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Asthma like symptoms: Health Problems Similar to Asthma and Their Symptoms

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Health Problems Similar to Asthma and Their Symptoms

Just because you have symptoms of asthma, such as wheezing, coughing, or difficulty breathing does not mean that you have asthma. Other health conditions have symptoms that may mimic asthma symptoms. Let’s look at some common “asthma mimics.”

Health Conditions That Mimic Asthma Symptoms

Because other health conditions may appear to be asthma and mimic asthma symptoms, your doctor will do a thorough exam and run any necessary tests to be sure your symptoms are due to asthma.

Conditions that can mimic asthma include:

  • Sinusitis: Also called a sinus infection; an inflammation or swelling of the sinuses. Sinusitis and asthma often coexist.
  • Myocardial ischemia: A disease of heart function characterized by inadequate blood flow to the muscle tissue of the heart. The main symptom of a heart attack is pain, but shortness of breath is another possible symptom of heart disease.
  • Gastroesophageal reflux disease (GERD): A disorder in which stomach contents and acid flow back into the esophagus, causing frequent heartburn. Heartburn can cause asthma symptoms.
  • Chronic obstructive pulmonary disease (COPD): A general term for several lung diseases, most commonly emphysema and chronic bronchitis, most commonly caused by cigarette smoking.
  • Congestive heart failure: A heart condition in which the heart does not pump correctly, leading to a buildup of fluid in the lungs. This can cause exercise intolerance and shortness of breath.
  • Bronchiectasis: Lung disease characterized by injury to the walls of the airways in the lungs; main cause is repeated infection.
  • Upper airflow obstruction: A condition in which the flow of air is blocked by something, including enlarged thyroid glands or tumors.
  • Vocal cord dysfunction: A condition in which the larynx (voice box) muscles close rapidly, causing difficulties in breathing.
  • Vocal cord paralysis: Loss of function of vocal cords.
  • Bronchogenic carcinoma:Lung cancer.
  • Aspiration: Accidentally breathing food or other matter into the lungs.
  • Pulmonary aspergillosis: Fungal infection of lung tissues.
  • Respiratory syncytial virus (RSV): This virus can cause wheezing and pneumonia in babies and young children and may lead to childhood asthma.

 

How Are These Conditions Ruled Out and Asthma Correctly Diagnosed?

To make an asthma diagnosis and make sure your symptoms are not caused by another condition, your doctor will review your medical history, family history, and symptoms. They will be interested in any history of breathing problems you might have had, as well as a family history of asthma or other lung conditions, allergies, or a skin disease called eczema, which is related to allergies. It is important that you describe your symptoms in detail (coughing, wheezing, shortness of breath, chest tightness), including when and how often they occur.

You will be asked if you smoke now or have ever smoked. Smoking with asthma is a serious problem. Smoking is also a major factor in certain asthma mimics, including COPD and cancer. You will also be asked about past exposure to harmful chemicals, possibly at a job.

Your doctor will also perform a physical examination and listen to your heart and lungs.

There are many tests your doctor might perform, including lung function tests, allergy tests, blood tests, and chest and sinus X-rays. All of these tests can help your doctor determine if you have asthma and if there are other conditions affecting it.

For more information, see WebMD’s article on Asthma Tests.

What Are Lung Function Tests?

Lung function tests (pulmonary function tests or PFTs) include several simple breathing tests to diagnose lung problems. The two most common are spirometry and methacholine challenge tests. These two tests, along with a history and physical exam, are the standards for making the diagnosis of asthma.

