Bronchial asthma

Bronchial asthma is a condition characterized by a narrowing of the airways and bronchi through which air flows to and from the lungs.


Organic changes caused by asthma (physiopathology)

Asthma is a chronic inflammatory disease of the respiratory tract, it is based on chronic inflammation, which persists even when the patient feels well.
It is characterized by a reversible bronchial obstruction. With a mild seizure, it can pass spontaneously again.
Rarely, severe asthmatic forms with non-reversible bronchial obstruction occur.

Another important characteristic is bronchial hyperresponsiveness, which means that the muscles of the bronchi contract:

  • like the clappers
  • due to non-specific stimuli (for example, cold air or smoke leading to dryness of the respiratory tract).

Asthma is characterized by:

  • Presence of inflammatory cells, especially eosinophils (white blood cells involved in allergic reactions), Th2 lymphocytes, while mast cells and neutrophils are less present.
  • Hyperresponsiveness of the respiratory tract – an exaggerated reaction to different stimuli. This is an important but not exclusive feature of asthma. There are several causes, including: inflammation, neurological dysfunction, and structural changes. Inflammation appears to be the main factor because anti-inflammatory treatment reduces hyperresponsiveness.
  • Some asthmatics have airway changes that only partially trigger reversibility of obstruction:
    • Desquamation and damage to the bronchial epithelium (inner mucosa of the bronchi)
    • Thickening of the basement membrane (especially the lamina reticularis) is a characteristic sign of bronchial asthma
    • Increase in the volume of bronchial muscles
    • Proliferation and dilation of blood vessels
    • Oversecretion and increase in size of mucus-producing glands

Origin of asthma

The origin of asthma has still not been determined and many scientific studies are being carried out.
The development of asthma is a process that depends on the interaction of two main factors:

  • Genetic factors
  • Environmental factors – which occur during the development of the immune system.

Scientists have detected an imbalance in the airways in the amount of two cytokines (substances that serve the communication between cells of the immune system):

  • Th1 – decreased
  • Th2 – increased

Th1 lymphocytes produce IL-2 and interferon γ (IFN-γ), which are essential in cell defense mechanisms against infection.

Th2 lymphocytes produce a family of cytokines (IL-4, -5, -6, -9 and -13) that stimulate the production of IgE (antibodies that cause allergic reactions).

Factors favoring the production of Th1Factors favoring the production of Th2
  • Older siblings, attending kindergartens
  • infections such as measles, tuberculosis hepatitis A,
  • Rural environment
  • Use of antibiotics
  • Urban environment
  • Lifestyle and Western Diet
  • Sensitization to dust mites and cockroaches

Sources: Eder W, Ege MJ, by Mutius E. The asthma epidemic. N Engl J Med. 2006;355(21):2226–2235. Review. [PubMed]

According to conventional medicine, asthma is a chronic and incurable disease.

In children and adolescents, the male sex is more often affected, in adults mainly the female.

Forms of asthma

1) Intrinsic asthma (less than 10% of cases) manifests itself in the following way:

  • It occurs in adults around the age of 50.
  • Patients do not suffer from an allergy.
  • Between two asthma attacks, the symptoms do not disappear completely.
  • It often becomes chronic.
  • Organs are often damaged.
  • It can lead to death.

2) Extrinsic asthma has the following characteristics:

  • It occurs in adolescents or children.
  • The adolescent suffers from allergies that can be diagnosed using a cutaneous test (prick test or SKIN test).
  • Organs are not involved and death occurs only in exceptional cases.

Asthma caused by stress
This pathology occurs when doing sports (during physical training) and lasts about half an hour.

Symptoms include:

  • Dry cough
  • Breathlessness
  • Wistling breath

Nevertheless, there are many Olympic champions who suffer from asthma.

Causes of asthma and risk factors

The causes of asthma are not known, but research shows that it can be caused by many genetic risk factors, environmental factors, or infections.

Scientists believe that this condition can be hereditary (hereditary), therefore the child is more likely to develop the disease if the parents already suffer from the following conditions:

  • Asthma
  • Allergic rhinitis
  • Allergy

Immune system

With allergic asthma, there are allergic reactions to some common substances such as:

  • Cat hair (most common in children)
  • Mould
  • Dust
  • Scents
  • Pollen (most common in adults)

The immune system could also react excessively to bacteria and viruses, increasing the likelihood of an allergic asthma attack.

