Bronchial Asthma – Triggers of Symptoms, Diagnosis, and Treatment (in Adults) for Chronic Asthma

In medical terms, the bronchi refer to the part of the respiratory tract located below the trachea. Air enters the lungs through the respiratory tract, with each lung receiving air via a separate bronchus.

People with asthma are hypersensitive to certain physical, chemical, or allergic triggers. Their bronchial mucosa then swells significantly, leading to a narrowing of the bronchi and shortness of breath. In addition, the lining secretes a clear to yellowish mucus (sputum) that must be coughed up from time to time.

The narrowed airways cause a lack of oxygen in the patient’s body. To compensate, the patient breathes in and out more frequently. Nevertheless, this results in insufficient oxygen supply to the blood (hypoxemia).

One in ten children and one in twenty adults exhibit asthma symptoms. Among children, more boys are affected, while among adults, women are more likely to suffer from asthma. Untreated or improperly treated bronchial asthma becomes chronic. The disease can cause permanent damage to the lungs and heart.

Anatomical illustration of the trachea and bronchi in both lungs © SciePro | AdobeStock

Depending on the cause, a distinction is made between non-allergic and allergic bronchial asthma. Non-allergic asthma (endogenous, nonspecific asthma) is caused by certain physical and chemical triggers. However, it can also have an allergic component and then presents as mixed-type asthma.

In allergic bronchial asthma, allergy triggers such as

• grass and flower pollen,
• house dust mites,
• mold spores,
• food, or
• food additives

are the cause. Asthma in children is usually also the result of an existing allergy.

The exact causes of the disease have not yet been sufficiently clarified scientifically. However, lung specialists believe that a combination of genetic and environmental factors leads to it.

Patients with atopic dermatitis and those allergic to pollen have an increased risk of developing bronchial asthma. Atopic dermatitis is an inflammatory skin condition characterized by weeping, intensely itchy rashes. In addition, people with a family history of asthma and allergies are at higher risk of developing asthma.

Non-allergic bronchial asthma manifests as an asthma attack triggered by a nonspecific irritant. These can include, for example,

• stress,
• mental health issues,
• perfume,
• tobacco smoke,
• ozone,
• cold,
• chemical fumes, or
• excessive physical exertion

.

Medications, such as aspirin, or respiratory infections can also trigger symptoms in this type of asthma.

Doctors distinguish between

• between spontaneous asthma symptoms (asthma attacks) and
• long-term asthma symptoms such as shortness of breath and a dry cough.

Coughing usually occurs at night and is often accompanied by a feeling of tightness in the chest. Exhaling is difficult and is often accompanied by a clearly audible wheezing sound.

During an asthma attack, the person affected is unable to speak. They experience a racing heart, and in particularly severe cases, their nails and lips turn bluish. The patient must then immediately inhale their emergency asthma inhaler. If emergency care is not provided in this critical situation, it can even lead to a coma or cardiac arrest. People who suffer from episodic shortness of breath should consult a pulmonologist and seek treatment.

The treating specialist checks the asthma patient’s respiratory rate and listening for abnormal breathing sounds. Then they will percuss the patient’s chest: The sound heard during this procedure provides insight into the extent to which the lungs are already inflated. Lung function tests (LFTs) using specific devices reveal abnormal values in the patient, particularly during exhalation.

If asthma is suspected, the doctor will have the patient inhale a fast-acting bronchodilator. If the patient then achieves better test results in certain areas than before, asthma is likely.

The provocation test determines whether the patient has nonspecific or allergy-induced bronchial asthma. To do this, the pulmonologist has the patient inhale methacholine and then performs another pulmonary function test. The medication induces artificial shortness of breath. If the patient’s test results are worse afterward, the condition is not caused by an allergy.

A blood sample taken from the patient is tested for IgE (immunoglobulin E) antibodies. Elevated levels of these antibodies are detectable when the immune system reacts to an allergen (allergy trigger). If this is the case, the bronchial asthma is allergy-related.

In the next step, the examining physician must determine which allergen is the trigger. This is done using the so-called prick test. The asthma triggers cause red spots or hives to form at the skin incisions, each of which has been dabbed with a single allergen.

Only a portion of patients can be cured. However, with appropriate medication, bronchial asthma can be effectively managed. In approximately 40 percent of adult asthma patients, the symptoms also subside.

To treat asthma symptoms, the pulmonologist prescribes

• corticosteroid medications (glucocorticoids) to reduce inflammation in the bronchi and/or
• beta-adrenergic agonists, which dilate the airways.

As an emergency asthma inhaler, the patient uses a fast-acting beta-agonist. During an asthma attack, it immediately provides the urgently needed relaxation of the bronchial muscles. The doctor prescribes glucocorticoids for inhalation or as tablets. If the patient experiences severe asthma symptoms, they are given ipratropium bromide, which has a bronchodilator effect. In addition, oxygen is administered via a breathing mask.

Avoiding individual triggers of asthma attacks is also effective. Anyone who experiences asthma attacks due to cigarette smoke should quit smoking and also avoid secondhand smoke. Asthmatics who come into contact with allergens at work are best advised to change jobs so that their condition does not worsen.

Swimming or walking are good ways to strengthen the lungs. The patient should start with short training sessions and then gradually increase the intensity. However, they should be careful not to overexert themselves under any circumstances.

To breathe more easily during exercise, it’s a good idea to use a bronchodilator asthma medication before working out. In addition, it’s essential to always carry your emergency asthma inhaler and to take a few minutes to warm up before your workout. Patients who are prone to asthma attacks in stressful situations can benefit from learning specific relaxation techniques. These include yoga or autogenic training.

Asthma is a common chronic respiratory disease and ranks among the most common chronic diseases worldwide. Asthma is a chronic condition characterized by bronchial hyperreactivity and narrowing of the airways. The causes of asthma are diverse and range from allergic asthma to non-allergic asthma or extrinsic asthma. Various triggers can cause asthma, which is why an accurate diagnosis of asthma is particularly important.

Asthma is diagnosed through a thorough examination, with specialist diagnosis and treatment playing a central role. Guidelines such as the National Asthma Care Guideline, as well as recommendations from the Association of Scientific Medical Societies, support a structured approach to the diagnosis and treatment of asthma. Typical symptoms such as shortness of breath or coughing can also be seen in other conditions, such as chronic bronchitis; therefore, any suspicion of asthma should always be investigated.

The treatment of asthma depends on the specific type of asthma and its severity, such as mild asthma or severe asthma. The goal is to prevent acute asthma attacks and improve quality of life. Early treatment is particularly crucial for children and adolescents with asthma. Even though asthma cannot be completely cured, the condition can be well controlled with the right treatment.

What is bronchial asthma?

Bronchial asthma is a chronic respiratory disease in which the bronchi become inflamed and narrowed. This leads to typical symptoms such as shortness of breath and coughing.

What are the symptoms of asthma?

Typical symptoms include shortness of breath, coughing, wheezing, and a tight feeling in the chest. These symptoms can occur in episodes and intensify during an asthma attack.

What are the triggers for asthma?

The most common triggers include allergens, cold air, physical exertion, and infections. Allergic asthma is also triggered by specific allergens.

How is asthma diagnosed?

Asthma is diagnosed through a medical history, physical examination, and lung function tests. These tests measure the narrowing of the airways.

How is asthma treated?

Asthma is usually treated with inhaled medications. The goal is to reduce inflammation and keep the airways open.