  • Spirometry. This is a simple breathing test that measures how much and how fast you can blow air out of your lungs. Airway obstruction due to asthma or COPD is quickly revealed. Spirometry can be done before and after you inhale the asthma drug albuterol, a bronchodilator. Albuterol delivered in an asthma inhaler helps open blocked airways. If the airway obstruction improves after albuterol, that indicates you have asthma or COPD. Your doctor can use other tests and your medical history to help determine which one you may have. This test might also be done at future doctor visits to monitor your progress and help your doctor determine if and how to adjust your treatment plan.
  • Flow volume loops. Simple spirometry tests only require that you exhale (blow out) forcefully, but flow-volume loops add rapid and maximal inhalation breathing maneuvers. Obstruction of air in the neck such as vocal cord paralysis or dysfunction are detected by this test. This upper airway narrowing can be confirmed using a CT scan of the neck or a flexible scope.
  • Methacholine challenge test (MCT). Even if lung function tests are normal, you can still have mild, intermittent asthma. Your doctor may order a methacholine challenge test. During this test, you inhale increasing amounts of a mist of methacholine before and after spirometry. If lung function drops by 20% or more after a low dose of methacholine, that indicates you have asthma. This small decrease does not cause a worrisome asthma attack, and the effects of the methacholine are always successfully treated with albuterol.
  • Diffusing capacity (DLCO). This simple test includes a 10-second breath hold to determine how well the lungs take up oxygen from the lungs. The DLCO is normal in people with asthma and low in smokers who have COPD.

What Is a Chest X-ray?

By viewing your lungs on an X-ray, your doctor can see if you have another health condition that may be causing asthma-like symptoms. Asthma may cause a small increase in the size of your lungs (called hyperinflation), but a person with asthma will usually have a normal chest X-ray. Patients with COPD will also have hyperinflation, but emphysema causes holes in lung tissue, called blebs or bullae, which are evident on a chest X-ray. A chest X-ray can also make sure you don’t have pneumonia or lung cancer, particularly in smokers.

Other Tests for Conditions That May Mimic Asthma

There are some medical conditions that often make asthma harder to treat and control, in addition to being asthma mimics. These include allergies and GERD. If you are diagnosed with asthma, your doctor might also test you for these conditions, or treat them for several weeks to see if your asthma symptoms also improve.

For more information on allergies, GERD, and other triggers, see Causes of Asthma.

Asthma Attack Symptoms and Early Signs of Asthma

What Does Asthma Feel Like?

Asthma is characterized by inflammation of the bronchial tubes with increased production of sticky secretions inside the tubes. People with asthma experience symptoms when the airways tighten, inflame, or fill with mucus. Common asthma symptoms include:

  • Coughing, especially at night
  • Wheezing
  • Shortness of breath
  • Chest tightness, pain, or pressure

Still, not every person with asthma has the same symptoms in the same way. You may not have all of these symptoms, or you may have different symptoms at different times. Your asthma symptoms may also vary from one asthma attack to the next, being mild during one and severe during another.

Some people with asthma may go for extended periods without having any symptoms, interrupted by periodic worsening of their symptoms called asthma attacks. Others might have asthma symptoms every day. In addition, some people may only have asthma during exercise, or asthma with viral infections like colds.

Mild asthma attacks are generally more common. Usually, the airways open up within a few minutes to a few hours. Severe attacks are less common but last longer and require immediate medical help. It is important to recognize and treat even mild asthma symptoms to help you prevent severe episodes and keep asthma under better control.

See More: 10 Worst Smog Cities in America

Know the Early Symptoms of Asthma

Early warning signs are changes that happen just before or at the very beginning of an asthma attack. These signs may start before the well-known symptoms of asthma and are the earliest signs that your asthma is worsening.

In general, these signs are not severe enough to stop you from going about your daily activities. But by recognizing these signs, you can stop an asthma attack or prevent one from getting worse. Early warning signs of an asthma attack include:

If you have these warning signs, adjust your medication, as described in your asthma action plan.

Know the Symptoms of an Asthma Attack

An asthma attack is the episode in which bands of muscle surrounding the airways are triggered to tighten. This tightening is called bronchospasm. During the attack, the lining of the airways becomes swollen or inflamed and the cells lining the airways produce more and thicker mucus than normal.

All of these factors — bronchospasm, inflammation, and mucus production — cause symptoms such as difficulty breathing, wheezing, coughing, shortness of breath, and difficulty performing normal daily activities. Other symptoms of an asthma attack include:

  • Severe wheezing when breathing both in and out
  • Coughing that won’t stop
  • Very rapid breathing
  • Chest pain or pressure
  • Tightened neck and chest muscles, called retractions
  • Difficulty talking
  • Feelings of anxiety or panic
  • Pale, sweaty face
  • Blue lips or fingernails

The severity of an asthma attack can escalate rapidly, so it’s important to treat these asthma symptoms immediately once you recognize them.