Asthma and childhood
Premature babies are particularly at risk of respiratory diseases and infections because their lungs are not fully developed at birth.
Sometimes infection can lead to inflammation of the airways.

Nutrition and breast milk
Asthma can occur in children who are not breastfed, because the proteins of cow’s milk:

  • are not suitable for feeding the child (they are suitable for the calf, which is a herbivore),
  • are available in too large quantities.

Obesity is a risk factor because adipocytes (fat cells) release pro-inflammatory substances that promote the occurrence of asthma.

Asthma and the environment
There are various environmental factors that can trigger the onset of asthma, for example:

  • Passive smoking
  • Air pollution
  • Puddle
  • Chemicals

Feuchtigkeit kann das Wachstum von Milben und Schimmelpilzen begünstigen, die Asthmaanfälle auslösen können.

Berufsbedingtes Asthma: Im Arbeitsumfeld können schädigende Substanzen vorhanden sein, die Asthmasymptome hervorrufen.

Anxiety and stress
In the development of asthma there is a psychosomatic component, in fact, stressful situations can aggravate the symptoms.

Gastroesophageal reflux
There is a link between asthma and gastroesophageal reflux because:

  • Asthma caused by gastroesophageal reflux is caused by the rise of stomach acid
  • Nocturnal asthma attacks can be caused by reflux. The acid in the esophagus causes a reaction of the vagal autonomic nervous system: bronchospasm.
  • Asthma improves with medication for reflux.
  • Reflux often occurs in asthma patients taking bronchodilator medications.

Asthma caused by aspirin
Aspirin and nonsteroidal anti-inflammatory drugs can trigger asthma.
This is a form of extrinsic asthma.

Premenstrual asthma
Women may have severe asthma attacks in the days leading up to menstruation.

Asthma caused by fungi and mycetes
Asthma caused by the fungus Aspergillus occurs when the patient lives in a damp apartment.

Acute or chronic asthmoid bronchitis

Asthmoid bronchitis occurs in children under 5 years of age.
It is the combination of two lung diseases:

  • Asthma
  • Bronchitis

Asthmoid bronchitis occurs in people who suffer from bronchitis and then develop characteristic asthma symptoms:

  1. Dyspnea (shortness of breath)
  2. Wheezing (similar to whistling) when exhaling, especially at night or after physical exertion

These symptoms are not caused by asthma, but:

  1. due to the small size of the bronchi in children
  2. by an excessive bronchial reaction (bronchospasm), which occurs in some children.

The symptoms of these diseases are similar to each other, so it is difficult to make a diagnosis.

Causes of asthmoid bronchitis

  • Weakened immune system
  • Infections caused by bacteria and viruses
  • Respiratory infections
  • Contact with allergens, irritants and some chemicals
  • Physical and emotional stress

Symptoms of bronchial asthma and allergic asthma

Symptoms of asthma in children

Young children may develop asthma at an early age.
The symptoms of asthma in childhood are similar to those of adults. However, since the airways in young children are much smaller, the expression is much stronger.

The main symptoms are:

Shortness of breath or resting dyspnea: Since the nasal passages are narrowed, the toddler has difficulty breathing.
This is especially pronounced if the child:

  • weeps
  • exert himself physically.

With a severe asthma attack, there may be superficial and rapid breathing.

Rapid and superficial breathing: This symptom clearly indicates that the airflow is constricted and only a small amount of air can pass through the airways.
Weezing during breathing: You can hear a whistling while the child exhales.

Cough: Chronic cough can be dry or productive.
Patients may only have to cough occasionally during the day, but the cough often worsens at night.

Insomnia – due to the symptoms and cough that occur during sleep.

Tightness in the chest: Since there is a smaller amount of air available in the lungs, the child makes an effort to get more air.
This causes a feeling of tightness in the chest.

There are some serious symptoms for which one should visit the hospital immediately:

  1. Facial pallor
  2. Blue discoloration of lips and fingernails

Symptoms in adults

Symptoms may occur in adults:

  • sudden
  • a few hours or days after contact with irritating substances.

