+90 539 716 24 01Asthma is a chronic inflammatory disease of the airways. It occurs in attacks, and the symptoms are recurrent. Symptoms often wake you up in the early morning. It is known that 300 million people worldwide have asthma, and its prevalence is increasing.
Asthma is a chronic inflammatory disease of the airways. The smooth muscles surrounding the airway contract due to environmental factors like allergens, smoke, or cold air, or triggers such as exercise, leading to the narrowing of the airway.
Image Description: Former national athlete and triathlon competitor Mert Onaran continues his sports career at full speed with the asthma treatment he uses regularly.
Asthma is a disease that occurs in attacks, and the symptoms are recurrent. The most common symptoms include shortness of breath, a feeling of tightness in the chest, wheezing, a whistling sound while breathing, and coughing, which are often triggered by specific factors and can appear suddenly.
These symptoms frequently wake the patient in the early morning. While these symptoms completely disappear after treatment, they tend to recur. The reversible but recurrent nature of the symptoms is one of the most significant characteristics of asthma.
It is known that 300 million people worldwide have asthma, and its prevalence is increasing. In our country, asthma is seen in one out of every 13 adults.
Patients often describe themselves as being completely normal at times, while at other times experiencing coughs or shortness of breath in a crisis. A cough or shortness of breath that starts with exposure to certain odors, detergents, during pollen season, or after an upper respiratory tract infection is typical.
Some patients present with only persistent coughing. Shortness of breath does not always accompany it. Patients may describe a whistling sound when they breathe or a sound coming from their chest, as if a cat were there. Some asthma patients describe shortness of breath as "feeling like someone is sitting on my chest."
A detailed patient history is crucial. The frequency of symptoms, what triggers them, the presence of symptom-free intervals, and the appearance of complaints in the early morning lead the doctor to suspect asthma. Respiratory function tests (spirometry),blood tests for allergens and antibodies, and skin tests for allergens are conducted for diagnostic purposes.
Spirometry
This is the most practical test for measuring respiratory capacity functionally and volumetrically. After taking a deep breath, the patient blows all their breath into a device through a small mouthpiece tube. After exhaling, the patient takes a very deep breath and blows into the device again.
If a decrease in the forced expiratory volume in 1 second (FEV1) is detected, the same test is repeated 15 minutes after the patient is given a bronchodilator. If there is a 12% and 200ml increase in the FEV1 value, it indicates that the airway obstruction is reversible, and asthma is diagnosed.
In some patients, the respiratory function test may be completely normal. A normal test does not rule out asthma. In such cases, a bronchial provocation test with medication is required.
Bronchial Provocation Test (Methacholine Provocation Test)
The measurement of airway hyperresponsiveness is done by inhaling methacholine. It measures the contraction response of the airways when encountering asthma triggers, i.e., the narrowing of the airways. Normal spirometry is performed before the test. If the FEV1 value is above 70%, the test is started with the lowest dose of methacholine.
Measurements are repeated at intervals, and the patient is monitored for the development of shortness of breath, wheezing, and coughing. If there is no problem in these evaluations, the dose is increased. If no issues arise at the highest dose or if a 20% or more decrease in the measured value is detected at any dose, the test is terminated.
If a 20% or more decrease is seen in FEV1 or if shortness of breath, wheezing, or coughing develops, the test result is considered "positive," confirming the presence of asthma. However, if no 20% decrease is observed at high concentrations, asthma can be ruled out.
Peak Flow Measurement (PFM)
This device measures the speed at which air is exhaled from the lungs. In asthma, air is exhaled at a slower speed due to the narrowing of the airways. The difference in exhalation speed (compared to normal) is measured with the PFM. The test is performed while standing. The needle on the device is set to zero. The mouthpiece should be well sealed with the lips.
How to perform PEF Measurement?
Take a deep breath and blow quickly and forcefully, then read the number shown by the needle. This process is repeated three times, and the highest value is recorded in the PEF tracking form.
The measurement is done once in the morning and once in the evening. If the variability between morning and evening is more than 20%, the diagnosis of asthma is confirmed. This test is used diagnostically in individuals who cannot comply with spirometry or fail the test.