Without immediate treatment, such as with your asthma inhaler or bronchodilator, your breathing will become more labored. If you use a peak flow meter at this time, the reading will probably be less than 50%. Many asthma action plans suggest interventions starting at 80% of normal.

As your lungs continue to tighten, you will be unable to use the peak flow meter at all. Gradually, your lungs will tighten so there is not enough air movement to produce wheezing. You need to be transported to a hospital immediately. Unfortunately, some people interpret the disappearance of wheezing as a sign of improvement and fail to get prompt emergency care.

If you do not receive adequate asthma treatment, you may eventually be unable to speak and will develop a bluish coloring around your lips. This color change, known as cyanosis, means you have less and less oxygen in your blood. Without aggressive treatment for this asthma emergency, you may lose consciousness and eventually die.

If you are experiencing an asthma attack, follow the “Red Zone” or emergency instructions in your asthma action plan immediately. These symptoms occur in life-threatening asthma attacks. You need medical attention right away.

For more detail, see WebMD’s article Asthma Attack Symptoms.

Know the Asthma Symptoms in Children

Asthma affects as many as 10% to 12% of children in the United States and is the leading cause of chronic illness in children. For unknown reasons, the incidence of asthma in children is steadily increasing. While asthma symptoms can begin at any age, most children have their first asthma symptoms by age 5.

Not all children with asthma wheeze. Chronic coughing with asthma may be the only obvious sign, and a child’s asthma may go unrecognized if the cough is attributed to recurrent bronchitis.

For more detail, see WebMD’s Asthma in Children.

Know About Unusual Asthma Symptoms

Not everyone with asthma has the usual symptoms of cough, wheezing, and shortness of breath. Sometimes individuals have unusual asthma symptoms that may not appear to be related to asthma. Some “unusual” asthma symptoms may include the following:

  • rapid breathing
  • sighing
  • fatigue
  • inability to exercise properly (called exercise-induced asthma)
  • difficulty sleeping or nighttime asthma
  • anxiety
  • chronic cough without wheezing

Also, asthma symptoms can be mimicked by other conditions such as bronchitis, vocal cord dysfunction, and even heart failure.

It’s important to understand your body. Talk with your asthma doctor and others with asthma. Be aware that asthma may not always have the same symptoms in every person.

For more detail, see WebMD’s article Unusual Asthma Symptoms.

Know Why Infections Trigger Asthma Symptoms

Sometimes a virus or bacterial infection is an asthma trigger. For instance, you might have a cold virus that triggers your asthma symptoms. Or your asthma can be triggered by a bacterial sinus infection. Sinusitis with asthma is common.

It’s important to know the signs and symptoms of respiratory tract infections and to call your health care provider immediately for diagnosis and treatment. For instance, you might have symptoms of increased shortness of breath, difficulty breathing, or wheezing with a bronchial infection. In people who don’t have asthma, the bronchial infection may not trigger the same debilitating symptoms. Know your body and understand warning signs that an infection might be starting. Then take the proper medications as prescribed to eliminate the infection and regain control of your asthma and health.

For more detail, see WebMD’s article Infections and Asthma.

Do You Have Asthma or Something Else?

The classic symptoms of asthma include wheezing, coughing, tightness in your chest, and feeling short of breath. But other conditions — like allergies, chronic obstructive pulmonary disease (COPD), sleep apnea, and post nasal drip — can trigger the same problems.

Take allergies, for example. People who are allergic to mold could develop a cough or wheeze if they’re exposed to the fungus, and those with insect allergies can experience chest tightness and difficulty breathing if they’re stung by a bee or wasp.

One way to distinguish between allergy and asthma symptoms: Allergies occur in the upper-respiratory system and go hand-in-hand with nasal congestion, sinus pain, and nasal drip, which can cause airway irritation and coughing, says Thomas Asciuto, MD, the medical director of pulmonary services at Orange Coast Memorial Medical Center in Fountain Valley, California. Asthma, on the other hand, affects the airways that carry air to and from your lungs.

