Asthma is a chronic bronchial disease that affects more than 4 million people in France, both children and adults. Symptoms of a crisis, causes, treatment: all you need to know.
4 million people are affected by asthma in France reports theInserm. Asthma, including World Day is Tuesday, May 2, 2023is a chronic respiratory disease manifested by crises. Its first manifestations most often occur during childhood. Asthma cannot be cured but it is believed that 95% of asthma cases are well controlled. What are the symptoms of an asthma attack? What is the cause ? What are the consequences ? How can we cure it?
What is the definition of asthma?
I’asthma is a chronic inflammatory pathology of the bronchi due to inflammation of the bronchi. Inflammation leads to a narrowing of the respiratory airways, which “causes wheezing and more or less frequent seizures“, explains Professor Bertrand Dautzenberg, pulmonologist at Pitié-Salpêtrière (Paris). During an asthma attack, the bronchi contract, then develop an edema reducing their diameter. The bronchi become blocked and prevent the air to circulate. Asthma often occurs in childhood“but half of the cases of asthma in children disappear at puberty. However, it can reappear at menopause.“.
What are the symptoms of an asthma attack?
This inflammation of the bronchi prevents the passage of air and causes the symptoms of an asthma attack, namely:
- A cough
- Breathing difficulty
- A hiss of breathing
- Shortness of breath
- Even suffocation.
What are the causes of asthma?
Asthma attacks have two main causes:
► Asthma can beallergic origin. Pollen allergies, for example, are a classic cause. “Typically, it is the child who throws tantrums when he goes to his grandparents’ country house“, gives the expert as an example. Pollution (pesticides, fine particles, etc.) is also a major risk factor.
► Asthma can also be caused by exertion : it is triggered during physical activity, “generally 10 to 15 minutes after the start of the effort”. This asthma of effort is related to a drying up of the respiratory tracts. “The child, in particular, tends to breathe through the mouth. To avoid this, you should put a scarf on him and invite him to breathe through his nose – this breathing allows better hydration“, advises Professor Dautzenberg.
Can an asthma attack be serious?
“One can die from an untreated asthma attack; fortunately, most patients know how to react in a crisis. It is necessary to train patients and their entourage to react appropriately (take their treatment and call 15 in serious cases)“, advises the doctor.
What is allergic asthma?
Allergic asthma is a pathology linked to an allergic phenomenon, as its name suggests. “There is an impaired immune response, which becomes excessive in the face of various antigens“, specifies the pulmonologist.
What is cardiac asthma?
Finally, cardiac asthma is a disease related to the heart. “This pathology develops in people with heart failure. An edema forms in the bronchi and hinders air circulation. But this is an abuse of language: it is not asthma strictly speaking, only, it looks like it“, wishes to specify the specialist.
What is exercise-induced asthma?
Exercise-induced asthma is induced by physical activity. There are treatments to avoid it.
When and who coinsult?
If asthma is suspected, you should consult a doctor without delay. The first symptoms (cough, wheezing, etc.) should alert you and encourage you to make an appointment with your doctor, or with a pulmonologist. In the event of allergic asthma, the allergist is a suitable interlocutor.
What diagnostic tests to know if you have asthma?
The diagnosis of an asthma attack is quite simple to perform. But a large majority of asthmatics do not have wheezing attacks and live for years with slowly but surely progressing asthma. Many people have been bothered for years by less impressive manifestations, without the diagnosis being made. Episodes of dry cough evolving for several weeks, even several months or years, often occurring during the night or on exertion, can also be signs of asthma. Repeated episodes of bronchitis can also indicate asthma.
To make the diagnosis of asthma, the doctor conducts questioning and assesses the patient’s respiratory function. A stress test is conducted in children. “If a variation of 20% of the breath before and after the effort is observed, the diagnosis is made.“, specifies Professor Dautzenberg. Finally, if salbutamol manages to correct the loss of breath, then the diagnosis is no longer in doubt.
