Asthma is a disease in which the airways become so narrow that it is difficult to breathe, either temporarily or permanently. This condition is also sometimes referred to as bronchial asthma. Asthma typically comes in episodes or attacks of wheezing, coughing and shortness of breath. Without proper treatment, the lungs may gradually take in less and less oxygen from the air and general physical fitness can worsen.
But asthma does not always get worse. Nowadays asthma can be treated quite effectively using medicine and other interventions. This means that most people with asthma can manage their illness and live a life largely free of symptoms. It is important to understand what you can do on your own, and to find out what kind of therapy is best suited to you.
Common asthma symptoms in children include coughing and whistling or wheezing sounds when breathing. Other typical signs of asthma are usually not yet present at that age. In teenagers and adults, asthma is characterized by the following symptoms:
- Shortness of breath (often in sudden attacks)
- Breathlessness following physical activity
- Sounds when breathing (out): e.g. wheezing, whistling, rattling
- Tightness in the chest
- Coughing and/or the urge to cough
These symptoms mostly happen in episodes or attacks, commonly at night too. This is one of the reasons why people who have this chronic illness often feel so tired and groggy during the day. During an asthma attack, initial minor breathing difficulties can worsen and develop into more serious shortness of breath.
Causes and risk factors
Asthma is more common in some families than in others, which suggests that genes might play a role. Further risk factors for children include having other allergic disorders, such as hay fever or eczema, either themselves or in their family. Being born with low birth weight is another risk factor. Asthma is more common in boys than in girls. Children are more likely to get asthma if they are exposed to cigarette smoke. Parents who smoke can reduce this risk by kicking the habit.
Asthma symptoms are the result of a combination of two factors working together: People with asthma have an immune system that permanently tends to overact. This tendency goes mostly unnoticed until the mucous membranes that line the insides of the bronchi come into contact with specific triggers.
Depending on the type of trigger, asthma is classified as being either allergic or non-allergic.
- Allergic asthma is also called “extrinsic asthma” because the trigger is breathed in with the air. Different people may have reactions to very different types of triggers, including cigarette smoke (active and passive smoking), plant pollen, animal fur, dust mite excrement, and some kinds of food as well as cold air, perfume, exhaust fumes or certain chemicals.
- Non-allergic asthma (also called “intrinsic asthma”) is caused by triggers released by the body. These triggers include bacterial or viral inflammations of the airways in particular. Sometimes taking certain kinds of painkillers causes asthma. These painkillers include acetylsalicylic acid (ASA, the drug in medicines like Aspirin) and other non-steroidal anti-inflammatory drugs (NSAIDs). In some people, physical or emotional stress that causes their breathing to speed up can also induce asthma symptoms.
In many people, both intrinsic and extrinsic factors play a role, so it is not always possible to clearly distinguish between allergic and non-allergic asthma. The effects on the lungs and breathing are nearly the same though:
- Immune system cells in the membranes lining the bronchi are activated,
- the muscles surrounding the airways tense up,
- the membranes lining the airways become inflamed and swollen, and
- very viscous mucus is often produced.
The muscles tensing up, the swelling of the mucous membranes and the extra mucus production all cause the airways to become narrower and narrower, which can result in an asthma attack.
Structure of the airways in the lungs: healthy bronchi and bronchi narrowed by asthma
Prevalence and outlook
About 10% of children and 5% of adults in Germany have asthma. It is the most common chronic (long-lasting) disease among children.
Although asthma is a chronic condition, it can develop in many different ways over time, and symptoms will not automatically get progressively worse. Some people who have asthma as children or teenagers have hardly any symptoms, or even none at all, as adults. Others have the same symptoms, or the symptoms get worse. A lot depends on how easy it is to avoid the asthma triggers, how effective the asthma treatment is, and how you cope with the disease yourself. Medication and other interventions can help make it possible to live an almost normal life.
Asthma can develop at any age. But it often first occurs in childhood or teenage years. People who have asthma frequently also have allergies such as hay fever, allergic conjunctivitis, or eczema. So their symptoms can change depending on the season or other environmental factors, or may disappear for a while, or even for good. Sometimes other allergic disorders then come to the fore again. If adults with asthma experience a long symptom-free period, however, it does not mean that their asthma has been “cured.”
Doctors are only able to determine whether the symptoms are caused by asthma or another illness if they consider their patient’s symptom descriptions and the results of various tests together. The main diagnostic procedures for asthma are:
- an in-depth talk with the doctor (anamnesis). This will cover, among other things, the type of symptoms, medical history and aspects of the person's lifestyle.
