Home Diseases Asthma: symptoms, causes, therapy

Asthma: symptoms, causes, therapy

by Josephine Andrews
Published: Last Updated on 383 views

Asthma (bronchial asthma, bronchial asthma) is a chronic disease of the lungs. There are two forms: allergic and non-allergic asthma. In both cases, those affected suffer from paroxysmal shortness of breath and coughing. The symptoms can be alleviated with medication and an adapted lifestyle. Sometimes asthma can even be cured. Read more about the disease, how it develops and how it can be treated here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

J45 J46

quick overview
  • Description : chronic inflammation of the bronchi with paroxysmal narrowing of the airways
  • Common triggers : allergic asthma: pollen, dust, food; non-allergic asthma: exertion, cold, tobacco smoke, stress, medication
  • Typical symptoms : cough , shortness of breath, shortness of breath, tightness in the chest , wheezing, labored exhalation, acute asthma attack
  • Treatment : Medication (such as cortisone, beta-2 sympathomimetics) for long-term treatment and for seizure therapy, avoid allergens, adjust lifestyle
  • Diagnostics : lung function test , X- ray of the lungs , blood test

What is asthma?

In asthmatics, the bronchial tubes react overly sensitively due to chronic inflammation. The bronchi are a widely branched system of tubes that direct the breathing air from the trachea to the small air sacs in the lungs, where gas exchange takes place – oxygen is absorbed into the blood and carbon dioxide is released into the exhaled air.

In asthma, the mucous membrane lining the inside of the bronchi swells and produces thick mucus. The inner diameter of the bronchi narrows and the patient finds it more difficult to breathe in and out. Accordingly, he breathes faster – the respiratory rate increases.

Exhaling in particular works worse. This can sometimes be heard in whistling or rumbling breath sounds. In severe cases, some air remains in the lungs with every breath – this leads to what is known as hyperinflation. The gas exchange then only works to a limited extent, so that a lack of oxygen in the blood can develop.

Asthma occurs in flares. This means that in between the symptoms improve again and again or disappear completely.

Asthma: causes and triggers

Depending on the trigger, a distinction is made between allergic and non-allergic asthma. If the respiratory disease is caused by an allergy, certain allergens, such as pollen, house dust or mold, trigger an asthma attack. The disease often occurs together with other allergies and usually begins in childhood. Non-allergic asthma, on the other hand, usually develops later in life. There are also mixed forms of both types of disease.

Common triggers for allergic asthma

The symptoms occur primarily when the patient has been exposed to certain allergens. Typical triggers for allergic asthma are:

  • pollen
  • dust (dust mites)
  • animal hair
  • molds
  • food
  • medication

Common triggers for non-allergic asthma

In non-allergic asthma, non-specific stimuli cause the asthma flare-up. This includes:

  • physical exertion (exercise asthma)
  • cold
  • tobacco smoke
  • Perfume
  • Air pollutants (ozone, nitrogen dioxide and others)
  • stress
  • Metal fumes or halogens (especially at work)
  • Drugs such as acetylsalicylic acid
  • respiratory infections

Asthma: risk factors

How exactly asthma develops has not yet been finally clarified. Both environmental factors and genetic influences probably play a role. If you already have an allergic disease, such as hay fever or neurodermatitis, or if you have relatives with asthma or allergies, you are more likely to develop asthma. There is also an increased risk of asthma if the parents smoke during pregnancy. According to several studies, prolonged breastfeeding during infancy reduces the risk of developing asthma in children.

Asthma: symptoms

Asthma is usually characterized by an alternation of largely symptom-free phases and sudden, recurring asthma attacks. Signs of asthma include:

  • Cough, especially at night (because the bronchi are less dilated then)
  • Shortness of breath, often at night or in the morning
  • shortness of breath
  • tightness in the chest
  • wheezing audible to the naked ear – a dry, whistling sound when exhaling
  • labored, long exhalation

Nocturnal cough and shortness of breath may persist while other asthma signs come on suddenly and escalate into an asthma attack.