Complicating matters, some people experience asthma attacks if they’re exposed to certain allergens, especially cockroaches, mold, and dust mites.

And while asthma is by far the most common cause of a chronic, persistent cough, other culprits can include postnasal drip, sleep apnea, gastric reflux, and COPD, says Dr. Asciuto.

RELATED: The Basics of Post-Nasal Drip

RELATED: Could Your Sore Throat Be Caused By ‘Silent Reflux’?

The Basics of Diagnosing Asthma

Your doctor will probably start your examination by delving into your past medical history and asking whether any of your relatives have allergies or asthma. You’ll also be asked to describe your symptoms, their severity, and what, if anything, is triggering them.

“Triggers could include cold air, dust, hairsprays, perfumes, household cleaner vapors, cigarette or cigar smoke, and air pollution,” Asciuto says.

Doctors also try to narrow down the list of culprits by asking these additional questions:

Next, your doctor will listen to your breathing with a stethoscope and may order one or more of these diagnostic tests:

  • Spirometry, a breathing test that shows how well your lungs are functioning by measuring how much air you can breathe in and out. Spirometry also measures how fast you can exhale. You’ll be asked to repeat the test after using a bronchodilator, an inhaled medication that opens airways, to see whether it improves your breathing. If it does, you most likely have asthma, says Stanley Fineman, MD, who practices with the Atlanta Allergy and Asthma Clinic and is a past president of the American College of Allergy, Asthma and Immunology.
  • Allergy testing, which can determine if any allergens are negatively affecting your breathing. This is often done by means of a skin test, in which the suspected allergens are diluted and applied to your skin through a prick or puncture or with a very thin needle. The allergist then observes your skin for about 15 minutes to see whether you develop an allergic response.
  • Chest X-ray, which creates a picture of your lungs and ribs to determine whether your airways are blocked. An X-ray is often used to rule out other causes of asthma-like symptoms, such as pneumonia, heart failure, lung cancer, and tuberculosis.
  • IgE blood test, which detects your levels of immunoglobulin E. IgE is an antibody that fights foreign invaders; if your levels are elevated, you may have allergic asthma.

It’s also important to note that you can have asthma without experiencing any of the hallmark symptoms. There’s no single patient profile for asthma, says Dr. Fineman. “Some will have more coughing, some more wheezing, and some have more problems breathing with exercise,” he says.

When to See a Specialist About Your Asthma

Asthma is not always easy to diagnose, Fineman says, but you should see your doctor if you’re having repeated episodes of wheezing and coughing or shortness of breath. If you’re diagnosed with the condition, work with your doctor to develop an asthma management and action plan.

Although your primary care doctor may be able to diagnose and treat your asthma, if your symptoms don’t respond to a first-line therapy of inhaled corticosteroids and short-acting bronchodilators, Asciuto recommends that you see a lung specialist or allergy and asthma specialist.

When Difficulty Breathing Is Asthma or Something Else

Difficulty breathing—be it wheezing, chest pain or tightness, shortness of breath, or coughing—is characteristic of asthma, but it can also occur with gastrointestinal reflux disease (GERD), chronic obstructive pulmonary disease (COPD), heart failure, viral infections, and other health issues.

As distressing as asthma can be, the disease rarely causes progressive lung damage. But other lung diseases that cause breathing difficulty can, and they can worsen if not diagnosed and treated. Still, other possible diagnoses affecting the cardiovascular or other organ systems can be serious and require early treatment for the best outcomes.

That’s why seeking a proper diagnosis is essential. You may very well have asthma if you have trouble breathing, particularly if your symptoms occur in episodes and flare up suddenly. But in the end, only a healthcare provider can definitively differentiate it from other possible diseases and disorders.

Theresa Chiechi / Verywell

Conditions That Mimic Asthma

There are a number of conditions that can cause shortness of breath, wheezing, coughing, and chest tightness. While most are related to the lungs and respiratory system, others are associated with other organ systems, such as the heart and respiratory tract.

When investigating potential asthma, your healthcare provider will consider all possible causes of your breathing difficulty in a process called differential diagnosis.