- A physical examination: Your lungs, heart and circulation are checked, as well as your general health.
Lung performance can be measured using a lung function test (peak flow measurement and /or spirometry). The peak flow meter measures how fast you can blow air out of your lungs. In spirometry, both the amount of air you breathe out and how fast you blow it out are measured.
Other tests may be needed to be absolutely sure of the diagnosis.
Good management of chronic asthma involves both treating symptoms and preventing asthma attacks. The best way to do this is by avoiding the asthma triggers as much as possible. Medications for keeping symptoms under control are another important part of prevention.
But it is not always that easy to avoid asthma triggers in everyday life, and in some situations it may be almost impossible. Although it is helpful to know what your triggers are – be they animal fur, dust or cold air – avoiding those triggers does not guarantee that asthma symptoms can always be prevented. Most people who have asthma do not need to worry too much about the triggers if they use their medication correctly.
A treatment called allergen-specific immunotherapy may be an option for people who are allergic to certain substances. It can help make their bodies react less sensitively to those substances.
The first goal of asthma treatment is to reduce the frequency and the severity of the symptoms as much as possible. The treatment should also help people with asthma to lead a normal life and maintain an active lifestyle as far as possible. It is important to know that asthma treatment has very few side effects. This is also the case for women with asthma who are pregnant. A doctor can help you decide which medications are right for you.
Two main groups of medications are used to treat asthma: long-acting controller medications and short-acting reliever medications. Controller medications soothe the chronically inflamed airways to help prevent asthma attacks. These medications are usually used regularly every day. Reliever medications are used as needed. The choice of treatment always depends on how severe the symptoms are.
Many people with asthma usually only take medication when they already have symptoms, and tend to forget about their controller medication. This can be dangerous because controller medication helps reduce the frequency and severity of asthma attacks over time. Long-term treatment can only be effective if controller medication is used regularly.
Like most chronic diseases, asthma does not only affect one single organ – in this case, the lungs – but the entire person. For example, asthma attacks at night can disturb sleep, making people tired and unable to concentrate properly during the day. Physical fitness can also be affected.
It often takes some time to learn to live with a chronic disease. This may also be the case for other family members. Yet people with asthma do not want to be seen as being ill or weak.
Getting enough information and managing your disease well (good self-management) can help both children and adults to cope better with asthma and become more independent. This can also make them more prepared to deal with critical situations such as an acute asthma attack. The right kind of disease management can prevent emergencies that would require hospitalization.
Disease management also includes knowing where to find support, advice and the best possible treatment. Advice from doctors, good patient education or joining a self-help group can help you become an expert in handling asthma yourself. Patient education is offered by lung specialists and specialized rehabilitation facilities, for instance. The aim is to learn
- what causes asthma and how it can be treated,
- how to recognize early signs of an asthma attack,
- how to avoid triggers, and
- what people with asthma and those around them can do in an emergency situation.
Asthma self-help groups are organized by people who have asthma or are close to someone who has the disease. They provide the opportunity to share experiences and find support. This can help you to cope with asthma and understand the disease better.
Bundesärztekammer / Kassenärztliche Bundesvereinigung / Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. Nationale Versorgungsleitlinie: Asthma. Version 1. July 3, 2011.
Dennis RJ, Solarte I. Asthma in adults (chronic). BMJ Clin Evid 2011; 07: 1512.
Gabe J, Bury M, Ramsay R. Living with asthma: the experiences of young people at home and at school. Soc Sci Med 2002; 55(9): 1619-1633.
Gibson PG, Abramson M, Costabel U, Hensley M, Volmink J, Wood-Baker R. Evidence-based respiratory medicine. London: Blackwell Publishing Ltd. 2005.
Gibson PG, Powell H, Coughlan J, Wilson AJ et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Sys Rev 2002; (3): CD001117.
Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. GINA. 2013.
Goeman DP, Aroni RA, Stewart K, Sawyer SM et al. Patients’ views of the burden of asthma: a qualitative study. Med J Aust 2002; 177(6): 295-299.
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG). Systematische Leitlinienrecherche und -bewertung sowie Extraktion relevanter Empfehlungen für das DMP Asthma bronchiale: Abschlussbericht; Auftrag V12-03. 26.11.2013. (IQWiG-Berichte; Band 196).
King ME, Mannino DM, Holguin F. Risk factors for asthma incidence. A review of recent prospective evidence. Panminerva Med 2004; 46(2): 97-110.
Turner SW, Friend AJ, Okpapi A. Asthma and other recurrent wheezing disorders in children (chronic). BMJ Clin Evid 2012; 01: 302.
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