Main
- Chronic inflammation: the airways remain inflamed even when you feel well, so the condition requires constant monitoring.
- Reversibility of changes: narrowing of the bronchi and muscle spasm resolve with timely help, and breathing is restored.
- Night-time signs: a dry cough towards morning, wheezing and chest tightness often precede an exacerbation.
- Examination: spirometry, a bronchodilator test, allergy tests and peak flow measurement confirm the diagnosis and show control.
- Urgency: if there is severe shortness of breath, blueness of the lips or usual help is ineffective, call an ambulance.
What is bronchial asthma
Bronchial asthma is a long-term inflammatory disease of the airways, in which they become sensitive to various irritants. Because of this, attacks of difficulty breathing, coughing and wheezing periodically occur.
What happens in the body
In this condition, the airways are constantly in a state of inflammation, even when the person feels well. The walls of the bronchi react too acutely to irritants, so the lumen narrows faster than in a healthy person. At the same time, the muscles around the airways tense and squeeze them even more. The mucous membrane begins to produce more mucus, which additionally blocks the passage for air. Because of this, air passes through the bronchi with difficulty, and the characteristic whistling on exhalation appears. The person notices attacks of coughing, shortness of breath and a feeling of tightness in the chest. Such changes are reversible, so with timely help breathing is restored.
What causes it to develop
- Heredity: if close relatives had asthma or allergy, the risk is passed down the family line.
- Household and outdoor allergens: dust, animal fur and plant pollen often become the trigger for an exacerbation.
- Respiratory infections: viral diseases of the airways often trigger the first attacks and make the course more severe.
- Tobacco smoke and polluted air: constant inhalation of irritants maintains inflammation in the bronchi.
- Strong odours, cold air, physical exertion: these circumstances do not themselves cause the disease, but provoke narrowing of the bronchi.
Who encounters this more often
Most often the condition is detected in people with a hereditary tendency to allergic reactions. If the parents had asthma or allergy, the likelihood of similar symptoms appearing in a child is noticeably higher. In children, attacks often begin after viral infections of the airways. In adults, the trigger is often contact with dust, animal fur or pollen during the flowering season. Residents of large cities with polluted air encounter exacerbations more often than people from areas with clean air. Workers who inhale strong odours and industrial irritants are also in the risk group. Therefore, with recurring attacks of coughing and shortness of breath, it is important to discuss with a doctor what exactly causes them.
What symptoms can occur?
The manifestations of bronchial asthma depend on how narrowed the airways are at a particular moment. Below is an explanation of how to recognise the onset, which signs occur most often and in which situations help is needed immediately.
How it is noticed at the very beginning
Difficulty breathing, especially on exhalation, is often put down to tiredness after a working day or to a residual cough after a cold. A person notices that the usual staircase feels harder, and that exhalation has become longer and requires effort. At night a dry cough appears, which interferes with sleep and recurs towards the morning. Wheezing or hissing sounds in the chest are audible to the person themselves in the quiet of a room. Rapid fatigue on physical exertion is perceived as loss of fitness rather than as a sign of illness. Asthma symptoms can appear in waves: exacerbations alternate with calm periods, and during the clear intervals it is easy to forget about them. If such episodes recur after contact with a trigger, it is worth making a routine appointment with a doctor and describing to them everything that is happening.
Signs that occur most often
- Difficulty breathing: exhalation is harder than inhalation, the air seems not to come out fully, and this is noticeable when talking and walking.
- Wheezing: hissing sounds are audible in the chest, which intensify at night or in the early morning and interfere with sleeping peacefully.
- Cough: it can be paroxysmal and more often troubles a person at night, because of which they wake up and cannot fall asleep again for a long time.
- Chest tightness: a feeling of constriction appears, as if the chest is being squeezed from within, and breathing becomes uncomfortable.
- Fatigue on exertion: the usual journey or climbing the stairs requires stops, and strength is restored noticeably more slowly than usual.
When to seek help urgently
Examinations and tests
Examination for bronchial asthma begins with a conversation with the doctor and a physical examination, and then includes investigations that confirm the diagnosis and show how well the disease is controlled. Below are the main methods used in practice and the information each of them provides.
How the examination begins
The doctor asks about the symptoms and their connection with triggers, examines the patient and prescribes investigations. At the appointment it is important to recall when the cough, wheeze or difficulty breathing appear and what causes them. The connection of the complaints with dust, cold air, exertion or the season helps the doctor choose the necessary investigations. The examination complements the conversation: the doctor listens to the breathing and pays attention to signs of narrowing of the airways. After that, spirometry is prescribed to see how the air passes through the airways. If necessary, a bronchodilator test is performed and the reversibility of the narrowing is assessed. Allergy tests help identify provoking allergens if a connection with them is likely. Peak flow measurement is recommended for home monitoring of the expiratory flow rate, and imaging investigations are performed according to indications. Keep the results of previous tests and records of observations: they make the picture fuller and help the doctor assess the condition more accurately.
What is prescribed and what it shows
What is worth preparing for the appointment
- Observation diary: records of when and under what circumstances the cough, wheeze or difficulty breathing appeared help the doctor see patterns.
- Results of previous investigations: earlier spirometries, tests and images make it possible to compare the values and assess the changes over the period of observation.
- List of triggers: list what you react to — dust, cold air, exertion or the flowering season, this clarifies the direction of the examination.
- Records of home measurements: if you measure the expiratory flow rate yourself, take the records with you, they show how the condition changes between visits.
