Asthma

Asthma is a chronic disease of the respiratory system with inflammation of the airways, mucosal edema, hypersensitivity and temporary narrowing of the bronchi. The major complaints are difficulty breathing, coughing fits, chest tightness, and wheezing. In case of a severe attack, the patient might develop cyanosis and respiratory failure, which may result even in death if untreated.

The incidence of asthma has significantly increased since the 1970s. Since 2011, it has affected 235 to 300 million people worldwide, out of who approximately 250 000 died.

In Hungary, the number of registered patients with asthma increased from 195 000 to 290 000 in 10 years. In 2014, nearly 16 000 new patients were registered by the pulmonary institutes for adult patients (see Korányi Bulletin 2015).

Nevertheless, the real number of patients with asthma is estimated to be approximately 1.5 times as much as that (including mild, undiagnosed cases as well).

Symptoms may appear as early as young childhood, mostly after the age of three years, but asthma can develop basically at any age. Some asthmatic patients have symptoms only as a result of certain trigger factors, and others constantly have significant symptoms. Generally, symptoms are worse during the night and at dawn; they may be exacerbated by physical exercise or cold weather. They may manifest as a short course of dyspnea (lasting for some minutes or even hours) or as an asthma attack after exertion or an allergic reaction. Symptoms triggered by an airway infection may also be present even for several days. In patients with severe asthma, symptoms may be continuously present even for years.

The development of asthma may be the result of the combination of some genetic and environmental factors. Environmental factors involve allergens, air pollution, and other chemicals present in the environment of the patient. Smoking during pregnancy and after delivery increases the risk of developing asthma-like symptoms. Air polluted by road traffic and the high ozone content of the air are related to both the development of asthma and the exacerbation of the disease. Volatile organic compounds, such as formaldehyde, present in buildings and inhaled by people staying in the buildings may also lead to the development of asthma. Other frequent indoor allergens include dust mites, cockroaches, dead epithelial cells of the animals and mold. In young children, certain viral infections of the airways may increase the risk of developing asthma.

The development of symptoms can be prevented by avoiding the trigger factors, for example allergens and irritants, and by the regular use of anti-inflammatory inhalers (corticosteroid inhalers).

The primary aim of the treatment is to achieve and maintain a controlled state of asthma. It is, therefore, essential to use a steroid drug dosed by an inhaler in the dose and frequency prescribed by the doctor.

Appropriate disease control also means that the patient does not need rescue drugs, i.e., fast-acting bronchodilators, more than twice a week. If the patient needs to use them more frequently, it indicates that there is an inflammatory process in the background, and the therapy should be modified by the treating physician as in the long term, chronic inflammation may result in changes and damages in the bronchial walls. During this process, the characteristic, temporary (reversible) broncho-constriction gradually turns into permanent, irreversible constriction. Therefore, if you have partially controlled or uncontrolled asthma based on the below table, you are recommended to visit your respiratory physician as soon as possible.

Definition for asthma control*:

*L. Tamási et al.: Az asztma diagnosztikájának, kezelésének és gondozásának alapelvei felnőtt korban [Principles of asthma diagnostics, treatment and care in adults]; MEDICINA THORACALIS 65:(5) pp. 307-328. 2012