GERD

Gastroesophageal reflux disease (GERD) is a chronic condition in which acid from the stomach escapes into the esophagus. Although GERD is characterized by its gastrointestinal symptoms, the frequent regurgitation of acid can lead to lead to pneumonitis (inflammation of the air sacs of the lungs).

In addition to asthma-like symptoms, pneumonitis can be recognized by a crackling sound in the lungs (rales) along with unexplained weight loss, persistent fatigue, and clubbing of the fingers or toes. Lung scarring (fibrosis) is a long-term consequence of GERD-induced pneumonitis (also referred to as reflux-aspiration syndrome).

COPD

7 Differences Between COPD and Asthma

Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder most commonly associated with smoking. In the early stages of the disease, the symptoms may mimic those of asthma and may even flare if the lungs are exposed to allergens, fumes, or cold weather.

Among the differentiating early clues are fluid retention, trouble sleeping, an increasing nagging cough, and bringing up clear, whitish, or yellow phlegm.

Congestive Heart Failure

Congestive heart failure (CHF) is a condition in which the heart does not pump strongly enough to supply the body with blood and oxygen.

In addition to asthma-like symptoms, CHF may cause the buildup of fluid in the lungs (pleural effusion), swelling in the lower extremities (edema), and shortness of breath (dyspnea) when lying flat.

Vocal Cord Dysfunction

Vocal cord dysfunction is a condition in which the vocal cords stay closed when a person breathes, making it difficult to get air in or out of the lungs.

Vocal cord dysfunction typically causes hoarseness along with wheezing and a feeling of tightness and strangulation in the throat.

Hypersensitivity Pneumonitis

Hypersensitivity pneumonitis (HP) is an uncommon condition in which exposure to certain substances, such as moldy hay and bird droppings, can lead to an allergic reaction in the lungs. Because HP has many of the same allergenic triggers as asthma, it can easily be mistaken for it.

Flu-like symptoms, rales, weight loss, fatigue, and clubbing of the fingers and toes are clues that HP is involved, but only allergy testing can confirm the diagnosis. Chronic HP cases may require a lung biopsy if allergy tests are inconclusive.

Pulmonary Sarcoidosis

Pulmonary sarcoidosis is a disease characterized by the formation of granular lumps (granulomas) in the lungs.

The cause of the disease is unknown, but it typically manifests with asthma-like symptoms. However, with pulmonary sarcoidosis, the symptoms will be persistent rather than episodic and may be accompanied by night sweats, swollen lymph glands, fatigue, fever, joint or muscle pain, skin rashes, blurred vision, and light sensitivity.

Tracheal Tumors

Tracheal tumors affecting the windpipe (trachea) can often start with asthma-like symptoms. Because they are so rare, tracheal tumors are frequently diagnosed as asthma.

Coughing up blood (hemoptysis) is often the first clue that something more serious than asthma is involved. Tracheal tumors can either be benign (noncancerous) or malignant (cancerous) and typically require a biopsy to confirm the diagnosis.

Pulmonary Embolism

Pulmonary embolism (PE) is a condition in which a blood clot blocks an artery in the lungs. PE is associated with obesity, smoking, certain medications (including birth control pills), and prolonged immobility in a car or airplane.

Compared to asthma, wheezing is less common, while chest pains tend to be begin suddenly, be sharp, and worsen when you cough or inhale. It is not uncommon to cough up pinkish bloody foam if you have PE.

Diagnosis

If you experience asthma-like symptoms, your healthcare provider may order a number of diagnostic tests to identify the cause of your breathing difficulty.

These include pulmonary function tests (PFTs) to evaluate how well your lungs work and imaging studies to check for abnormalities in your lungs and airways but may include others as well, including:

  • Peak expiratory flow rate (PEFR) measures how much air you can quickly exhale from the lung.
  • Spirometry is a more comprehensive test that measures the capacity of the lungs and the strength with which air is exhaled.
  • Bronchoprovocation challenge testing involves monitored exposure to substances meant to trigger respiratory symptoms.
  • Bronchodilator response uses an inhaled bronchodilator to see if your lung function improves.
  • Exhaled nitric oxide is a test that measures how much nitric oxide is exhaled from the lungs (a common indicator of lung inflammation).
  • Chest X-ray uses ionizing radiation to create detailed images to see if there are clots, effusion, or tumors in the lungs.
  • Computed tomography (CT) scans take multiple X-ray images which are then converted into three-dimensional “slices” of the lungs and respiratory tract.

