Asthma bronchial asthma is a chronic inflammatory disease of the Airways. These parts of the lungs react in asthmatics to certain stimuli, such as psychological distress or overexertion, oversensitive and narrow krampfartig.
Due to hypersensitivity to actually harmless substances, the Airways in asthma are bronchial constantly inflamed. Therefore, the mucosa is very much tough mucus in the bronchi and swells. As a result, the Airways narrow. In addition, the respiratory muscles cramped. This leads to a shortness of breath occurring in seizures.
Asthma is the most common chronic disease of childhood. In Germany about 10 percent of the children and five percent of adults of asthma are affected asthma. In children, asthma is predominantly allergic caused and also for adults, allergens are often the triggers of asthma. About 50 percent of the adult asthmatics, however, exists a so-called non-allergic asthma – here, respiratory infections are often the triggers. Non-allergic asthma only occurs in Middle adulthood. There are also hybrid forms of allergic and non-allergic asthma.
An asthma attack lasts from a few seconds up to several hours (severe asthma attack). Triggers are allergies, upper respiratory infections, overexertion, psychological distress, cold, drugs or contaminated air. To make a diagnosis, the doctor picks up the medical history and examines the affected physically. It checks the lung with a lung function test and clarifies possible allergies. Ist der Auslöser für das Asthma bekannt (z.B. Staub , Haustier-Allergie , Zigarettenrauch ), ist es wichtig, diesen so gut wie möglich zu meiden.
Bei der Asthma-Therapie unterscheidet man zwischen zwei Behandlungen:
- Behandlung eines akuten Asthmaanfalls
- Behandlung in den Zeiträumen zwischen den Anfällen (Intervalltherapie)
In der Regel verschreibt der Arzt Bronchialsprays zum Inhalieren, selten Tabletten beziehungsweise Kapseln. Important active ingredients come from here of the Group of Beta-2-sympathomimetic drugs, cortisone preparations, Antileukotriene and, where appropriate, of the active substance cromoglycate. In severe cases of asthma, it may be necessary to administer medicines, where appropriate, through a vein.
Boys more often have asthma than girls. However, the risk is higher that they have more asthma problems as adults in sick girls. Overall, the chance to have no more complaints, when the disease is recognized and treated in adult has approximately one out of three children with asthma bronchial. The respiratory tract remain hypersensitive, but the whole life long so that at any time, an asthma attack can occur.
Asthma bronchial asthma is a disease of the respiratory tract in the mucous membranes of the respiratory tract walls – in particular of the bronchi – are chronically inflamed.
A bronchus is the tubular sections of the lungs, beginning with the separation of the trachea in the two main bronchi. Carry the air of the trachea, to the alveoli. To certain stimuli to narrow the Airways for asthmatics and evoke an often convulsive shortness of breath that occurs especially at night and in the early morning. Is asthma does not or not sufficiently treated, the functioning of the lungs becomes progressively worse, because the Airways can permanently narrow.
The term asthma is of Greek origin and means as much as “Shortness of breath” or “heavy breathing”. Already the Roman physician Galen (to 129-199 ad) described the disease.
Asthma is the most common chronic disease in the child age. It affects about 10 percent of all children in Germany, where boys ill twice as likely as girls. Cancer girl, they however have a higher risk that they have more asthma problems as adults. Overall, at least one of three has the chance to be free of pain, in adulthood when the asthma bronchiale recognized and adequately treated. About 70 percent of affected children asthma begins bronchial before the fifth year of life.
Asthma in about five percent of the population is found in adults.
The increasing number of asthma sufferers is accompanied by the rising, not sufficiently clarified number of allergic diseases. Allergies are a major risk factor for the occurrence of asthma.
Asthma bronchial the causes are varied. Health professionals share a the causes of asthma in the following categories:
Allergic triggers of asthma: here lies – as the name implies – an allergic reaction (e.g. to pollen, dust mites, animal hair or flour dust) based on the disease. Physician also called the “extrinsic asthma” allergic asthma. Bei allergisch-bedingtem Asthma spielt eine vererbte Veranlagung eine Rolle: Leiden zum Beispiel beide Elternteile an der Erkrankung, so liegt das Risiko für ihr Kind , ebenfalls an allergischem Asthma zu erkranken, deutlich höher als für ein Kind gesunder Eltern.
