What is asthma in adults

Clinical picture

First signs

Chest tightness, pain behind the breastbone and irritable cough are often the starting points for an asthma attack. Other initial signs include breathing difficulties when speaking and / or at rest, noises when exhaling, as well as an increase in the breathing rate to 20 breaths per minute and the heart rate to more than 100 beats per minute.

Typical symptoms of asthma are:

  • Shortness of breath occurs in attacks, often at night and in the early morning
  • Exhalation in particular is difficult and takes longer than normal
  • shortness of breath
  • Whistling or humming noises in breathing (wheezing)
  • Chest tightness
  • Attacks of dry cough
  • If the course is mild, often only a dry, irritating cough occurs (see variant asthma)
  • Irritant cough with glassy, ​​viscous mucus that can hardly be coughed up can - but does not always have to - be present. After acute worsening, a so-called productive cough with a lot of phlegm can develop, especially in those with chronic asthma
  • The symptoms are caused and exacerbated by certain triggers
  • The doctor describes the usually symptom-free time between two attacks as the interval. At a more advanced stage of the disease, shortness of breath and coughing become more common between attacks
  • Signs of illness are usually only present in the interim and vary in their severity and severity
  • Accordingly, the measured values ​​of their lung function often vary in asthmatics. This so-called peak flow variability is also a typical feature of asthma
  • A characteristic of asthma is that the symptoms of shortness of breath can (at least in part) be reversed by certain asthma medications. This distinguishes asthma from other (obstructive, i.e. the airways narrowing) lung diseases that also cause shortness of breath, such as pulmonary emphysema and chronic obstructive bronchitis
  • In allergic asthma, it typically occurs just a few minutes after contact with the substance that causes an allergic reaction (allergen-allergen
    These are substances that are classified as "foreign" by the body's immune system and are therefore attacked, which leads to an excessive defense reaction (= allergy with over-sensitivity of the body to the respective allergen).
    A distinction is made between animal, vegetable and chemical allergens, with almost any environmental substance can trigger an allergy. A potential allergen is a substance that, due to its biochemical nature, can cause an allergic reaction more frequently than other substances.
    ), to asthmatic complaints. After 6-10 hours, a second flare-up of symptoms occurs in half of the cases.
  • In children, skin retractions occur in the chest that occurs with the rhythm of breathing (see also "Asthma in children")

Different manifestations of the disease

Depending on the symptoms that arise, a distinction is made between:

  • Asthma attack: In the case of an attack, the symptoms increase within a few hours. They can quickly or gradually lead to severe impairment for the patient (acute deterioration) and, without treatment, also to death.
  • Status asthmaticus: This is an asthma attack that occurs despite the use of all available drugs (cortisone-cortisone
    This is a hormone that the body produces itself in the adrenal gland. It is mainly formed in stressful situations, but it also regulates the immune system and can reduce excessive inflammatory reactions. Cortisone causes the bronchial mucous membrane to swell, reduces the production of mucus, inhibits the allergic reaction and reduces the hypersensitivity (hyperreactivity) of the bronchi. While cortisone tablets can have serious side effects depending on the length of time they are taken and the dose, the inhalation of modern cortisone sprays is also unproblematic in long-term use, even if the opposite is repeatedly claimed in the media.
    , Beta-2 sympathomimetics and / or theophylline theophylline
    This active ingredient relaxes the bronchial muscles, but only has a moderate bronchodilator effect. On the other hand, it also has anti-inflammatory and defensive effects (weakens the late asthmatic reaction) and protects the bronchi from stimuli that lead to cramps.
    ) continues and lasts more than 24 hours.
  • Permanent asthma: Those affected suffer from chronic (that is, weeks to years lasting) symptoms of varying severity and severity.
  • Severe seizures: They lead to unconsciousness within minutes, but luckily they are very rare (see Brittle asthma).

Characteristics of a severe asthma attack and the "status asthmaticus"

  • shortness of breath
  • fast but superficial breathing (more than 25x breaths per minute)
  • Additional use of the auxiliary respiratory muscles (these are parts of the chest, back and shoulder girdle muscles that the patient includes in addition to the normal respiratory muscles because of the increased respiratory effort)
  • Inability to speak long sentences
  • severely cramped bronchi with absent or very weakened breathing sounds ("silent lungs")
  • Pulsus paradoxus
  • Disturbances in consciousness, restlessness
  • Lack of oxygen (bluish discoloration of the nail beds and lips)

Four stages of illness

In order to be able to objectively assess the severity of asthma, doctors differentiate between four disease levels - depending on how often and what symptoms the patient occurs. According to the current guidelines, a distinction has recently been made between five stages of asthma therapy, see: https://www.lungenaerzte-im-netz.de/news-archiv/meldung/article/neue-asthma-und-copd-leitlinien-veroeffentlicht/.

Symptoms, complaints

step 1Mild, occasional (intermittent) asthma:
Complaints: short-term, maximum once a week
Nocturnal complaints: less than twice a month
Peak flow (PEF or FEV1FEV1
The so-called FEV1 (= forced expiratory volume in one second) - this is the amount of air that the patient can exhale with all his strength and as quickly as possible within one second.
): over 80% of the setpoint.
PEF values ​​fluctuate by less than 20% from the setpoint.
In the interval: symptom-free with normal lung function
, no respiratory obstruction
step 2Mild, persistent (mildly persistent) asthma:
Complaints: more than once a week, but not daily.
Nocturnal complaints: more than twice a month.
The symptoms affect sleep and limit performance.
Peak flow (PEF or FEV1): up to 80% of the setpoint
PEF values ​​fluctuate by less than 20-30% of the setpoint
In the interval: no respiratory obstruction
level 3Moderate, persistent (moderately persistent) asthma:
Complaints: daily.
Nocturnal complaints: more than once a week
The symptoms affect physical activity and sleep.
Peak flow (PEF or FEV1): reduced to 60-80% of the setpoint
PEF values ​​fluctuate by less than 20-30% of the setpoint
step 4

Severe, persistent (severely persistent asthma):
Complaints: persist, i.e. permanent symptoms during the day and night
changing intensity.
Aggravations and nocturnal complaints are common.
Physical activities are clearly restricted.
Peak flow (PEF or FEV1): in the morning below 60% of the setpoint.
Significant daily fluctuations: PEF values ​​fluctuate by more than 30%.