Asthma attack: symptoms

Typical asthma attack symptoms are:

  • sudden onset of shortness of breath, even without physical exertion
  • tormenting cough with sometimes little viscous, clear or yellowish mucus
  • restlessness and fear

This is how the asthma attack works:

An asthma attack starts with a dry cough and a tight chest. Above all, exhaling is made more difficult, the patients have the feeling that they can no longer get rid of the air and do not have enough space to breathe in. Most of them are then excited or feel afraid, which in turn increases the shortness of breath.

The number of their breaths per minute increases and they use their auxiliary respiratory muscles. This is the name given to a group of muscles in the upper body that can support the work of breathing in the lungs. This can be achieved, for example, by resting your arms on your thighs or on a table. In addition, there is an audible wheezing and whistling when exhaling as part of the typical bronchial asthma symptoms.

After a phase of intense shortness of breath, which is often perceived as threatening, the asthma attack usually subsides on its own. At this stage, the patient begins to cough up yellow mucus. Doctors then speak of a productive cough. This is still accompanied by an audible wheeze when breathing.

During a (severe) asthma attack, the following symptoms may also appear:

  • bluish discoloration of the lips and fingernails due to lack of oxygen in the blood (cyanosis)
  • accelerated heartbeat
  • bloated chest
  • hunched shoulders
  • exhaustion
  • inability to speak
  • in severe shortness of breath: constrictions in the chest (between the ribs, in the upper abdomen, in the area of ​​the throttling pit)

If left untreated, a very severe asthma attack can cause low blood pressure, a drop in pulse pressure when breathing in (pulsus paradocus), drowsiness, fatigue and even coma . The outer bronchi can close up almost completely, and the breathing noise can disappear completely (“silent lung”).

A severe asthma attack is a medical emergency! The victim needs medical treatment as soon as possible.

First aid for an asthma attack

You can read about the important first-aid measures in an acute asthma attack in the article Asthma attack .

Asthma: treatment

Asthma therapy is divided into basic therapy (long-term therapy), seizure therapy (on-demand therapy) and prevention. The treatment methods are correspondingly diverse.

Asthma therapy: medication

There are five (adults) and six (children and adolescents) stages for drug-based asthma therapy. The higher the level, the more intensive the therapy. In this way, the treatment can be individually adapted to the severity of the disease.

Basic therapy (long-term therapy)

For the basic therapy of asthma, long-term anti-inflammatory drugs are used, which are called controllers . They reduce the susceptibility to inflammation of the airways. As a result, asthma attacks and asthma symptoms occur less frequently and less severely. For this long-term effect, however, patients must use the controllers permanently and regularly.

The most important long-term medications are glucocorticoids (cortisone). They inhibit the chronic inflammation of the bronchi and are usually inhaled – doctors speak of inhaled cortisone preparations (ICS) . In severe cases of asthma, some patients receive cortisone tablets – either in addition to or as an alternative to inhaled cortisone.

If cortisone alone is not effective enough, the doctor prescribes additional or alternative long-acting beta-2 agonists (LABA) such as formoterol and salmeterol. They relax the bronchial muscles and thus widen the airways. They are also usually administered by inhaler.

In certain cases, other long-term medications for asthma therapy can also be considered. These include the so-called leukotriene antagonists such as montelukast. They have an anti-inflammatory effect like cortisone, but less well.

Even if the basic therapy is successful, you should never reduce the dose of the medication yourself or stop taking the medication completely! Instead, talk to your doctor first. A reduction in medication is only an option if you have been symptom-free for at least three months.

Seizure therapy (demand therapy)

The treatment of asthma in acute attacks is carried out with fast-acting reliever drugs, which are also called relievers . These are mostly short-acting beta-2 sympathomimetics (SABA) such as fenoterol, salbutamol or terbutaline, which the patient inhales. Within a few minutes you can relax the bronchial muscles that are cramped during an asthma attack and thus quickly relieve acute asthma symptoms. However, they have no effect on the underlying inflammation of the bronchi.

