Generality
Asthma is a chronic inflammatory disease of the airways, characterized by the generally reversible obstruction of the bronchi.
The obstruction of the bronchial tree is caused by inflammation of the lower airways and its consequences:
due to the inflammatory process, the bronchi contract, fill with liquid and produce an excess of mucus, reducing overall the space available for the free circulation of air.
As a result, bronchial asthma causes:
- shortness of breath or difficulty
- cough
- whistling or hissing breath
- sense of tightness in the chest.
Causes
Bronchial inflammation is often caused by sensitization of the bronchial tree to particular allergens; in practice, when in contact with certain substances (pollen, pollutants, smoke, etc.) the respiratory tract of an asthmatic person responds in an exaggerated way by becoming inflamed and shrinking.
We speak of bronchial hyper-reactivity precisely because the same stimuli, at the same dose, do not determine significant responses in healthy subjects.
Epidemiology
Asthma is particularly common among the population, since it affects on average about 5% of Italians and almost 10% of infants. To these data should then be added all those cases in which the subject is ill without knowing it.
In fact, it may happen that the symptoms of asthma are misinterpreted or underestimated by the patient, especially if he is young; a certain slice of the population tends to ignore the typical symptoms of the disease without giving too much weight to the warning signals sent by the body.
Asthma symptoms
To learn more: Asthma symptoms
When a person suffers from asthma he has symptoms such as:
- sneezing cough, more or less persistent, which may appear or be accentuated during the night or upon awakening, sometimes associated with a sense of a stuffy nose or repeated sneezing
- difficulty breathing or wheezing (shortness of breath, shortness of breath)
- the breath is hissing even if this characteristic is not always perceived by the patient
All these symptoms do not occur simultaneously in the same person, nor do they always occur with the same intensity (when they are very intense we also speak of an asthma crisis) and can develop at different times over the course of life.
Finally, it should NEVER be forgotten that as long as it does not show signs of self, asthma is a chronic disease which, if neglected, undergoes sometimes severe exacerbations.
Importance of an Early Diagnosis
In any case, if symptoms like coughing, shortness of breath and wheezing occur, it is necessary to carry out appropriate investigations, since asthma, unfortunately, is certainly not a disease to be taken lightly. It should also be remembered that, even if it mainly affects young people, asthma can occur at any age. Particularly after the age of thirty, this disease mainly affects women, tends to have no allergic origin and responds poorly to drug therapy.
The important thing in any case is to diagnose asthma as soon as possible since the treatments exist, are effective and allow the patient to lead an absolutely normal life.
The presence of one of these signs and symptoms should lead to the suspicion of asthma:
- Frequent (more than once a month) episodes of wheezing
- Cough or wheezing induced by physical effort
- Especially nocturnal cough, even outside of respiratory infections
- Absence of a seasonal pattern of symptoms
- The symptoms are persistent even over 3 years
- The symptoms worsen in the presence of:
- Aeroallergens (household dust, animals with fur, cockroaches, mushrooms)
- physical exercise
- chemical pollutants
- viral respiratory infections
- intense emotions
- smoke
- The symptoms respond to anti-asthmatic drugs
- Cold episodes that "fall on the bronchi" or that take more than 10 days to resolve
Causes and Risk Factors
When we talk about asthma it is not possible to define a single cause of origin with certainty.
Certainly, some factors have a very important role, such as familiarity with the pathology, allergies and hypersensitivity to particular irritants and non-irritants (smoke, pollution, pollen, mites, beta-blockers, aspirin, etc.).
During pregnancy about 1/3 of asthmatic women suffer a worsening of the disease.
Exercise is also a stimulus that can induce or exacerbate an asthmatic episode (sports asthma). In these cases the symptoms of the disease emerge only during sports activity or during particularly intense physical commitments.
About 20% of asthmatic children do not return asthma after adolescence.
| Risk factors for the appearance of asthma | |
| Individual factors | Environmental factors |
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The risk factors shown in bold are generally considered to be causal factors, while the others are to be considered favoring factors.
Importance of genetic predisposition
The various studies carried out show that the hereditary component affects approximately 30-60% (more and more the more important are asthma or atopy in the two parents) and that the mother has a preponderant role.
Asthma and Gastroesophageal Reflux
Gastroesophageal reflux is a particular situation that appears due to the incontinence of the sphincter of the same name (gastroesophageal). In asthma sufferers this condition can cause attacks that occur mainly at night and especially when you lie down immediately after a meal. Because of the incontinence of this sphincter that normally allows the passage of food in a single direction, it can happen that a part of the gastric contents goes up through the esophagus. The subsequent passage of small quantities of food into the respiratory tract triggers the asthmatic crisis in predisposed subjects.
To investigate the causes of asthma: Genetic and Environmental Risk Factors
Diagnosis
To assess the progress of asthma, small and simple devices are sufficient to provide the patient with a general indication of the health of his or her bronchi. For a more in-depth diagnosis, a specialist visit is necessary.
