Asthma (Asthma bronchiale) affects approximately 5-10% of the population. The chronic inflammation is associated with bronchial hyperresponsiveness and leads to recurrent episodes of wheezing, dyspnea, chest tightness and cough, especially at night or early in the morning. Come with us to take a closer look at how this unpleasant disease occurrs, who is predisposed to it, what treatment options are available, and how it is affected by the coronavirus pandemic.
Risk and triggering factors
When it comes to asthma, we distinguish between host risk factors (predispositions) and environmental factors. Some of these environmental factors are referred to as precipitating, so-called triggers, and can cause a sudden worsening of asthma. Host factors include genetic predisposition, atopy (risk of asthma in atopics is 10-20 times higher than in non-atopics), airway hyperactivity, gender (higher risk in boys), race and ethnicity, low birth weight, maternal smoking, or obesity. .
Regarding genetic predispositions, it is also a fact that the risk of developing asthma is about 3-5 times higher, if one parent has it (about 5 times higher in allergic asthma); if both parents suffer from asthma, the risk is 7-10 times higher.
Negative effects of the environment
Allergens are on top of the list of the main environmental risk factors. In 95% of cases, asthma is caused by an allergic reaction and it's usually part of a general allergic disease. In childhood, for example, it is often preceded by food allergies (especially to cow's milk protein and eggs), chronic allergic eczema or allergic conjunctivitis. The most common allergens include pollens, fungi, mites, animals and food allergens. Other factors include viruses and environmental factors such as cold and hot air, diesel exhaust, cigarette smoke, smog, respiratory infections or medications (such as asthma caused by acetylsalicylic acid - ASA - found in aspirin).
What can make asthma worse?
Factors that can suddenly worsen asthma include allergies and medications, as well as weather changes (temperature inversion or pre-storm conditions), outdoor air pollution, hyperventilation (this can occur not only during excessive physical exertion, but also due to strong emotions - laughter, crying, fear, etc.), excessive mental stress, menstruation, pregnancy, oral contraceptives or food additives.
How does asthma manifest itself?
shortness of breath - the patient perceives it as a lack of air, difficulty breathing or a feeling of shortness of breath (after exertion, often at rest)
unpleasant sensations on the chest (feeling of tightness, distress or pressure)
wheezing - especially during exhalation or forced exhalation
cough - often nocturnal, usually unproductive or with a small amount of sputum (may be the only symptom, especially in children)
Asthma occurs at any age. It can affect both children and adults or the elderly. In general, however, asthma developed at a later age is typically more severe. Asthma is divided into 5 steps according to its severity.
The first years of life are still considered to be the decisive life period. However, fetal sensitization (increased sensitivity) may occur intrauterinely, from the 22nd week of pregnancy. There are currently no measures available that could be recommended prenatally as primary prevention. An effective postnatal measure is to prevent secondhand smoke. If the first signs of allergy appear, triggers should be immediately removed, after which efforts should be made to prevent the development of asthma.
The alarming fact is that in 40% of families of asthmatic children in the Czech Republic, the parents still smoke, and 30% of adolescent asthmatics are active smokers. The main measures should include:
removal of allergens from apartments and buildings
elimination of air pollutants - ozone, nitrogen oxides, acidic aerosols and dust aerosols, as well as active and passive smoking
reduction of exposure to external allergens, i.e. pollens, molds, diesel engine exhaust, which in combination with the allergen can induce an immune (allergic) response
removal of food allergens, including preservatives (sulfites and various additives such as tartrazine, benzoate, sodium glutamate, etc.)
in case of ASA intolerance, its elimination and elimination of other non-steroidal anti-inflammatory drugs, beta-blockers are a huge contraindicant in asthmatics (caution should also apply to eye drops)
regular flu vaccinations in patients with asthma
regular treatment with anti-inflammatory drugs
What to expect when you visit the doctor's office to get examined?
The doctor examines the chest of a patient with a stethoscope, which is followed by a functional examination of the lungs, the so-called spirometry. It can be performed as early as at about 5 years of age in cooperating children. Furthermore, the ability of the bronchi to dilate and thus improve lung function is determined, sometimes tests that in turn show disproportionate bronchial contractility are performed as well, and inflammatory factors from exhaled air are examined. A patient with suspected asthma also needs to be examined by an allergist using skin tests and blood tests. Last but not least, the patients is examined at an ENT clinic, as it is necessary to rule out associated diseases (allergic inflammation, polyps, etc.). A chest X-ray should be performed initially to rule out other possible diseases.
First of all, it is necessary to remove the triggers, as listed above. The basis of treatment are inhalation medicaments, which aim to suppress bronchitis. The main medications are those with a preventive effect, most importantly inhalation corticosteroids. They are newly recommended as the drug of first choice for all 5 steps of asthma. This treatment can be supported by other drugs that relax the contracted muscles in the bronchi (so-called bronchodilators). They are suitable for use in the event of a sudden worsening of asthma, when it's necessary to quickly expand the bronchi and thus improve breathing. They can also be administered as a precaution before excessive physical activity.
Some patients with more severe asthma have to take bronchodilators along with inhalation corticosteroids long term. The goal is to induce complete asthma control (stabilization) in each asthma patient. Last but not least, people who suffer from asthma need to give up smoking for the rest of their lives. Every asthma patient should be instructed on how to administer medication from different inhalation systems and his/her ability to do so should be regularly monitored.
Asthma and coronavirus
As if the lives of asthma sufferers weren't already difficult enough, the COVID-19 disease, caused by a coronavirus that affects the airways, was added to the list of risks at the beginning of the year. Patients with asthma belong to a high-risk population group and must pay even more attention to their health. Professor of the 2nd Medical Faculty of Charles University, prof. MUDr. Petr Pohunek, CSc., confirms this.
"Asthma is a chronic respiratory disease and therefore has the potential to worsen the course of coronavirus pneumonia, but if asthma is under good control, lung function is normal and the patient's state has been stable, devoid of acute attacks in the long term, the risk of severe coronavirus pulmonary infection isn't substantially higher,"
explained prof. MUDr. Petr Pohunek, CSc.
Respiratory protection in the form of a face mask or a respirator should now become an integral part of every asthma sufferer's life. Wearing them, however, can cause slight discomfort, which could be solved by using a disposable non-woven cloth face mask for easier breathing.
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Our lungs, founded by a real estate agency during the first wave of the COVID-19 pandemic, is an endowment fund dedicated to supporting the treatment of respiratory diseases in adults and children.
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And why the combination of real estate business and healthy lung care? Elena Jakubovič and her team believe that a well-chosen house or apartment is a place where you can breathe with ease. And everyone should be allowed to experience this feeling.