Non-allergic triggers of asthma: the causes are here including respiratory infections and certain drugs (such as aspirin), air pollutants (such as exhaust and tobacco smoke) or also physical exertion and cold air. Asthma caused by non-allergic causes, is the medical term “intrinsic asthma”.
Hybrid from allergic and non-allergic asthma
Why is it now – for example by an allergic reaction or a viral infection – to asthma? The causes are inflammatory processes in the Airways (bronchi) in response to the infection or contact with the allergen (e.g. pollen). In asthmatics is doing an “overreaction” in the bronchi. The Airways narrow (so-called bronchospasm), the bronchial mucous membrane swells and singles off tough phlegm – this allows less air through the airway can stream and the typical asthma symptoms such as shortness of breath occur.
In allergic asthma bronchiale “fought” the own immune system substances that are not actually harmful for the body and not be attacked should (so-called allergens). Possible allergens are pollen, animal hair or droppings of house dust mite. The most asthma sufferers exhibit elevated levels of immune globulins E (IgE). IgE is an antibody that usually serves the immune system–he is also involved in allergic reactions.
Asthma often occurs bronchial asthma related allergies such as hay fever or Eczema (atopic dermatitis). If you have an inherited tendency toward hypersensitivity reactions of a particular type (Soforttyp) as for eczema, is called this atopy. Is a parent of so-called Atopiker, the risk for the child, to develop allergic diseases is increased. Both parents suffer from allergic asthma, their children develop also allergic asthma, in a sick parent to 30 to 40 per cent to 60 to 80 percent. The genetic component is responsible not only for the global increase in allergic diseases. Environmental factors and lifestyle changes, as well as changed living conditions contribute their part. Examples include smoking, passive smoking and childlike overweight (obesity).
An allergic reaction to various allergens in the air we breathe may occur in allergic asthma, for example, on
- House dust or the excretions of dust mites
- Mold spores
- Birds of a feather
- Animal hair
- Chemical solvents
Most people respond with allergic asthma so-called allergens such as dust mites and animal hair. Allergic asthma is typically a disease of childhood and adolescence, showing up but rarely only in adulthood. Allergies are the main risk factor for asthma in children. Usually, a few minutes after contact with the triggering allergen contact the breathing difficulties on (so-called Soforttyp reaction). Sometimes, complaints (so-called late reaction) occur until about six to twelve hours after contact with the triggering stimulus in allergic asthma. Bei manchen Betroffenen mit allergischem Asthma treten sowohl die Sofort- als auch die Spätreaktion nacheinander ein und sorgen für Atembeschwerden.
Auch im Beruf kommen viele Menschen häufig mit Stoffen in Kontakt, die zu Allergien führen und ein berufsbedingtes Asthma auslösen können. Klassische Fälle sind:
- Mehlstauballergie des Bäckers
- Nickel- oder Pflegemittelallergie des Friseurs
- Holzstauballergie des Schreiners
- Allergies to paint and solvents in printing workers
An allergy tendency is already known, the persons concerned should include this aspect in choosing a career. Also chemicals can irritate the bronchial system and lead to a non-allergic occupational asthma.
Inflammation caused by viral infections of the respiratory tract makes the Airways more vulnerable to other stimuli and can trigger such an infectious asthma. It occurs mainly in adults and infants. In younger children, respiratory syncytial virus (RS virus) for the infectious asthma are often responsible. Older children and adults will often develop after infection with rhinoviruses, which cause a whole normal common cold. Andere Virus-Arten, welche Infektionen der Atemwege hervorrufen, spielen ebenfalls eine Rolle, etwa:
- Influenza- Viren
Arzneimittelasthma entsteht infolge einer pseudoallergischen Reaktion und tritt fast nie allein, sondern in der Regel kombiniert mit anderen, meist allergischen Asthma-Formen auf. About 10 to 20 percent of asthma sufferers respond to certain pain relievers oversensitive. Often, the active ingredient acetylsalicylic acid raises a medicinal asthma. Also beta blockers (drugs) and others against high blood pressure can increase asthma symptoms and trigger an asthma attack.
The pharmacy asthma is not an allergy in the true sense. It is rather this form of drug intolerance due to a metabolic variance (pseudo allergy), which is may be hereditary.