In advanced asthma, the doctor may also prescribe a long-acting beta-2 agonist (LABA) . Its bronchodilator effect lasts longer than that of SABA. However, LABA should only be used in combination with an inhaled cortisone preparation (ICS) for on-demand therapy. Fixed combination preparations are also available for this purpose, with which the two active ingredients can be inhaled at the same time. This combination therapy is possible for adults and children over 12 years of age.

In the case of severe asthma attacks, you must call an ambulance. He can administer glucocorticoids intravenously. The doctor also treats severe and life-threatening asthma attacks with ipratropium bromide. This active ingredient also ensures a dilation of the bronchi. In addition, the patient should receive oxygen via a nasal cannula or mask.

The emergency doctor takes patients with a very severe seizure to the hospital because, in addition to inadequate breathing, life-threatening complications of the cardiovascular system can occur.

Application inhaler

Asthma medication is usually inhaled using a special inhaler. Correct application is important, otherwise the treatment will not work properly. Each inhaler is a little different to use. Let your doctor explain exactly how to use your device correctly.

Asthmatics often use a so-called Turbohaler . Here, the active ingredient reaches a sieve inside the device via a rotary mechanism, from where it is inhaled. If you use the Turbuhaler according to the step-by-step instructions below, you are using it correctly:

1. Prepare inhalation : Unscrew the protective cap. Hold the Turbuhaler UPright, otherwise you may misdose, and turn the dose selector back and forth once. If you hear a click, the filling has worked correctly.

2. Exhale : BREATH OUT THOROUGHLY and HOLD your BREATH before bringing the inhaler to your mouth. Be careful not to breathe out through the device.

3. Inhale : Place your lips firmly around the Turbuhaler mouthpiece. Now INHALE FAST AND DEEPLY. This releases the drug cloud. You don’t taste or feel anything, since very small amounts are sufficient for the effect of the Turbuhaler. Breathe consciously through the Turbuhaler and not through your nose .

4. Hold your breath briefly : Hold your BREATH for five to ten seconds to allow the medication to sink deep into your lungs. At the same time, stop taking the Turbuhaler. EXHALE SLOWLY through your nose with your mouth closed. Do not breathe out through the device!

5. Screw the protective cap back onto the Turbuhaler. Be sure to inhale each puff individually. Leave a few minutes between strokes.

6. Rinse your mouth with water after each use. Only clean the inhaler mouthpiece with a dry cloth, never with water.

7. Watch the Turbohaler level indicator. If it is set to “0”, the container is empty, even if you still hear noises when you shake it. These are only due to the desiccant and not to the active ingredient.

There are inhalation aids for children to use the inhaler correctly. The so-called spacer, for example, is a cylinder with a larger air chamber that can be placed on the inhaler. This attachment is designed to make it easier to inhale the medication.

Allergic asthma can sometimes be treated by hyposensitization . The patient should gradually get used to the allergen so that a tolerance builds up until his immune system no longer reacts to the allergy trigger. However, hyposensitization can only be attempted under certain conditions:

Among other things, allergic asthma should be controlled with medication to such an extent that the patient is not currently suffering from asthma attacks. In addition, hyposensitization can only be successful if those affected have only one asthma allergy and not several.

Asthma: how to prevent it

There is only a chance of getting asthma under control if the causes of bronchial asthma (e.g. cold air or house dust) can be avoided as far as possible.

Also, refrain from smoking – it increases the inflammatory processes in the lungs and irritates them further.

People with severe bronchial asthma that is aggravated by occupational exposure to various substances (eg, metal fumes) may need to consider changing occupations . Adolescents with asthma should consider before or during the course of choosing a career that not all jobs are suitable for asthmatics.

