This stenosis causes the characteristic symptoms of asthma which are:
1. Cough (usually dry, rarely productive with sticky expectoration)
2. Whistling (kittens) in the chest. Appears in the evening or early morning hours or during exercise
3. Shortness of breath
4. Tightness in the chest
5. Easy fatigue.
“These symptoms usually coexist with the restriction of expiratory air flow from the bronchi that we see in spirometry and can subside automatically or after appropriate treatment. “Both the symptoms and the obstruction of the bronchi vary in intensity, frequency, time of onset and duration, while they may be seasonal or occur all year round,” explains Mr. Dimitrios Vassos, Pulmonologist – Tuberculologist, Scientific Associate of the Metropolitan General.
Types of asthma
Several clinical phenotypes of bronchial asthma have been identified. The most common are:
1. Allergic or exogenous bronchial asthma. It is the most common type of asthma recognized in children and young adults. It is related to heredity and usually coexists with other allergic conditions such as allergic rhinitis, nasal polyps, eczema and allergies to drugs and food.
2. Endogenous, non-allergic asthma. It usually occurs in adulthood, more often in women, and has a more severe course and less response to medication.
3. Asthma during exercise: Occurs during exercise.
4. Occupational asthma: Related to exposure to materials in the workplace. It accounts for about 15% – 20% of asthma cases that occur after adulthood and requires avoidance of exposure to irritants.
5. Nocturnal: Associated with gastroesophageal reflux.
6. Asthma and obesity: Associated with gastroesophageal reflux disease, characterized by persistent symptoms and decreased response to treatment.
How is bronchial asthma diagnosed?
1. Compatible history
Getting a good history is the first step that raises the clinical suspicion of bronchial asthma. The appearance of symptoms after exposure to attractive factors, their fluctuation during the day or year, the coexistence of allergic rhinitis or nasal polyps requires further investigation by a pulmonologist for spirometry.
2. Spirometry
A key test in controlling asthma is spirometry. It is a very easy and painless examination, during which the patient exhales forcefully into the spirometer and thus the respiratory function, the size of the bronchial obstruction and the reversibility of the obstruction after administration of bronchodilator drug in inhalations are assessed.
3. Challenge tests
To confirm the diagnosis in patients who show symptoms and a compatible clinical picture but normal spirometry, tests can be performed to induce bronchial reactivity. In these tests, substances (methacholine, histamine, mannitol) are inhaled that cause a controlled airway response measured by spirometry.
4. Allergic tests
When there is a history of atopy, skin tests or specific IgE RAST can be done in the blood to detect hypersensitivity to certain allergic agents.
Staging and treatment of asthma
“The goal after the diagnosis of asthma is to achieve control of symptoms, improve the quality of life so that the patient has a normal daily life and avoid exacerbations.
Depending on how easily or not we control the symptoms and exacerbations of asthma we divide it into mild, moderate or severe uncontrolled asthma. “Each stage requires higher doses or a combination of inhaled, oral or injectable agents to achieve control,” says the doctor.
Treatment of bronchial asthma
Asthma treatment includes:
1. Regulatory drugs
These drugs reduce the inflammation of the airways and thus prevent the onset of symptoms and exacerbations. They are given once or twice a day and include inhaled corticosteroids alone or in combination with long-acting B2 stimulants.
2. Palliative drugs
These include B2 stimulants and / or rapid onset anticholinergics and are used as adjunctive therapy to reduce symptoms.
3. Complementary drugs
If good control has not been achieved with the above, long-acting anticholinergics, leukotriene antagonists, theophylline and oral corticosteroids may be given mainly to treat seizures and for short periods of time.
4. Monoclonal antibodies
In recent years, monoclonal antibodies have entered the therapeutic quiver and changed the landscape as they achieved better control of symptoms, reduction of exacerbations and reduction of the need for oral cortisone. Such as for severe persistent uncontrolled allergic bronchial asthma are antibodies against IgE immunoglobulin (omalizumab) given subcutaneously once or twice a month and antibodies for severe eosinophilic asthma, IL-5 inhibitors (mepolizab) given monthly or bi-monthly subcutaneously.
Bronchial asthma and COVID-19
“Patients with moderate to severe bronchial asthma belong to the vulnerable groups for new coronavirus disease because, like any viral infection, it can trigger an exacerbation of bronchial asthma. However, patients with well-regulated asthma do not appear to have a higher risk of COVID-19 disease, severe disease, and death. In contrast, patients who needed oral corticosteroids due to exacerbation of asthma had a higher risk of death than this. That is why it is of primary importance to continue the treatment to control the asthma symptoms and to avoid the exacerbations during the pandemic “, concludes Mr. Vassos.
Writes:
K. Dimitrios Vassos, Pulmonologist – Tuberculologist,
Scientific Associate of Metropolitan General
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