the typical symptoms of asthma, namely shortness of breath. This is where the disease gets its name: Asthma = constriction or cramping. In bronchial asthma, the alveoli are not affected by the disease. The cause of the disease is inflammation of the mucous membrane of the respiratory tract. This inflammation is caused by certain cells that control the inflammatory process: These inflammatory cells are, on the one hand, the eosinophilia cells (so named because of their stainability) and, on the other hand, the lymphocytes, which control this special inflammatory process. Through certain mechanisms, these immune cells cause a release of inflammatory substances, which appears as an inflammatory reaction in the mucous membrane. Inflammatory reactions take place in different ways in the body. The inflammation always leads to redness and swelling or pain in the affected area. For example, think of the reaction to a skin injury or the reaction after an insect bite. Both are inflammatory reactions, albeit due to very different causes and very different mechanisms in the inflammatory process.
Asthmatic inflammation differs from other inflammations in that the inflammation is not triggered by bacteria or viruses, i.e. pathogens, but by immunological processes that lead to this very special, i.e. immunological, inflammation. This inflammation also leads to swelling in the bronchial mucosa, then to increased or excessive mucus formation and, in particular, to spasm of the bronchi. A layer of muscle is arranged in a ring in the bronchial walls. The inflammatory stimuli from the mucous membrane stimulate the muscle layer to contract. This cramping (= spasm) leads to a narrowing of the bronchi and thus to the breathing obstruction when exhaling that is typical of bronchial asthma: shortness of breath occurs. Depending on the intensity of the narrowing and/or the simultaneous development of mucus, shortness of breath is associated with audible breathing noises such as whistling or rattling. Sometimes there is only rattling or whistling at first.
A common phenomenon of bronchial asthma is the urge to cough and mucous sputum. These phenomena are directly caused by the inflammation of the bronchial mucosa. Bronchial asthma is therefore not a disease that always and from the outset has to be associated with threatening shortness of breath. Especially in the early stages, the asthmatic disease often only appears as a long-lasting cough, which can last for months and usually does not respond to antibiotics. A particular problem for many asthmatics is the enormous production of mucus. The slime is characterized by its particular stickiness and toughness. Not only is the amount of mucus greatly increased and it is very difficult to cough up because of its viscosity. The mucus further narrows the bronchial tubes. In addition to the cramping of the muscles, this means an increase in breathing difficulties. When the mucus has finally been coughed up with difficulty, those affected not only find this a relief, but understandably also experience an improvement in their shortness of breath. Excessive mucus production with acute worsening of shortness of breath occurs particularly frequently in acute infections, such as flu-like infections, because the bronchi are now also irritated by acute bronchitis.
Asthmatic inflammation of the mucous membranes can take different courses over time. For example, it can only be a short-term process that stops on its own. Of course, the symptoms then disappear quickly. This is typically found during an asthma attack, for example. B. as a result of an allergic reaction to animal hair (most commonly cats or dogs). If contact with the animal is interrupted (for example after visiting friends who keep cats), the allergic symptoms such as itchy eyes, runny nose or coughing with shortness of breath stop on their own.
However, if the asthmatic inflammation persists due to continuous exposure (the inflammation continues to “smolder”), then a special type of chronic inflammation develops in the mucous membrane.
These (immunological) inflammatory reactions can go unnoticed for a long time or cause only minor symptoms. This is the case, for example, if the affected person complains of a persistent cough, which is often misinterpreted as a “persistent cold”. Or the inflammation leads from the outset to permanent bronchial asthma with breathing difficulties that exist from the start (“permanent bronchial asthma”).
One of the main problems in detecting bronchial asthma is that the symptoms initially appear very mild and not typical and are therefore often not recognized as bronchial asthma.
This can be a big problem, especially in children, because children naturally often suffer from bronchitis and this makes it difficult to distinguish it from incipient bronchial asthma. It can be helpful in the assessment if other typical characteristics are present, such as allergies (hay fever) or skin diseases (neurodermatitis), or if such diseases occur in relatives. In medicine, this is referred to as atopy, as a predisposition to the occurrence of allergies, bronchial asthma or skin eczema.
Diseases that often occur with bronchial asthma are allergies such as pollen allergy, food allergy, skin eczema, neurodermatitis or inflammatory diseases of the upper respiratory tract such as sinus infections or sinus polyps.
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