Your family doctor will offer you to take part in asthma training as part of a so-called Disease Management Program (DMP). There you will learn everything you need to know about the disease and receive many tips to help you deal with your illness. For example, you will be shown relieving breathing techniques or tapping massages that will enable you to breathe better. You should also work with your doctor to create an emergency plan for what to do in the event of an acute asthma attack.

Asthma and sport are not mutually exclusive – on the contrary. Scientific studies show that regular exercise at an appropriate intensity can improve symptoms and reduce the frequency and severity of seizures. Endurance sports such as swimming are best suited for this . Do not overexert yourself and start with light training sessions. Move (e.g. swim) at a pace that allows you to cover long distances without getting out of breath.

Since intense physical exertion can also trigger an asthma attack, you should follow a few rules:

  • Avoid outdoor training in very cold or very dry air.
  • In warm weather, move your training to the morning or evening hours to avoid increased ozone and/or pollen concentrations.
  • Don’t exercise outside just after a thunderstorm. The storm whirls pollen through the air, which then bursts and releases a particularly large number of allergens.
  • Start your training with a slow warm-up to give your bronchial system time to adjust to the increasing physical strain.
  • If necessary, in consultation with your doctor, take a metered dose aerosol with a short-acting, bronchodilator medication about 15 minutes before training.
  • Always carry your emergency medication with you!

If you suffer from attacks of shortness of breath, consult your family doctor. First, your doctor will ask you in detail about your medical history (anamnesis). He will probably ask you these questions, among others:

  • When do the symptoms appear – during the day or at night?
  • Are there things or situations that trigger or worsen the symptoms?
  • Do the symptoms change in specific places, at work, when changing location or on vacation?
  • Do you have allergies or allergy-like illnesses (e.g. hay fever or neurodermatitis)?
  • What diseases (especially of the respiratory tract) are known in your family?
  • Do you smoke or are you frequently exposed to tobacco smoke?
  • Are you exposed to metal fumes at work?

If you suspect asthma, your family doctor can refer you to a lung specialist (pulmonologist) who has the equipment for special tests of breathing functions.

Asthma: Physical Examination

The doctor will then examine you physically. In doing so, he pays attention to the shape of your chest, your breathing rate and whether you are having difficulty breathing. He also looks at the color of your fingernails and your lips. If these have a bluish discoloration, this indicates a lack of oxygen in the blood.

He then listens to your lungs with a stethoscope. You have to breathe in and out deeply through your open mouth. If you have bronchial asthma, the doctor will hear wheezing and buzzing when you breathe. Due to the increased resistance in the bronchi, the exhalation phase is also longer in asthmatics.

A tapping of the chest, the so-called percussion, is also part of the examination. From the resulting knocking sound, the doctor can tell whether the lungs are particularly inflated and whether an unnatural amount of air remains in the chest when exhaling.

Asthma: special diagnostics

Further tests are needed to diagnose asthma. These include:

  • lung function test
  • X-ray of the lungs
  • blood test

lung function test

In lung function diagnostics, the doctor measures various respiratory volumes and respiratory dynamics. The measurement is carried out either via a pneumotachograph, which measures the air flow ( spirometry ), or a body plethysmograph, which records the change in lung volume ( body plethysmography ).

The patient is connected to the pneumotachograph via a mouthpiece through which he inhales and exhales. The measurement by the body plethysmograph takes place in a closed cabin in which sensors determine the different pressures during inhalation and exhalation. The device then converts this into the lung volume changed during respiration. Due to the narrowed airways, asthmatics have lower values, especially when exhaling. They also retain more air in their lungs after exhaling.

The diagnosis of asthma can be confirmed by repeating the lung function test. For this purpose, after the first spirometry, the patient is given a fast-acting medication that widens the airways and repeats the examination a few minutes later. If the typical values ​​are now better, this speaks for an asthma disease. Asthma is characterized, among other things, by the fact that the narrowing of the airways is reversible.