The impact asthma or exertion asthma is more common than the pharmacy asthma in asthmatics. Physical effort raises in the affected asthmatics asthma attacks. Above all, children and young people often have a stress asthma. Cold and dry air favours the attack. Shortness of breath under load is an indication that the therapy is not sufficient in asthmatics often. Gradually increased effort, preventive administration of bronchodilator drugs and the choice of suitable sports like for example swimming, asthma restricts but hardly people in many cases. Sport is especially important for asthma sufferers, because the movement improves physical function among other things and strengthens the muscles – this is useful especially during an asthma fit.
Asthma bronchial incur the typical symptoms, because the Airways are permanently inflamed and swell in particular the bronchial mucosa. The bronchial Mucosa, by this inflammation, produce excessive amounts of viscous mucus. The mucus and the swelling of the mucous membrane constrict the airway and make breathing more difficult. Children get asthma as adults more frequently because their mucous membrane surface in relation to the vastness of the respiratory tract is especially great. The muscles of the “small bronchi” (the so called Bronchioles), parts of the lower respiratory tract, pull himself in asthma krampfartig together. Especially exhaling is thereby disturbed: the expiration is extended as a whole: it is a typical whistling and humming. Interictal (called intervals) the asthma symptoms often absent.
Common symptoms of asthma include:
- Shortness of breath: especially in the morning and at night, after physical exertion, respiratory infections, and contact with allergens
- whistling breathing out (so-called droning) when concurrent respiratory distress
- persistent cough: may occur instead of choking or addition
- Acute asthma attack
A sudden constriction of the Airways can cause an acute asthma attack. Symptoms are then severe shortness of breath and a tightness in the chest. The asthma attack can take on a few seconds to several hours (in the case of a severe seizure), in some cases even several days. The doctors then speak of a so-called status asthmaticus.
Also interictal, asthma symptoms such as coughing and shortness of breath can occur if asthma is not adequately treated, and the asthma attacks permanently affect the viability of the lungs. Heart – and lung tissue are charged, by the insufficient main lungs in the long term can bloat strongly himself (emphysema).
In severe cases asthma may restrict the general development of bronchial asthma in children. In extremely advanced, the chest through the over distension of the lungs can deform like a barrel. The movement of the muscles is altered breathing. Zusätzlich zu den normalen Atemmuskeln unterstützt die sogenannte Atemhilfsmuskulatur , bestehend aus Teilen von Brustraum-, Rücken- und Schultergürtelmuskulatur , bei der vermehrten Atemanstrengung der Betroffenen das Atmen. So stützen Asthmatiker bei einem Asthma-Anfall häufig die Arme ab; dies fixiert den Schultergürtel und die Atemhilfsmuskeln können den Brustkorb zusätzlich heben und senken.
In asthma the doctor is asthma diagnosis usually because people describe the characteristic symptoms. To listen typical lung sounds are audible: A whistling and humming from breathing. The whistling noise also known as droning. Often, also a dry cough occurs in asthmatics. The doctor also asks how the symptoms express themselves during or after physical work or respiratory infections. Also existing stressors, as can support the diagnosis in the profession (e.g. working with flour, animal materials or detergents), as well as familial disorders (such as eczema).
To make bronchial asthma diagnosis, the doctor exclude other causes and diseases with a similar appearance, such as:
- Breathing in a foreign
- acute inflammation of the bronchi (bronchitis)
- Whooping cough (pertussis)
- Cystic Fibrosis
- Softening of the tracheal cartilage (Tracheomalacia)
Within the framework of the asthma diagnosis further investigation be, for example, lung function tests (spirometry, whole-body plethysmographic). In this way, the doctor receives detailed information on respiratory function and the nature of the constraint of breath.
Effort causes asthma, the lung function tests under physical stress can be made. Those affected despite asthmatic complaints have a normal lung function, the doctor can trigger the hypersensitivity of the respiratory system by a so-called inhalative provocation. Here, the patient inhales a substance which irritates the respiratory tract. Mostly used for this histamine, Methacholine, or substances which the subject known to be allergic response (allergens, such as pollen). For severe asthma attacks, the doctor may determines the concentration of oxygen and carbon dioxide in the blood of an artery.
