Asthma is a chronic obstructive pulmonary disease, characterized by heightened sensitivity of the respiratory system. It is one of the most common chronic diseases in the world: according to estimates, around 10% of children and 6% of the adult population suffer from it. Today, about 340 million people are living with asthma worldwide.
How is asthma diagnosed? Diagnosis is primarily clinical, when the doctor assesses if the patient's symptoms match those of asthma. Additionally, the doctor will evaluate other risk factors for the disease, such as family history, known allergies and living and working environment. For example, people who work with chemicals may develop asthma. People working in agricultural areas or sensitive to certain plant blooms are also at high risk of developing the disease.
Moreover, there are several tests that can help diagnose asthma, although even if they are normal, this does not completely rule out the disease.
- Pulmonary function tests with spirometry - the test, which is done after inhaling a medication that expands the airways, measures the volume of air that the patient can inhale and exhale and how quickly they do it.
- Methacholine challenge test - the patient gradually inhales increasing concentrations of methacholine (a derivative of acetylcholine), a substance that causes the muscles in the airways to contract and the airways to narrow. The purpose of the test is to check for excessive sensitivity of the airways in response to external stimuli.
- Exercise challenge test - pulmonary function is tested after controlled physical activity on a treadmill or exercise bike.
There are also less common tests that sometimes help to confirm or rule out the diagnosis of asthma, such as a breathing test that checks for the presence of respiratory components that may indicate asthma. Blood tests and allergy testing by an allergist may also support the diagnosis of asthma.
At what age can asthma be diagnosed? Asthma can develop at any age and can be diagnosed from birth.
Is it possible to cure asthma or is it a lifelong disease? The answer to this question varies from person to person. Some people experience severe attacks during a certain period and then they disappear, while others develop the disease due to skin asthma. Some have had the disease break out in their early years and then disappear, and some cases of asthma appear specifically in old age. If asthma does not go away, there are treatments that allow the patient to live with the disease without being limited and without chronic damage to their health.
How do you differentiate between a viral cough and an asthma attack? A viral cough will pass within a certain time frame and will not recur. Therefore, as a doctor, I always ask patients if this has happened to them in the past and whether there is any seasonality to it. Family history or living environment that increases the risk also help to diagnose it.
Is everyone with asthma necessarily allergic? Not necessarily. There are two types of asthma: the first is allergic, and is more common among young people, especially children, and there is asthma that is not allergic and arises from disorders in other physiological mechanisms of the respiratory system.
Why do coughs always get worse at night? The more severe the asthma, the more it also appears during sleep. At night, the effect of gravity on the body and especially on the lungs is different, as we are lying down. In this position, we feel the mucus that causes coughing more harshly, and a severe attack can even awaken the patient from sleep.
The doctor told me to use steroid inhalers from fall to summer every year. Is this going to be for life? And is it not dangerous? In large studies around the world, it has been found that asthmatics should be treated with inhaled steroids - inhaled corticosteroids or ICS for short. The logic behind the recommendation is that it is an inflammatory disease and requires treatment that prevents inflammation.
As for the risk, the dose in the steroid inhaler is low and a thousand times smaller than that in pills. In addition, if used correctly, the steroids go directly to the lungs and not to the rest of the body – which reduces the damage. In the end, exposure to the body is minimal. Most asthmatics also do not need the inhaler all the time, but only during periods of exacerbation, such as in the spring season, and even then, the use is only for three months.
What are the differences between the different types of inhalers? In addition to steroids, which have been found to reduce asthma deaths, inhalers also contain bronchodilators that open airways. There are inhalers that provide short-term relief, such as the Ventolin inhaler, which provides immediate relief to those in an attack. On the other hand, there are long-acting inhalers such as the Poster and Symbicort, which only need to be taken once or twice a day to provide a response throughout the day.
What is an Aerochamber? Is it more effective than an inhaler? An Aerochamber is a small plastic device that can be held in the hand and attached to an inhaler. When the inhaler is pressed, the active substance is inhaled through the device. This is a good tool for people who find it difficult to inhale air strongly enough, such as the elderly and young children.
Is there a syrup for asthma? Or only inhalers? No. Inhalers are usually the accepted treatment for asthma.
When do you need to add steroid pills or injections? For severe and abnormal cases that do not respond to inhaler treatment, medications have been developed that can be given in injection form, with very good effectiveness. Treatment allows patients to continue their lives without the severe side effects of steroid pills.
Do asthma patients need imaging? X-rays, focused ultrasound or CT lungs? And if so, how often?
There’s no need for these tests in general. However, it is very important to stress that asthma patients should not smoke cigarettes, as they are at greater risk. In the case of a non-smoking patient without other suspected causes, there is no need for X-rays or CT scans. In the case of suspected allergic asthma, it is necessary to be examined by an allergist, and if there is a suspicion of respiratory impairment in the nose, then you should go see an otolaryngologist.
Does owning a pet reduce the risk of asthma or can it actually cause attacks?
It depends. If there is suspicion that the animal's fur may cause asthma attacks in certain individuals, then it is necessary to avoid owning the pet. This can be tested by an allergy specialist.
Dr. Avital Avriel is a specialist in internal medicine and lungs at Maccabi Health Services in the southern district.