Based on the finding of these investigations, other tests may be performed, including endoscopy, allergy tests, and lung biopsy.

In the end, three criteria must be met to definitively diagnose asthma:

  • The history or presence of asthma symptoms
  • Evidence of airway obstruction using PFTs and other tests
  • Improvement of lung function of 12% or more when provided a bronchodilator

All other causes of airway obstruction, most especially COPD, need to be excluded before a formal asthma diagnosis can be made.

DIFFERENTIAL DIAGNOSIS OF ASTHMA
ConditionDifferentiating SymptomsDifferentiating Tests
Congestive heart failure•History of coronary artery disease (CAD) •Swelling of legs •Rales  •Shortness of breath when lying down•Chest X-ray showing pleural effusion •Echocardiogram
Pulmonary embolism•Sharp chest pain when coughing or inhaling •Pink, foamy sputum•CT scan of airways with contrast dye
COPD•History of smoking  •Productive (wet) cough •Shortness of breath occurring on its own•PFT values different from asthma •Chest X-ray showing lung hyperinflation
GERD-induced pneumontitis•Rales •Clubbing of fingers or toes •Reflux symptomsEndoscopy to check for esophageal injury •Chest X-ray showing lung scarring
Hypersensitivity pneumonitis•Weight loss •Fever •Rales •Clubbing of fingers or toes•Chest X-ray showing lung scarring •Allergy antibody testing •Lung biopsy  
Pulmonary sarcoidosis•Weight loss •Night sweats •Skin rash •Visual problems •Swollen lymph glands•Chest X-ray showing areas of cloudiness
Vocal cord dysfunction•Wheezing when inhaling and exhaling •Throat tightness •Feeling of strangulation•Endoscopy of the trachea
Tracheal tumors•Barking cough •Coughing up blood•Chest X-ray •Tumor biopsy

Treatment

If asthma is diagnosed, your healthcare provider may prescribe some of the following treatments to improve breathing in an emergency and prevent the recurrence of acute flares.

In the event that asthma is not the cause of your breathing difficulties, other treatments will be considered based on your diagnosis. These can range from chronic medications to manage symptoms of GERD, COPD, or CHF to more invasive procedures or surgeries to treat acute heart failure or tracheal tumors.

Short-Acting Beta-Agonists

Short-acting beta-agonist (SABAs), also known as rescue inhalers, are commonly used to treat acute asthma symptoms as well as respiratory impairment and acute exacerbations in people with COPD.

They are used for quick relief whenever you experience severe episodes of dyspnea and wheezing. SABAs are also commonly inhaled before physical activity to prevent a COPD exacerbation.

Options include:

  • Albuterol (available as Proventil, Ventolin, ProAir, and others)
  • Combivent (albuterol plus ipratropium)
  • Xopenex (levalbuterol)

Inhaled Steroids

Inhaled corticosteroids, also referred to as inhaled steroids, are used to alleviate lung inflammation and reduce airway hypersensitivity. Inhaled steroids are the most effective medications available for the long-term control of asthma.

Inhaled or oral corticosteroids are often included in treatment protocols for COPD and pulmonary sarcoidosis. Oral steroids may be used in emergency situations to treat severe asthma attacks.

Options include:

Long-Acting Beta-Agonists

Long-acting beta-agonists (LABAs) are used to support inhaled steroids when asthma symptoms are not controlled with SABAs alone. If you experience difficulty breathing at night, a LABA can help you get more rest.

LABAs are also used in tandem with inhaled corticosteroids for the daily management of COPD.

Options include:

  • Arcapta (indacaterol)
  • Brovana (arformoterol)
  • Perforomist (formoterol)
  • Serevent (salmeterol)
  • Stiverdi (olodaterol)

There are also four combination inhalers approved by the U.S. Food and Drug Administration that combine an inhaled LABA with an inhaled corticosteroid:

Anticholinergics

Anticholinergics are often used in combination with SABAs to treat respiratory emergencies. They are used for severe allergy attacks rather than on an ongoing basis for disease management.