In allergic asthma, blood tests show usually an increased concentration of the antibody typically increase in allergies – of immune globulins E (IgE). The doctor determines the triggering allergen with skin tests (e.g. prick test). The result is unclear, an inhalatory provocation test can help. The data subject it inhales the suspected allergen under medical supervision. Show then typical asthma symptoms, the cause is identified and should be avoided in the future.
X-ray of the lungs can be in asthma bronchial unobtrusive, executed however with the initial diagnosis, to exclude other disorders as a cause for the complaints. In severe forms, consequential on the X-ray visible sometimes (e.g., emphysema).
In asthma, bronchial asthma is the first step of treatment, to avoid the triggering substances. Also, behaviors and medications can help in the treatment of asthma.
Bronchial asthma with medications to treat asthma, it inserts two main product groups:
- bronchie-extending and
- anti-inflammatory drugs
Anti-inflammatory treat the inflammation of mucous membrane as a root cause of asthma. Active substances from the Group of corticosteroids (e.g., budesonide, fluticasone, Mometason) causes the swelling and mucus formation back in the respiratory tract. Typically, asthma sufferers breathe the corticosteroids to treat (inhale) – so the active substances reach the destination directly and with fewer side effects. Corticosteroids are the essential component of asthma duration of therapy.
Depending on the severity of asthma bronchiale are different medications or different doses and formulations used: with mild asthma, affected such as corticosteroids to inhaling, with severe asthma get however, bronchial tablet to the revenue. In addition to active substances from the Group of corticosteroids to the duration of therapy, doctors put also known as Beta-2-sympathomimetic drugs. Beta-2-sympathomimetic drugs expand the bronchial tubes – it in technical jargon also known as bronchodilators. You loosen the tense respiratory muscles and thereby expand the Airways. So you fight the symptoms, not the cause of asthma. Among the bronchodilator medications, there are short and long. The symptoms relieve long sheet Beta-2 sympathomimetic drugs (e.g., formoterol, salmeterol) up to twelve hours. However seem not immediately and are thus not in an acute asthma attack treatment. They are therefore employed as the corticosteroids duration of therapy.
The short effective seed Beta-2-Sympathomimetics (e.g. salbutamol, terbutaline) help at the acute asthma attack, if the effect you want to use within a few minutes. Their effect is continuing about four to six hours. Need to sufferers too often rely on these substances, the asthma treatment is not optimal. Stakeholders often neglect the important period of therapy, as soon as they feel free of pain. But the inflammation in the Airways is back only to weeks to months. A good therapy can normalize long term lung function.
In addition to corticosteroids and Beta-2-sympathomimetic drugs, other active substances or pharmaceutical groups come in addition, or alternatively, call into question. Sufferers react for example allergic to Beta-2-sympathomimetic drugs, the active ingredient of ipratropium is a possible alternative. Active substances from the Group of Xanthine derivatives (e.g. theophylline) expand the bronchial tubes also, however the healing and the harmful dose are close together. Therefore the amount of drug in the blood should be controlled while taking regularly.
The active ingredients of cromoglycate or nedocromil make less sensitive the so called mast cells in the bronchial mucous membrane. Mastzellen sind Zellen des Immunsystems , die an Entzündungsreaktionen beteiligt sind. Cromoglicinsäure oder Nedocromil werden jedoch nur noch selten eingesetzt. Antileukotriene (wie der Wirkstoff Montelukast ) gewinnen dagegen zunehmend an Bedeutung. Sie richten sich gegen die Leukotriene – das sind Botenstoffe, die ebenfalls an Entzündungsreaktionen der Bronchialschleimhaut beteiligt sind. In adults, it is recommended leukotrienes in the long-term treatment of medium to heavy grade-asthma (in combination with corticosteroids or a Beta-2 Sympathomimektikum). Montelukast is approved without this combination in children between 2 and 14 years old. This is a strong growth in particular sense if children can inhale no corticosteroids or if side effects of corticosteroids, for example.
In the light to medium-heavy allergic asthma bronchiale helps in some cases a desensitization. The body accustomed here by regular gifts of allergens to the asthma-inducing substances.