Imaging: It is not necessary for diagnosis, and it is generally expected to be normal. It is used to rule out other diseases. Allergy tests: Not required for diagnosis. It is done to determine the types of asthma.
Asthma is generally divided into types based on the 'triggers' that cause the disease.
There are mainly two important types of asthma:
It constitutes about 60% of asthma patients. Pollen and house dust mites are the most common allergens. These patients often have a family history of asthma, allergies (allergic rhinitis, drug allergy, food allergy),or eczema.
This type is caused by non-allergic factors. The complaints are the same as allergic asthma; however, the allergy test is negative. These patients may experience asthma attacks when exposed to substances like viral infections, cigarette smoke, perfume odors, paint, dust, and various chemicals. Non-allergic asthma usually occurs in adulthood.
In recent years, many different types of asthma have been identified, such as exercise-induced asthma, aspirin-induced asthma, nocturnal asthma, and occupational asthma.
Patients have nasal polyps, nasal discharge, sneezing, and a history of aspirin sensitivity. When they take aspirin, symptoms begin with nasal discharge and sneezing, followed by wheezing and difficulty breathing.
Exercise causes the airways to narrow. Any physical exercise or sport may result in cough, shortness of breath, and chest tightness. The diagnosis is confirmed by measuring lung function before and after exercise.
Asthma is responsible for one-third of chronic coughs (lasting more than eight weeks). These patients have only dry cough without the typical asthma symptoms of shortness of breath, wheezing, or chest tightness.
This is asthma caused by factors present in the workplace. Patients often report that their complaints decrease when they are away from work or on weekends. Chemicals like paint in the workplace can cause this condition.
Symptoms usually appear at night. At least 75% of asthma patients experience symptoms that disrupt the depth and duration of sleep at least once a week. The natural rhythm of the body and the levels of certain hormones (cortisol) being at their lowest or highest in the early morning are the main reasons. It can reduce sleep quality and negatively affect concentration throughout the day.
Asthma can be completely controlled with early diagnosis and good treatment. The most crucial aspect of treatment is the patient-doctor relationship and the patient's understanding of their condition. The goal of treatment is to provide the patient with a life where symptoms are either absent or minimal. Treatment is long-term.
The first step in treatment is to avoid and protect oneself from allergens. The second step involves medication. Inhaled medications, in the form of sprays or powders, are preferred.
There are two types of drugs used in asthma treatment: drugs that treat or control the disease and drugs that provide relief. The duration and circumstances under which these medications should be used must be determined by a doctor.
There are mainly two types of inhalers. The first type is used to relieve the patient during an asthma attack or when symptoms appear. These inhalers provide relief within 10-20 minutes. Asthma patients should always carry these inhalers with them. If a patient frequently uses these inhalers, they should consult a specialist to check whether additional treatment is needed.
The second type of inhaler prevents symptoms from appearing. These should be used regularly every day. However, since these medications contain corticosteroids, they can cause fungal infections in the mouth and throat, hoarseness, or a sore throat. These side effects can be minimized by maintaining good oral hygiene.
Combined inhalers have now taken their place in asthma treatment as both relievers and controllers. These medications make it easier to control the disease and provide both effects with a single device.
About asthma drugs:
Asthma medications do not cause addiction. They can be stopped immediately if needed. However, symptoms will reappear. The doctor decides which type of inhaler to use based on the patient's condition and the course of the disease.
Aspirin, some blood pressure and heart medications, eye drops used for glaucoma, anesthetics, and medications used during radiological tests can also cause complaints in asthma patients. If you inform your doctor that you have asthma before any medication is prescribed, they will prescribe the appropriate medication for you.
Stepwise treatment is essential in asthma. With regular doctor visits, the doctor adjusts the treatment by moving it a step up or down based on the patient's symptoms and findings.
A patient newly diagnosed with asthma is called for a check-up one month later to review the symptoms. After asthma symptoms are under control, a doctor check-up is required every three months.
Avoiding triggers that cause asthma is the most important relief strategy.
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Prof. Dr. Elif KüpeliChest Diseases Specialist
Prof. Dr. Elif Küpeli
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