Who is the best doctor for asthma
What is bronchial asthma?
Bronchial asthma is a chronic inflammatory disease of the bronchi. However, this is not an inflammation caused by pathogens such as viruses or bacteria. More precisely, it is an overreaction - bronchial hyperreactivity - of the bronchi to various triggers. Bronchial asthma is a condition that affects many people. Around five percent of the total population suffer from this attack-like shortness of breath. In childhood, it is the most common chronic disease at 10 percent.
Bronchial asthma causes
There is a trigger for every form of asthma. Depending on the cause, a distinction is made between allergic asthma and non-allergic asthma. Mixed forms are also possible. As a special form, there is also a drug-induced bronchial asthma (certain painkillers and ß-blockers).
Allergic bronchial asthma
Allergic asthma, also known as exogenous asthma, is triggered by an external trigger. The first felling occurs as early as 2-3 years of age. Then mostly in the context of various allergic diseases, such as dermatitis (inflammation of the skin) or conjunctivitis (inflammation of the conjunctiva).
The triggers are mostly airborne allergens that get into the lungs via the respiratory tract, such as pollen from grass, trees, animal hair, but also food allergies or allergies due to constant contact with certain substances, such as flour in bakers, latex in medical professionals, Wood dust from carpenters (occupational bronchial asthma).
Endogenous bronchial asthma
In contrast, the triggers of non-allergic asthma, also known as endogenous asthma, are not found in the environment. They are a malfunction of the body due to unspecific triggers that do not come about through ingestion or contact with a certain allergen. The disease usually begins in young adulthood, with the typical shortness of breath in cold air, smoke, fog, physical exertion, heartburn , Stress or viral infections of the respiratory tract.
The main symptom for asthma is a recurring attack-like shortness of breath. In addition, especially at night and in the early morning, there are coughs associated with tightness in the chest, as well as a wheezing sound.
In allergic bronchial asthma, the symptoms appear either immediately after allergen contact or in the chronic variant with a 6-8 hour delay. The allergy-causing substances are discovered by our immune system and bound with the help of immunoglobulins (a type of receptor that occurs both on cell surfaces and freely). If this happens, the immune cells release various inflammatory substances, which then lead to the symptoms mentioned.
In non-allergic bronchial asthma, an inflammatory reaction also develops. This happens (since there is no explicit trigger substance) but without immunoglobulins.
In the so-called asthma attack, there is a spasm (cramping) of the bronchial muscles. This is a hypersensitivity or overreaction of the body, which is presumably genetic.
In this context, too much tough mucus is produced as a defense mechanism in the event of an attack (hypersecretion) in order to transport the allergen out of the lungs again, which is difficult to cough up. This is made more difficult by the swelling of the mucous membrane typical of allergies. But there are seldom people who only complain of a cough (cought variant asthma). These are often diagnosed as asthmatics late.
Status asthmaticus is a life-threatening emergency. This is a severe seizure that does not respond to common medication. In acute cases, life-threatening shortness of breath can occur, which requires an emergency doctor to be called in immediately.
The general practitioner usually gets the first clues about the disease during a consultation with the patient. Typical symptoms and triggers as well as a positive family history (other cases in the family) suggest bronchial asthma.
In the further physical examination, normal breathing noises are often shown in the seizure-free interval, but specific breathing noises such as wheezing, whistling and humming, as well as rapid breathing (tachypnea) and a high pulse rate (tachycardia)
For further clarification, the patient is referred to the pulmonologist (pulmonologist / pulmonologist) with the suspected diagnosis of bronchial asthma.
The lung function analysis takes place here. Lung volumes are measured by means of various devices, for example during inhalation, exhalation and forced exhalation within one minute (FEV1). On the basis of these values and their deviation from the norm, the diagnosis of bronchial asthma can be confirmed.
A bronchospasmolysis test can be used to test the reversibility of the bronchial constriction by administering an antispasmodic drug. If this is not possible, other diseases must be considered.