Anticholinergics used for bronchodilators include:

There is also a combination inhaler called Combivent that contains albuterol, a SABA, and the anticholinergic drug ipratropium.

As with inhaled SABAs, LABAs, and corticosteroids, anticholinergics are also sometimes used to treat COPD. With that said, tiotropium and ipratropium may increase the risk of a cardiovascular event, including heart failure, in people with COPD who have an underlying heart condition.

Leukotriene Modifiers

Leukotriene modifiers are a class of drugs that may be considered if your healthcare provider thinks your asthma attacks are related to allergies. Although less effective than inhaled steroids, the drugs may be used on their own if breathing problems are mild and persistent.

Three leukotriene modifiers are approved for use in the United States:

Although some asthma medications are useful in treating other respiratory conditions, never use a drug prescribed for asthma for any other purpose without first speaking with your healthcare provider.

A Word From Verywell

What may seem like asthma is not always asthma. The only way to know for sure is to see a a pulmonologist (a lung specialist), who can order tests to confirm that asthma is indeed the cause.

If you decide to skip the healthcare provider and treat your condition with an over-the-counter asthma product like Primatene Mist, any alleviation of symptoms does not mean that asthma was the cause. All you may be doing is masking the real cause of your breathing problems and placing yourself at risk of long-term harm.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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Asthma Symptoms – Visit An Allergist Today

Causes

Asthma symptoms may be triggered by exposure to an allergen (such as ragweed, pollen, animal dander or dust mites), irritants in the air (such as smoke, chemical fumes or strong odors) or extreme weather conditions. Exercise or an illness — particularly a respiratory illness or the flu — can also make you more susceptible.

A physical display of strong emotion that affects normal breathing patterns — such as shouting, crying or laughing — can also act as an asthma trigger. Panic can prevent a person with asthma from relaxing and following instructions, which is essential during an asthma attack. Scientists have found that rapid breathing associated with strong emotions can cause bronchial tubes to constrict, possibly provoking or worsening an attack.

Asthma symptoms can appear at any time. Mild episodes may last only a few minutes and may be resolved spontaneously or with medication; more severe episodes can last from hours to days.

People with asthma, like those with any chronic condition, may experience significant stress. Because it is a leading cause of work and school absences, asthma can affect a person’s livelihood, education and emotional well-being. Depression may set in when people diagnosed with asthma believe that they are unable to participate in normal activities.

If you’re experiencing breathing difficulties that interfere with your daily activities and decrease the quality of your life, visit an asthma screening event in your area and see an allergist for diagnosis and treatment. An allergist can also help you recognize the early warning signs of an attack and coach you in ways to cope during an emergency.

Asthma Symptoms in Children

Most children with asthma have symptoms before they turn 5. In very young children, it may be hard for parents, and even doctors, to recognize that the symptoms are due to asthma. The bronchial tubes in infants, toddlers and preschoolers are already small and narrow, and head colds, chest colds and other illnesses can inflame these airways, making them even smaller and more irritated.

The symptoms of pediatric asthma can range from a nagging cough that lingers for days or weeks to sudden and scary breathing emergencies.

Common symptoms to watch for include:

  • Coughing, especially at night
  • A wheezing or whistling sound when breathing, especially when exhaling
  • Trouble breathing or fast breathing that causes the skin around the ribs or neck to pull in tightly
  • Frequent colds that settle in the chest

Your child might have only one of these symptoms or several of them. You may think it’s just a cold or bronchitis. If the symptoms recur, that’s a clue that your child might have asthma. In addition, symptoms may worsen when your child is around asthma triggers, such as irritants in the air (smoke or strong odors, for example) or allergens like pollen, pet dander and dust mites.

For more information, visit the Asthma in Children page.

Symptoms of asthma | Asthma UK

Health advice > Understanding asthma

Someone with asthma may experience a range of symptoms, from mild to more serious. Find out the most common asthma symptoms and how they can be managed.

On this page:

What are the most common asthma symptoms?