A new approach to therapy for severe allergic asthma is a supplementary therapy with an antibody against the immunoglobulin E (IgE) distributed by the immune system. A doctor injects the antibodies the asthmatics in one up to twice per month under the skin. In children and adolescents under the age of 12, but not allowed this asthma therapy.
There are to breathe (for inhalation) or as an capsule or tablet to take a bronchial-extending active substances against the asthma symptoms. If possible, the inhaled application is for asthma drugs to prefer. Instead of via the bloodstream – like capsules or tablets – have reached the active ingredient when inhaling directly through the bronchi at the focus. This leads to a more targeted therapy as well as lower side effects.
Meanwhile, there are inhaled combination products with bronchodilator and anti-inflammatory agents (e.g., formoterol with budesonide or salmeterol with fluticasone). The asthma treatment is easier for those affected, since they require only an inhaler.
Essentially you will find two inhalation procedure:
MDIs: The active substance is dissolved in many small droplets which breathing of asthmatics. So-called spacer fabrics can serve as a spacer so that the “spray” more easily enters the lungs.
Dry aerosols: The asthmatic inhales a powder with the active substance. The drug is located in a so-called discus or Diskhaler.
The inhalation technique varies in the individual procedures and must be learned by the person concerned. Children and pregnant women with asthma bronchiale has special care – here affected parties (or their parents) together with the doctor weigh very precisely the advantages and disadvantages of therapy and clarify whether special precautions are necessary.
Treatment of acute asthma arises
Bronchie-extending medicines in the foreground are in the treatment of acute asthma fit. With a light to medium-heavy attack, the person concerned occupies sympathomimetic a short effective Beta-2-drug (e.g. the active substance Fenoterol or salbutamol). In addition the asthmatics of corticosteroids should be. Breathing easier to those affected in a sitting position and with arms supported on. In addition, the lip brake is a meaningful measure of behavior during an asthma attack. When a severe asthma attack, sufferers may need to a hospital. Get a sympathomimetic short effective Beta-2-drug and corticosteroids also to take up or through a vein. In severe cases, it may be necessary to also an artificial respiration of asthma sufferer.
Long term treatment
Bei Asthma bronchiale richtet sich die Langzeitbehandlung danach, wie gut die Erkrankung unter Kontrolle ist. Dies lässt sich in drei Grade einteilen:
- kontrolliertes Asthma
- teilweise kontrolliertes Asthma
- unkontrolliertes Asthma
Bei kontrolliertem Asthma bronchiale ist keine Langzeittherapie mit Medikamenten notwendig. Dann reicht es aus, allgemeine Verhaltensregeln zu befolgen, zum Beispiel nicht zu rauchen und Allergene zu meiden.
In addition to a customized behavior partly controlled asthma requires a long-term treatment with anti-inflammatory corticosteroids to inhaling beclomethasone, budesonide or fluticasone. In moderate to severe asthma a leukotriene receptor antagonist (e.g., montelukast) is useful in addition. Beta-2-sympathomimetic drugs are used as needed.
In uncontrolled asthma, the doctor – prescribes an antibody against the immunoglobulin E in addition the measures partially controlled asthma – such as the corticosteroids as tablets or allergic asthma. Possibly, other drugs as long term therapy are necessary in uncontrolled asthma.
Thus, the severity of asthma is bronchial crucial long-term treatment, but the disease is already as well under control. So a drug therapy may require also in mild asthma at the beginning, until it is under control.
The therapy of asthma is bronchial not only from drugs. Additional measures are important as
- Giving up smoking
- Regular sports
- Normalization of body weight
- Respiratory and physical therapy
It is also important that the doctor is well informed the parties concerned. The doctor gives the practical handling of asthma and the theoretical understanding of the disease. Many hospitals, established medical specialists, support groups, or rehabilitation centres for Atemwegserkrankte offer asthma training sessions.
In addition to medicines there are a number of other therapeutic activities, to support respiratory function and to improve the general condition. An important aid is targeted physical therapy. Die sogenannte Atemgymnastik im beschwerdefreien Zeitraum kräftigt die Atemmuskulatur und steigert damit die Atemleistung. Die Betroffenen erlernen zudem spezielle Atemtechniken. Eine der wichtigsten ist die sogenannte Lippenbremse : Bei dieser Technik kann nur wenig Luft durch die Lippen entweichen, wodurch sich ein Druck in der Mundhöhle aufbaut. The pressure continues in the lungs and prevents the small Airways and alveoli because to coincide.