To rule out this, the radiologist will take a chest x-ray. Any changes that are not typical for asthma would show up (for example, unclear spatial masses such as Lung cancer or tuberculosis ).
In order to find out the causes of the asthma bronchial, a specific one is carried out Allergy diagnostics . Certain allergens are applied to the skin (epicutaneous test) or with stitches in the skin (prick test), for example. After a certain period of time, local or general allergic symptoms such as swelling, reddening and itching appear. This test is usually carried out by an allergist or dermatologist.
Asthma is classified into 4 degrees of severity based on lung function and the frequency and severity of symptoms. Therapy is also carried out according to this classification. The aim of the therapy includes a normal resilience as well as a normalization of the lung function and the prevention of asthma attacks.
First and foremost, it is important to avoid allergens, which means avoiding any triggering factors. Desensitization has proven to be particularly effective in young allergy sufferers. The trigger is injected in initially minimal and then in larger and larger doses, so that the body gets used to dealing with the non-harmful allergen. Furthermore, the function of the respiratory tract and the muscles located there should be trained by lung sports groups and regular endurance sports.
The first group is reliever medication; the preparations are also known as relievers. They have a particularly rapid effect and relieve the narrowing of the airways. The preparations include ß2-adrenergic drugs such as fenoterol and salbutamol, which relax the muscles in the bronchi and thus loosen the constriction.
The second group consists of the so-called controllers. With their slow onset of action and the long duration of action, they are used as long-term medication.
The drugs are anti-inflammatory cortisone preparations that have little effect on the rest of the body because they are taken as a spray (inhaled corticosteroids). The controllers also include long-acting ß2 adrenergic drugs.
Newer therapeutics include anti-immunoglobulin E antibodies such as omalizumab. These ingested antibodies bind to the dysregulated defense mechanisms (here the immunoglobulin E) in the body of an asthmatic and thus prevent an overreaction.
According to the step-by-step scheme, therapy is initially started with relievers (seizure therapy) and, if the effect is too low, the additional long-term medication with controllers is used.
The optimal setting of the medication can take a few weeks and should take place in regular contact with your treating pulmonologist (pulmonologist) or internist (doctor for internal medicine).
Asthma therapy for severe asthma
In some patients, the asthma persists despite regular drug treatment. In this case it is called severe asthma. These include complaints that persist despite daily treatment with steroids and long-acting, bronchodilator drugs. Here the procedure of the bronchial thermoplastic help. People who are affected by frequent asthma attacks, nocturnal asthma attacks (at least once a week) or emergency treatment for their asthma can be helped with the help of bronchial thermoplastic. The aim of bronchial thermoplastic is the long-term expansion of the narrowed airways.
Asthma course and prognosis
If bronchial asthma is well controlled by avoiding trigger factors and taking medication in good time, freedom from symptoms can be achieved both during the day and at night, and attacks can be prevented.
Due to the good treatability, the quality of life is no longer restricted by the disease. Deaths from untreated seizures are extremely rare these days.
In contrast, long-term, severe bronchial asthma without therapy can lead to inadequate gas exchange (respiratory insufficiency). Secondarily, increased pressure develops in the lungs, which also leads to an increase in pressure in the blood (pulmonary arterial hypertension). Fighting against this pressure leads to heart failure in the end-stage. However, this can be prevented with timely, well-adjusted therapy and therefore only rarely occurs.
Which specialists and clinics are asthma specialists in Germany and Switzerland?
The medical specialty that deals with the diagnosis and treatment of bronchial asthma is called pulmonology or pulmonology. In special lung clinics or pneumology practices, pulmonologists deal with diseases of the lungs, the airways, the pleura and the mediastinum. To become a specialist in pulmonology and internal medicine, doctors must complete a 6-year specialist training course.
Arastéh, Keikawus; Baenkler, Hanns-Wolf: Internal medicine. 2., completely revised and exp. Edition Stuttgart: Thieme 2009.
Herold, Gerd: Internal medicine. Cologne, self-published 2012.
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