In short, we can make the diagnosis of asthma when we witness an attack as the symptoms are characteristic. Apart from an attack, it is nevertheless possible to determine the origin and severity of asthma by carrying out a series of analyses:
- respiratory function test, which determines respiratory capacity: it must be carried out at least once a year, even in patients who do not feel any discomfort. This examination is painless and is reimbursed by the health insurance fund.
- the bronchial provocation test (comparison between the volume of air exhaled before and after being brought into contact with an allergen);
- the reversibility test of the obstruction following the inhalation of a product that dilates the bronchi.
The peak flow meter is a small device that measures peak expiratory flow : this corresponds to the maximum speed at which the air can circulate during a forced expiration after having inflated the lungs to the maximum. The use of the peak flow meter consists in comparing the figure obtained with a theoretical value, which varies according to the age, size and sex of the patient. It should be noted that some patients must monitor their breath daily with this device: measurements are generally taken when getting up in the morning and when going to bed in the evening. A measurement may be necessary at any time of the day if discomfort appears.
- Put the cursor at the bottom of the graduated scale, at level 0 and stand upright.
- Hold the device horizontally.
- Inflate the chest to the maximum, mouth open.
- Introduce the mouthpiece into the mouth and firmly press it into the lips
- Blow all at once, as hard and as quickly as possible.
- The operation must be repeated three times and note the highest value.
What is the treatment for an asthma attack?
THE bronchodilator drugs short-acting and fast-acting are prescribed to relieve an asthma attack or bouts of coughing, minor equivalents of asthma. They act against the narrowing of the bronchi and allow them to expand. In most cases, the patient feels an improvement after a few minutes, helping him to breathe better. Their duration of action is four to six hours. Bronchodilators are also used before exercise to prevent discomfort from developing in people with exercise-induced asthma.
What is the treatment for chronic asthma?
Asthma that is continuous or has repeated attacks will be treated with long-acting bronchodilator drugs, prescribed as a daily background treatment and combined with anti-inflammatories such as corticosteroids (inhaled or in tablets), at the minimum effective dose. “Controlled asthma should allow the patient to have a normal life“, insists Professor Dautzenberg.
In severe asthma, treatment with anti-gE antibodies will be given, in cases where the IgE level is high. “It is a heavy, but effective treatment,” emphasizes the pulmonologist.
Can we do respiratory physiotherapy in case of asthma?
Therapeutic education sessions can be a useful resource to prevent and treat crises, and to act well when the treatments do not work as well as usual. Respiratory physiotherapy can be prescribed in case of repeated bronchitis, but has a limited place in asthma.
When to use spacers?
The use of a spacer is intended for young children. This inhalation chamber is a reservoir allowing easier inhalation of the product. A puff is delivered through the mouthpiece of the inhalation chamber. The child can then inhale the product by performing 5 to 10 inspiratory movements. When the child is very restless, two people are ideal to hold the child in place. The rules of use (shake the bottle well, dosage, make it drink after inhalation, keep the mask in place, etc.) must be scrupulously respected.
When to have a spa treatment?
A stay in spa treatment can bring help to asthmatics, even if no scientific study really brings their effectiveness. The psychological effect provided by the cure is of course very beneficial because asthmatics are taken care of daily and receive care allowing them to relax and be less embarrassed. This stay under favorable climatic conditions makes it possible to be supervised, to practice certain sports activities, to receive a more targeted education. Taking care of the patient, on a physical and psychological level, allows him to better adhere to the treatment and to become aware of the need to be followed regularly. However, a stay in spa treatment cannot definitively solve the problem of asthma by making the disease disappear.
There is no treatment that can cure asthma permanently. Nevertheless, crises are likely to become rarer and lessen in some cases. For this it is absolutely necessary stop smoking and avoid passive smoking. In addition, it is necessary, as far as possible, to avoid coming into contact with the allergen in the event of allergic asthma. For example, it is possible to use anti-mite household linen in case of allergy to these parasites, avoid contact with cats in case of allergy to animal hair… Education of the patient or his parents is essential and reduces the occurrence of serious crises. Asthma schools exist to educate families.
Thanks to Professor Bertrand Dautzenberg, pulmonologist at Pitié-Salpêtrière (Paris).