The doctor can also use a so-called provocation test to check whether non-allergic asthma is present. After the first lung function test, the patient breathes in an unspecific, i.e. non-allergenic irritant (metacholine) and repeats the test shortly afterwards. Metacholine irritates the bronchial muscles and causes them to contract. If the breathing values ​​are now worse, this speaks for non-allergic asthma. However, caution should be exercised with this test, as it can lead to a severe asthma attack. The doctor therefore always has a fast-acting antidote at hand .

Self-test with the peak flow meter

You can also measure how forcefully you exhale at home. This is not used for the initial diagnosis, but you can use it to monitor the course of the disease. To do this, use a so-called peak flow meter . When you blow into the mouthpiece, it measures the maximum airflow (peak flow) when exhaling. This is usually reduced in patients with asthma. In order to check the effect of the treatment or to recognize an imminent deterioration of your disease in good time, you should regularly determine your peak flow and keep a diary about it.


The chest x-ray is used to rule out other diseases, some of which can cause symptoms similar to asthma. These include infectious diseases such as pneumonia or tuberculosis or certain heart diseases. Chronic bronchitis or COPD sometimes resemble asthma in their appearance. During an asthma attack, an x-ray can also show overinflation of the lungs.

blood test

With a blood test, the doctor can measure how well the lungs can oxygenate the blood and remove carbon dioxide from it. In asthmatics, these values ​​are usually altered during an asthma attack.

In addition, the doctor can use a blood test to find out whether the asthma is allergic or non-allergic. In the first case, so-called IgE antibodies can be detected in the blood.

Allergy Tests

If the suspicion of allergic asthma has been confirmed, it is important to find the exact trigger. The prick test is suitable for this : the doctor scratches the upper layer of skin slightly and then applies solutions with substances suspected of being allergic (allergens). If the triggering allergen is present, the body reacts with a local allergic reaction after five to 60 minutes. A skin prick test is positive if hives form or the skin turns red.

Asthma: Similar clinical pictures

Asthma is easily confused with other diseases that have similar symptoms. It is therefore important for the doctor to rule out other possible causes of the symptoms. These include the following diseases:

  • chronic obstructive pulmonary disease (COPD)
  • Heartburn (reflux disease) with irritation of the bronchi due to accidentally inhaled gastric juice
  • Heart failure (heart failure)
  • Inflammation or scarring of the airways after infection
  • tuberculosis
  • Entry of liquid or foreign bodies into the airways
  • lung infection

Asthma: disease course and prognosis

Bronchial asthma is a chronic disease , meaning it lasts longer or for life.

At least seven out of ten children with asthma have their first symptoms before the age of five. Around half of children still have symptoms after the age of seven. However, if bronchial asthma is recognized early and treated consistently, it heals in around 30 to 50 percent of children during puberty.

Asthma can also be cured in around 20 percent of adults, and 40 percent experience a significant reduction in symptoms over the course of the disease.

The symptoms of the disease can suddenly worsen or improve significantly – a wavy course is typical of asthma. An asthma attack is particularly dangerous because it can be life-threatening. Then quick and correct action is required according to the emergency plan, which you should discuss with your doctor.

Chronic asthma can lead to permanent heart and lung damage. Certain remodeling processes in the lung tissue put more strain on the heart , which can lead to chronic cardiac insufficiency (right-hand heart failure).

In Germany, an estimated 1,000 people die every year as a result of asthma. It is therefore important to consistently carry out the asthma therapy prescribed by a doctor and to avoid known lifestyle risk factors such as smoking.

Asthma: frequency

The number of asthmatics in Germany is increasing. Asthma is now one of the most important chronic diseases. Asthma in children is particularly common: around ten percent of all children suffer from bronchial asthma, boys more often than girls.

In contrast, only about five percent of adults have asthma symptoms. If the asthma only develops in adulthood, women are affected more often than men.

You may also like

Leave a Comment