The first part of this article on bronchial asthma explains in an accessible format the causes of asthma, its most common symptoms and how to assess respiratory function.
Table of contents:
- Causes of asthma development
- Types of asthma
- Symptoms of asthma
- Factors causing asthma symptoms
- Additional tests for the diagnosis of asthma
The topic of allergic diseases has made its way into magazines, television programmes and social conversations. Allergic diseases, among them asthma, have become "trendy" in a peculiar way. Indeed, the incidence of allergic diseases is rising rapidly worldwide.
It is estimated that asthma affects around 10-15% of children and 5-10% of adults globally. The causes of this allergy invasion are not fully known. It is interesting to note that the highest number of asthma patients is in highly industrialised countries. An irresistible thought arises about the 'tribute' we have to pay for a degraded nature.... However, the root causes of asthma are not known. Environmental factors are important, but they are not the ones that determine the appearance of the disease's symptoms. Asthma is a genetically determined disease. This conditioning is called atopy. Let us note why people with atopy develop asthma symptoms.
Causes of asthma development
What the stage is to an actor, the bronchial mucosa is to asthma. We are convinced of this by sections taken from the bronchial mucosa, which show signs of inflammation in patients with asthma. And although asthma can be mild or very severe, this inflammation in the bronchi is observed in every form of the disease, even the mildest. But inflammation in asthma is distinctly different from inflammation caused by viruses or bacteria.
It is known as allergic inflammation, involving numerous cells (including acidophilic cells or eosinophils) and the substances they secrete, known as mediators of allergic inflammation (e.g. histamine and leukotrienes). The extraordinary power of these substances causes allergic inflammation to "burn" like a refinery on fire! The most important effect of this constant "fire" is a strong bronchospasm, in other words, an attack of dyspnoea in the course of asthma. The relatively recent discovery of this "inflammatory" mechanism of the onset of dyspnoea has completely changed the way asthma is treated. Previously, only the bronchospasm was treated; now we treat the cause. Modern asthma treatment consists of the continuous use of powerful anti-inflammatory drugs, such as adrenal steroids.
Bronchial asthma, photo: panthermedia
The systematic and daily "control" of allergic inflammation achieved by this treatment capably reduces the number of dyspnoeas and makes asthma practically impossible for the patient. Another effect of allergic inflammation, which has not yet been best controlled, is the slowly progressive thickening and consequent stiffening of the once very elastic bronchial wall. This somewhat mysterious phenomenon, as research convinces us, occurs even in patients with a mild form of asthma, who mostly feel great! Only steroids slow down this process.
Types of asthma
It turns out that the word 'asthma' does not describe a single disease, but rather several diseases that have different causes. If the shortness of breath has lasted since childhood and is accompanied by other symptoms, such as allergic rhinitis or allergic dermatitis, this form of asthma is referred to as atopic bronchial asthma. It used to be called "extrinsic" because the allergens that trigger the symptoms of this disease come from "outside", i.e. from the human environment.
But there is also "intrinsic" asthma, or, more correctly, non-atopic asthma. The symptoms of this form of asthma appear in adults (late onset asthma). They are often accompanied by a year-round and non-allergic rhinitis. The course of this disease depends on the severity and number of infections (e.g. sinusitis), which often severely worsen the patient's respiratory capacity.
The term 'occupational asthma' is sometimes encountered. This is a particular form of asthma that occurs after exposure to chemicals in the workplace and affects people with or without atopy. Let us now take a look at the basic - and known for centuries - symptoms of asthma.
Symptoms of asthma
The most important symptoms of asthma include:
- shortness of breath on exhalation,
- dry and tiring cough,
- afeeling of tightness in the chest,
- breathlessness after minor (previously tolerated without problems) exertion.
A brief commentary is required on the word "dyspnoea". Dyspnoea is the sensation of breathlessness combined with the fear of "suffocating" and audible wheezing in the chest during exhalation. The cough in asthma is tiring, dry and often occurs at night. In children, the cough may be the only symptom of the disease. Bouts of breathlessness may be preceded by unpleasant symptoms such as itching under the chin, discomfort in the upper back, anxiety.
Bronchial asthma in children, photo: panthermedia
Factors that trigger asthma symptoms
Many factors can trigger asthma symptoms, from various allergens in the air to changes in the weather. These include house dust mites, grass pollen, animal dander and skin, moulds and cockroaches. Allergies can be triggered by (unfortunately) ubiquitous tobacco smoke, polluted air from car exhausts or strong perfume smells!
Coughing and asthmatic dysp noea can occur after exertion in cold air (jogging) or, to the surprise of those around you, during hearty laughter. Viral respiratory diseases always worsen the course of asthma and require an increase in the doses of daily medication.
Unexpected dyspnoea may occur after certain cardiovascular drugs and anti-inflammatory drugs. Sometimes dyspnoea in the course of, for example, bronchitis, which we explain by a viral or bacterial infection, appears after the aspirin we took because we had a fever!
It is worth remembering that so-called non-steroidal anti-inflammatory drugs (NSAIDs), which are commonly used to relieve fever, headache or backache, can cause an attack of dyspnoea.
Additional tests for the diagnosis of asthma
Of course, not all dyspnoea means asthma. Doctors have an arsenal of tests on the basis of which the diagnosis of bronchial asthma is certain. Ideally, the diagnosis and treatment of this disease should be handled by an allergist or lung disease specialist. It is essential that the tests ordered are carried out in order to choose the most effective treatment.
The basic test to assess the condition and reserves of our respiratory system is spirometry. Correct performance of spirometry requires the active cooperation of the patient. During this test, various respiratory manoeuvres are ordered, such as a maximum slow inhalation followed by an immediate increased exhalation. If the attempt is unsuccessful, the test must be repeated. From several attempts, the computer selects the best results, which it documents in the form of a table and graph.
Bronchial asthma test, photo: panthermedia
A home method of measuring bronchial airflow is the picoflometer. This is a simple device that allows an objective and daily assessment of the behaviour of our bronchi. A decrease in several measurement results indicates impending dyspnoea and prescribes the rapid use of an aerosol medication to dilate the bronchi. Other additional tests for the diagnosis of asthma are: skin allergy tests, lung radiographs and blood tests. Of primary importance in the diagnosis of the disease, in addition to the test results, is the patient's history, i.e. the distressing symptoms reported by the patient.
Continued in Part Two