- Discharge summaries and reports: collect documents from other medical organisations so that the doctor sees the full picture and does not prescribe unnecessary tests.
- Questions for the doctor: formulate in advance what you want to clarify about your condition and further monitoring, this way the appointment will be more informative.
Which doctor should I see?
Bronchial asthma is treated by a pulmonologist, and when necessary an allergist-immunologist and a paediatrician are also involved. Below is an explanation of what happens at an appointment and what areas of care it comprises.
Which specialist manages this condition
Bronchial asthma is managed by a pulmonologist, and if the condition has an allergic nature, an allergist-immunologist is involved. Children are managed by a paediatrician, who refers them to specialist doctors when necessary. If there is no pulmonologist nearby, you can start with a therapist at your place of residence. At the first appointment, the doctor asks in detail about the complaints, their frequency and the conditions in which they occur. He clarifies which factors trigger an attack and how long this has been happening. The doctor examines the patient and assesses how freely the person is breathing at the moment of the conversation. Based on the results, he explains how to use the inhaler and draws up an action plan for an exacerbation.
What the treatment comprises
- Selection of therapy and training in inhalation technique: the doctor selects a suitable method of delivery and shows how to use it correctly so that the medication reaches the airways rather than settling in the mouth.
- Regular follow-up and adjustment of the plan: the condition changes over time, so the doctor periodically reviews the prescriptions and changes them if necessary.
- Control of triggering factors and treatment of concomitant conditions: it is important to identify what exactly causes exacerbations and to address other health problems in parallel.
- Action plan for an exacerbation: a memo drawn up in advance by the doctor suggests what to do when the condition worsens, so as not to get confused at the right moment.
- Vaccination as recommended by the doctor: vaccinations help protect against infections, which often become a trigger for worsening of the condition.
What depends on the patient themselves
The regularity of follow-up with a specialist largely determines how stable the condition will be. If a person attends appointments according to the schedule set, the doctor notices changes in time and manages to adjust the care. When visits are missed, worsening is often discovered only at the stage of an exacerbation. It is important to tell the doctor honestly how often attacks occur and what causes them. It is equally important to master the inhalation technique and use it exactly as the specialist has shown. It is worth clarifying with the doctor in advance what to do in case of a sharp worsening and to keep this plan at hand. The accuracy of these actions determines how freely a person will be able to breathe in everyday life.
What helps prevent an exacerbation?
Prevention in bronchial asthma helps reduce the frequency of exacerbations and maintain good health. It is important to avoid known triggers and follow the doctor's recommendations.
What changes in habits
Daily habits directly affect how often bronchial asthma exacerbations occur. Contact with allergens and tobacco smoke increases the risk of an attack, so it is worth knowing your triggers in advance and, where possible, removing them from your environment. Keeping the home clean and controlling humidity reduces the amount of dust and mould, which often provoke worsening. Following the prescribed treatment plan and not missing doses help keep the condition stable. Monitoring symptoms allows changes to be noticed earlier and timely medical advice to be sought if things worsen. Seasonal exacerbations require special attention, so measures for such periods are best discussed with the doctor in advance. If a trigger is known, it is sensible to think ahead about how to avoid it at home and outside the home.
What should be kept under control
- Contact with allergens: it is important to know what the body reacts to and to try to eliminate these triggers at home and outside it.
- Tobacco smoke: smoking near a person with asthma increases the risk of exacerbation, so smoky rooms should be avoided.
- Cleanliness and humidity: regular cleaning and maintaining normal humidity reduce dust and mould, which provoke symptoms.
- Treatment plan: it is important not to miss the doses prescribed by the doctor, because interruptions increase the likelihood of worsening of the condition.
- Symptoms: changes in how you feel should be noticed and recorded so that the doctor can be informed in time.
- Seasonal measures: vaccination and measures for periods of exacerbation are best discussed with the doctor in advance, before the difficult season begins.
How often to see the doctor
Regular check-ups with the doctor are needed even when you feel well and nothing is troubling you. Scheduled visits allow an assessment of how stable the condition is and timely notice of changes that the person themselves may not feel. If symptoms have become more frequent or more severe, the visit should not be postponed, because worsening is easier to correct at an early stage. During the appointment, known triggers, measures for seasonal periods and vaccination matters are discussed. The doctor also looks at how accurately the prescribed plan is being followed and, if necessary, makes changes. Such monitoring helps reduce the frequency of exacerbations and maintain the usual way of life. Therefore, visits to the doctor should be planned in advance, without waiting for the condition to worsen.
What is worth remembering
Bronchial asthma remains a condition that a person lives with for a long time, and how calmly and consistently they approach it determines their everyday wellbeing. Below are conclusions that help one not to lose one's bearings and not to harm oneself.
Main conclusions
Bronchial asthma is not an episode but a long-term condition, so the attitude towards it should be constant, not occasional. A calm course is possible when a person notices changes in their breathing before they become severe. An exacerbation rarely comes entirely without warning signs: it is usually preceded by a night cough, a feeling of tightness in the chest or a decrease in usual activity. If such signs appear more often than usual, a visit to the doctor should not be postponed, even when one's wellbeing seems tolerable. The mistake that occurs most often is stopping follow-up with a specialist when things improve, because the condition is perceived as temporary. The other extreme is trying to cope on one's own, relying on someone else's experience and random advice. The most reliable approach is to rely on a plan drawn up by the doctor and on one's own observations of what changes the condition.