Relaxation techniques, such as the autogenic training help some asthmatics. You can supplement the asthma treatment. Its usefulness is however not scientifically proven.
Sometimes also a treatment in a rehabilitation facility is bronchial asthma makes sense. It comes into question, if:
- Those affected suffer severe asthma and strong consequences of the disease, even though they are treated appropriately
- severe complications by drug treatment
- can be not outpatient carried out necessary therapy, such as an asthma training course or a training therapy
During a course of treatment, people learn to deal with their asthma. A targeted treatment helps in this time, better to control the disease, so that asthma sufferers have a higher quality of life afterwards and can participate more in society. This is important, especially for children so that they are age appropriate develop.
The better the treatment of asthma bronchiale customized, the cheaper this does affect the course of the disease. In optimal treatment asthma not restricts the average life expectancy.
In General, the prognosis of child asthma is bronchial very well. At least every third child with asthma has the chance to be free of pain, if the disease is recognized and treated in adult life – for some the disease occurs however after decades of asthma freedom again. In any case, the respiratory tract a lifetime remain vulnerable.
Most serious diseases, the General physical development of the child can be slowed and total restricted.
Targeted measures to prevent bronchial asthma acute asthma attacks and prevent long term damage in already existing asthma.
Dry air is a Reizfaktor for the bronchial tubes, therefore beware of a sufficient humidity in the room. Consider how you react to different climatic stimuli in the choice of your place of residence, as far as possible. In the high mountains and the sea are less allergens in the air. Your child has asthma, bronchial asthma and a pollen allergy, it can be helpful to send the child during the loaded of pollen season to an another location, for example, to the sea. Smoking asthmatics should forgo necessarily. Smoking in rooms where children live with asthma, is also to refrain from. Smoking and passive smoking adversely affect the frequency of occurrence of asthma as well as the course of the disease. In some children, it comes to asthma, if there is a bacterial inflammation of the paranasal sinuses or bronchial. In these cases a bacterial sinus infection or acute bronchitis should be treated early and consistently with antibiotics. A duration of treatment with antibiotics is but not useful.
In allergic asthma, it is very important to avoid the triggering substance in the air we breathe or in food. Under certain circumstances, it is necessary to give a pet. Bettdecken und Matratzen können Sie gegebenenfalls austauschen – im Handel sind allergenfreie Matratzen erhältlich. Bisweilen kann eine Hyposensibilisierung Erfolg bringen.
Was die Ernährung betrifft, müssen sich Asthmatiker nicht einschränken. Eine Ausnahme bilden Personen, die an einer Nahrungsmittelallergie oder -unverträglichkeit leiden. Für alle anderen ist eine ausgewogene , vitaminreiche Kost empfehlenswert. Take plenty of fluids, so the mucus in the Airways can drain away better.
Paracetamol (acetaminophen) instead of aspirin if an asthma erkranktes child gets a fever, you should use better preparations containing the active substance as received. Especially in older children, an intolerance of the active substance as an asthma trigger is known. Less frequently, other substances of the same class (e.g., ibuprofen, diclofenac, indomethacin) are responsible. So-called beta blocker (blood pressure lowering agent) are a different class of drugs you should take when asthma not or only after consultation with your doctor.
A continuous therapy is necessary to prevent an asthma attack. It is also important regularly to monitor the therapy and to adapt. So you can check also at home respiratory function by means of a so-called peak flow meter, to regularly control the course of the disease and the effectiveness of therapy.
- Parents may have available an emergency medicine in consultation with the physician,
- If your child has severe asthma.
- If the child there is a high risk, while an acute fit no air more to get and
- If an artificial respiration has become necessary in the child in the past
- They can inject this drug immediately in an emergency under the skin.
As asthma, you should wear a document stating what disease you have, what triggers are known, what drugs you are taking and who is to inform. Record also recommendations your doctor has given you for emergencies.
Asthma sufferers also exhibit an increased risk for pneumococcal infections of the lung. For this reason, you should consider a pneumococcal vaccination into consideration. Whether a flu shot has a protective effect in asthma has not been established.