Most asthma attacks cause difficulty breathing and shortness of breath.
Many patients have persistent dry cough, which leads to insomnia.
A sudden and unexplained feeling of chest tightness can be an early indication of a severe asthma attack.
Another symptom that may occur is pain and stiffness of the neck muscles.
An asthma attack also causes:

  • Excessive sweating
  • Hypertension
  • Accelerated heartbeat
  • Anxiety
  • Language barriers

Complications of bronchial asthma and allergic asthma

Chronic obstructive pulmonary disease (COPD)
It is a chronic lung disease with:

  • a narrowing of the bronchi
  • reduced air passage
  • degenerative change in the bronchi and pulmonary alveoli

An asthma patient may develop COPD after age 60 if the connective tissue of the bronchi loses its elasticity.

Symptoms of COPD
The symptoms may be:

  1. Shortness of breath, which increases with physical activity
  2. A chronic productive cough (with catarrh) that does not go away
  3. Lung infections are common, especially in winter
  4. Chest pain in the sense of constriction.

Other complications:

  • Respiratory acidosis – excessive blood acid due to excess carbon dioxide
  • Cor pulmonale – dilation of the right ventricle of the heart
  • Atelectasis – reduction of lung volume
  • Pneumothorax – air accumulation in the pleural cavity

Asthma during pregnancy

Taking asthma medication is not good for the child, but an uncontrolled asthma attack during pregnancy can lead to serious complications.

Asthma during pregnancy can cause:

  • A reduction in the amount of oxygen for mother and child, which can lead to serious complications
  • Congenital malformations:
    • Facial abnormalities
    • Defect of the fetal abdominal wall characterized by the exit of abdominal intestines (gastroschisis)
    • atresia
  • Preeclampsia
  • Low birth weight in the child
  • Premature birth of the child

The common treatment for asthma during pregnancy is the inhalation of cortisone.

This way:

  • the airways are opened,
  • the symptoms are alleviated.

The dose of this medication depends on:

  • Frequency of asthma attacks
  • Severity of symptoms

Diagnosis of bronchial asthma and allergic asthma

The difficulty of an asthma diagnosis in most cases is the absence of symptoms in patients when they come to the practice.
The doctor:

  • examines the patient,
  • determines whether the symptoms are typical of the disease.

In children, establishing the diagnosis is difficult, sometimes the only symptom present is a persistent dry cough.

The timing of the appearance of symptoms helps to recognize the form of allergy:

  • If the symptoms only occur in spring, this may be caused by pollen.
  • In the case of only winter asthma attacks, it is more likely that the cause is mites.

Examinations for bronchial asthma and allergic asthma

Spirometry – a lung function test that measures the amount of air inhaled.
This test confirms an existing narrowing of the airways, which improves with typical asthma with the treatment.
In addition, the exact degree of changes in lung function can also be measured.
This test:

  • can also monitor the response to asthma medications,
  • is recommended for adults and children over 5 years of age.

Methacholine test – this is a provocation test in which the doctor instructs the patient to inhale an increasing dose of methacholine as an aerosol.
This substance provokes a narrowing of the bronchi (reduces the internal volume of the bronchi).
Before and after test inhalation, spirometry must be performed to determine the difference.
If the maximum expansion volume of the one-second capacity (FEV1) is reduced by more than 20%, the test is positive.

Chest X-ray – usually not prescribed, but can help rule out other conditions, such as pneumonia.


SKIN PRICK test – a small amount of the substance to which the patient could be allergic (allergen) is carefully inserted under the skin.
The test is positive if small bubbles appear within 15 minutes.

The RAS test makes it possible to detect antibodies against some allergens.
Another, newer test is the ImmunoCAP ISAC TEST:

  • It is carried out simultaneously for 112 allergens.
  • It is just as reliable as the RAS test.

Differential diagnosis

When diagnosing, it is necessary to exclude:

  • Respiratory infection
  • Chronic bronchitis
  • COPD
  • Heart failure
  • Aortic aneurysm
  • Lung tumor that blocks the airways
  • Pulmonary tuberculosis
  • Pneumonia
  • Sarcoidosis
  • Congenital malformations:
    • of the vascular system
    • of the respiratory system

Read more: