The asthma is a disease characterized by inflammation more or less of the respiratory tract, in the bronchi and small bronchi, bronchioles (see diagram). It results in difficulty breathing, shortness of breath, wheezing, or tightness in the chest.
Asthma is a chronic disease most often manifested by crises interspersed with periods when breathing is normal. In some people, however, asthma induces permanent respiratory discomfort interfering with daily activities.
The asthma attack
The asthma attack is the sudden worsening of symptoms. In many people, asthma is manifested by occasional seizures, breathing is normal outside of seizures.
An asthma attack often begins with a dry cough, followed by difficulty breathing, which causes a clearly audible wheeze. It is usually accompanied by mucus sputum (coughing and spitting).
During a seizure, the opening of the bronchi is reduced because of an important inflammatory reaction and a contraction of the bronchial wall muscles.
Seizures can be effectively relieved by medications. However, they are potentially dangerous, especially in fragile people (elderly people, suffering from a respiratory infection, etc.).
The causes of asthma are not well known, even though we know that there are both genetic and environmental risk factors.
Inflammation of the airways results in the production of thick mucus inside the bronchi, which hinders the flow of air. At the same time, the muscles around the bronchi contract, causing the “closing” of the bronchi (bronchospasm). This causes respiratory discomfort.
The asthma is associated with respiratory allergies in 80% of cases, but it is not always of allergic origin. In people with asthma, there is excessive sensitivity of the bronchi ( hyperreactivity ) to one or more substances.
The following factors may help trigger an asthma attack or worsen respiratory distress, but they are not the cause of asthma.
- Aerial allergens (dust, pollen, animal hair, mites).
- Air pollutants (workplace irritants, wood-fired smoke, exhaust fumes, air pollution, etc.).
- Tobacco smoke.
- Food (food allergies ) or food additives, such as sulfites.
- Some drugs (aspirin and other nonsteroidal anti-inflammatory drugs, beta-blockers).
- Respiratory tract infections (colds, bronchitis, sinusitis, etc.), as they cause local inflammation.
- Physical exercise, especially if it is done outdoors in winter, in cold and dry weather.
- Strong emotions (laughs, tears, anger, excitement), especially in children.
Symptoms of asthma
The symptoms may be intermittent or persistent. They may appear after physical exercise or other triggering factors and are usually more pronounced at night and early in the morning.
- Difficulty breathing or shortness of breath (dyspnea)
- A feeling of tightness, chest tightness
- A dry cough
Note. For some people, asthma only results in a persistent cough that often appears at bedtime or after physical exertion.
The asthma is often a chronic condition that requires regular treatment, even between attacks. The medications to control asthma do not provide a permanent cure. They facilitate breathing by increasing bronchial opening (bronchodilatation) and reducing inflammation. Most of them are taken by inhalation, which allows them to act quickly, with the least possible side effects. The doctor also tries to give the smallest dose of medication for symptom control with the best tolerance of treatment.
Yet, despite effective treatments, 6 out of 10 people with asthma can not control their symptoms. The main causes are a poor understanding of the disease, fear of side effects and forgetting medicines. However, the side effects of inhalation treatments are minimal compared to the risks associated with severe and frequent asthma attacks.
The goal of asthma treatment is to maintain optimal control of asthma.
This control must be done by minimizing the secondary effects of treatment with the objective of reducing the number of crises and emergency procedures. By optimizing the respiratory function, it also improves the quality of life. The treatment of the asthma attack varies according to the severity of the crisis.
The beta 2 agonists alone are used in cases of mild or crisis prevention, through exposure to an allergen (weekend in the country, for example).
The use of inhaled corticosteroids for short courses is reserved for more severe attacks.
Long oral corticosteroids may be needed in severe asthmatics.
The medication must be accompanied by lifestyle changes, the fight against mites, smoking cessation, limitation of passive smoking.
Long-term treatment is offered when seizures occur repeatedly (more than one diurnal attack per week or more than two nocturnal attacks) or when respiratory function is reached outside periods of crisis. In this case, treatment with inhaled corticosteroids at low dose may be proposed associated with a mimetic beta 2 in case of crisis. Long-acting beta 2 mimetics and montelukast or omalizumab may be helpful in the most severe cases.
The treatment of excellence for allergic asthma is based on the removal of the allergen. This measure is difficult to implement when the allergen in question is a pneumallergene since it is everywhere in the atmosphere.
The doctor may propose desensitization, which consists of giving small amounts of increasing allergens over time, this desensitization being done weekly over a period of 3 to 5 years.
In occupational asthma, the employee must be reclassified.