Also in this case the exam is very simple: it consists of exhaling forcefully in a mouthpiece connected to a device called a spirometer (see: spirometry). Based on the results of spirometry (FEV1 or PEF) and the analysis of symptoms it is possible to classify asthma according to a warming of gravity reported in the following table.
Classification of asthma severity: Clinical features before treatment | |||||
| Severity | Frequency of Symptoms | FEV1 or PEF | Exacerbations | Night Symptoms | Note |
| Episodic | Up to 2 times a week | normal ≥80% | Slight and less than once a month | Up to 2 times a month | No influence on daily activity |
| Lieve-Chronic | More than 2 times a week but less than 1 time a day | normal ≥80% | Slight and Approximately one per Month | More than 2 times a month | Exacerbations can affect daily activity |
| Moderate-Chronic | daily | 60-80% | Light or medium 1-2 times a month | More than once a month | Conditions daily activity |
| Grave-Chronic | Keep it going | normal ≤60% | Mild or medium more than 2 times a month or severe | Popular | Limit physical activity |
Care and Treatment
To learn more: Drugs for Asthma care
Fund drugs and need drugs
Asthma, by definition, is a chronic disease and as such must be followed over time both from a diagnostic and a therapeutic point of view. It is in fact a pathology subject to asymptomatic phases alternated with exacerbations, sometimes severe.
Precisely for this reason, asthma therapy is based on the use of:
- anti-asthmatic drugs "background", to be taken continuously to keep the disease under control, ie in the absence of symptoms
- drugs "as needed", to be taken only before a real need
Unfortunately, the alternating phases "authorize" the patient to somehow suspend the underlying therapy or follow it in his own way. Unfortunately, all this freedom can be very expensive, as it increases the risk of exacerbations and can even aggravate the disease.
An asthmatic crisis is in fact determined by the reduction of the caliber of the bronchi, in turn responsible for a decreased supply of oxygen to the various tissues. Whenever this happens the body suffers damage that adds to the previous one, amplifying the symptoms and aggravating the disease.
Thus we come to define a fundamental rule that an asthmatic should never forget:
in the presence of asthma the therapy should never be abandoned or suspended in advance, even if the symptoms subside
If very often the patient mistakenly believes that he is cured and no longer needs therapy, it is undoubtedly due to the efficacy of anti-asthma drugs.
More information on the Correct Therapeutic Setting is available in this article.
Inhaler medications
The great revolution in the pharmaceutical field began in the 1970s with the advent of bronchodilators and inhaled cortisone. Thanks to the pharmacological evolution accesses to hospitals have been considerably reduced and the treatment of asthma has become for all intents and purposes home care.
In order to treat this pathology, inhalation therapy is mainly used, since in this way the drug reaches the respiratory tract faster giving an immediate benefit.
Each canister contains a different active ingredient, chosen and prescribed by the doctor or specialist who is treating the patient. Inside we can find:
- short and long-acting bronchodilators: they act mainly by dilating the airways and releasing the bronchial smooth muscle. Invert and / or inhibit bronchoconstriction and symptoms related to acute asthma, but do not reverse airway inflammation and do not reduce bronchial hyperreactivity;
- corticosteroids: used by inhalation they arrive directly in the bronchi reducing the side effects typical of cortisone-based oral products;
- non-steroidal anti-inflammatory drugs: they are more effective than treatment with bronchodilators in the long-term control of symptoms, to improve respiratory function of the airways.
Not even all bronchodilators are the same. Some produce an immediate effect of bronchodilation which, however, vanishes as quickly (short-term bronchodilators), others are instead indicated for prolonged use. If you frequently feel the need to use short-acting bronchodilators (recurrent asthma attacks), you should consult a specialist for a check-up.
The use of medicines by inhalation, although extremely effective, hides some difficulties linked to the method of administering the drug itself. To further complicate the situation we then bring the different systems of application of the sprays of common use. Below is a general indication:
when using an inhaler, remember to shake the can before use. The leaflet will in any case suggest the best procedure to use it:
keep the chest erect and exhale deeply. Bring the inhaler into the mouth or in front of it, inhale and simultaneously press the spray can. At this point hold the breath for about ten seconds, at the end of which exhale deeply. Repeat the operation if the therapy includes a second inhalation.
All these difficulties have prompted the pharmaceutical industry to produce new powder inhaler drugs.
Asthma therapy can also include the use of other medicines, which are second choice because they are burdened by a more unfavorable risk / benefit ratio. These drugs include methylxanthines (Theophylline and its derivative Aminophylline), to be taken systemically, or anticholinergics (ipratropium bromide) for aerosols.
Prevention
When suffering from asthma, some simple hygienic and behavioral rules should never be forgotten.
In case of dust allergy it is good, for example, to eliminate curtains and carpets from your home.
More generally, every asthmatic should stay as far away from those irritants or those allergens that trigger the crisis (smoking, fresh paint, animal hair, pollen, substances with a pungent odor, etc.).
