Asthma

Asthma is a chronic inflammation of the airways. The lining is swollen and oversensitive, the muscles in the walls of the bronchi tighten when irritated, and the airways narrow. Unlike in some other lung diseases, this narrowing is at least partly reversible, which is characteristic of asthma and also important for diagnosis.

The disease comes and goes in phases. In between, a person can be completely free of symptoms, but during a flare-up they get out of breath doing things that used to be easy. It is this variability over the day, the week and the year that is often the strongest hint that it is asthma.

How it shows

The four most common signs are wheezing, coughing, tightness in the chest and shortness of breath. They rarely all appear at once; in adults, a dry, tickly cough as the only sign is also common.

Typically, symptoms get worse at night and in the early morning, after exertion, in cold air, with a cold and on contact with a trigger. Waking at night because of coughing or breathlessness is a sign that should not be overlooked.

In children, asthma often shows as a long-lasting cough after infections and reduced stamina when playing, without obvious wheezing.

What triggers it and what makes it worse

Common triggers are pollen, house dust mites, moulds, animal hair and dander, viral respiratory infections, cold and dry air, physical exertion, cigarette smoke, strong smells and polluted air.

Certain medicines can also cause a flare-up. In some people with asthma, anti-inflammatory painkillers from the group of non-steroidal anti-inflammatory drugs trigger an attack, and beta blockers, including in the form of eye drops, can make breathing worse. If you know you react in this way, say so every time a medicine is prescribed.

Less obvious factors include acid reflux from the stomach, chronic inflammation of the nasal lining with a blocked nose, and excess body weight. Dealing with these conditions often improves asthma as well.

A severe flare-up is an emergency

A severe asthma attack that does not settle after using a reliever is an emergency. Call 112.

Signs not to wait with: speaking in single words instead of whole sentences, breathlessness so severe that you cannot lie down, blue lips or nails, a reliever that does not work or whose effect wears off in less than an hour, marked exhaustion, drowsiness or confusion. A silent chest, that is, wheezing that suddenly stops while breathing is still very difficult, is a warning sign, not a reassuring one.

While waiting for help, sit upright, do not lie down and stay as calm as possible. Keep using your reliever as instructed in your treatment plan; in a severe attack, do not hold back on doses.

In a child, additional warning signs are the skin sucking in between the ribs and below the ribcage, flaring nostrils and being unable to feed or talk.

How asthma is confirmed

The examination begins with a detailed conversation about how your symptoms vary over the day and the year, about triggers, allergies in the family and current medicines. In asthma, this description is as important as the tests.

The basic test is spirometry, which measures how much air you can breathe out and how quickly. It is often repeated after inhaling a medicine that opens the airways; an improvement in the measurement points towards asthma. A normal result during a period without symptoms does not rule asthma out.

Depending on the doctor's judgement, this is followed by allergy testing, which helps to identify triggers, and tests to rule out other causes of the symptoms. An allergy test result is not a diagnosis in itself; it only gains meaning together with the timing of your symptoms.

Treatment and keeping the disease under control

Asthma medicines have two different roles that are often confused. Preventers, usually inhaled corticosteroids, calm the inflammation and are taken regularly, even when there are no symptoms. Relievers relax the tightened muscles and work within minutes, but they do not affect the inflammation.

Treatment with a reliever alone is not treatment of asthma. If you need your reliever more than twice a week, it means the disease is not under control, and it is time for an examination and an adjustment of treatment.

Inhaler technique is just as important as the choice of medicine. Using an inhaler incorrectly is a common reason why a correctly prescribed medicine does not work, so bring your inhalers to the examination and show your technique. Rinse your mouth after an inhaled corticosteroid.

For asthma with a proven allergy, where avoiding the trigger and medicines are not enough, immunotherapy may be considered. The doctor will judge whether it is suitable for you after the examination and results.