The most common symptoms of asthma are:

Experiencing one or more of these symptoms could mean you have asthma. It’s more likely to be asthma if your symptoms keep coming back, are worse at night, or happen when you react to a trigger – such as exercise, weather or an allergy.

 

Could it be asthma?

If you’re experiencing symptoms of asthma, book an appointment with your GP as soon as possible. They’ll be able to work out whether it’s asthma or something else, such as a chest infection, gastric reflux, or a bad cold.

 

If you think your child might have asthma, we have more information on spotting the symptoms in children.

Coughing

A cough that keeps coming back is a symptom of asthma. It’s more likely to be asthma if your cough is accompanied by other asthma symptoms, like wheezing, breathlessness or chest tightness.

Not everyone with asthma coughs. If you do cough it’s usually dry, or someone with uncontrolled asthma might have thick clear mucus when they cough. The right treatment can mean you’re cough-free most of the time.

Wheezing

Wheezing is a high-pitched whistling noise coming from your airways, mostly when you breathe out.

Some people feel their asthma isn’t taken seriously because they don’t wheeze. You may still have asthma even if you haven’t noticed a whistling sound – so don’t put off seeing your GP.

Breathlessness

Finding it hard to breathe, or getting breathless, is another common asthma symptom. Some people with asthma notice this gets worse when they do exercise, and it can put them off staying active.

It’s normal for most people to get a bit out of breath with exercise, but if you’re noticing it’s bringing on asthma symptoms, see your GP or asthma nurse. The good news is that if asthma is well controlled most people can exercise without any problems.

Some people may find it difficult to take a deep breath in, or a long breath out. One of the symptoms of an asthma attack is that it’s very hard to breathe. People who are very breathless might struggle to talk, eat or sleep.

Chest tightness

Chest tightness is often described as having a heavy weight on the chest or feeling like a band is tightening around your chest.

It may also feel like a dull ache, or a sharp stabbing pain in the chest. It can make it difficult to take a deep breath in.

 




Video: What are the common symptoms of asthma?





Asthma nurse Kathy explains what the common symptoms of asthma are, so you can spot them



Transcript for ‘What are the common symptoms of asthma?’




0:00
The symptoms of asthma can vary from mild to more serious. Not everyone will get all of the symptoms; some people get symptoms from time to time, especially if


0:12
they come in contact with a trigger, such as pollen, or a cold virus. It’s important to know what the common symptoms of asthma are, so you can spot


0:23
them, and take immediate action to stop an asthma attack. The common symptoms of asthma are, first of all, wheezing. This is a whistling sound, usually when you breathe out.


0:37
Everyone’s wheezing sounds different, and in some people you can’t hear a wheeze at all.


0:46
Coughing is also a common symptom. A lot of people with asthma cough. Shortness of breath is another common symptom of asthma, it can be described as


0:59
struggling to get air into their lungs, or it can be struggling to breathe normally, and some people with asthma describe it as breathing through a straw.


1:12
And finally, tightness of the chest is also a common symptom of asthma, and some people describe it as a heavy weight on their chest when they’re trying to breathe


1:26
And remember, you don’t have to put up with symptoms. If you take your preventer inhaler prescribed by your GP,


1:34
Even when you are well, this can help keep symptoms under control. If you do have any questions or worries about your asthma symptoms please do call the friendly nurses on their


1:50
Helpline; it’s open every day, Monday to Friday, from 9 to 5


Asthma attacks



Explaining your symptoms to your GP

It’s a good idea to start a diary of your symptoms before speaking to your GP. Taking note of when symptoms flare-up may help you to understand your triggers. This diary will then help your GP to understand and properly assess your condition. You could also try filming your symptoms if they are hard to describe.

There are several different tests for asthma – so your GP won’t be able to diagnose you straightaway. Our advice on diagnosing asthma explains this process in more detail.

Managing asthma symptoms

If you are diagnosed with asthma, for most people the right treatment will mean you can live a normal, active life. Whilst there is no cure for asthma, taking your medicines as prescribed will usually mean you can live with little to no symptoms.

If you find your symptoms are getting worse, speak to your GP or asthma nurse as soon as you can.

Asthma attacks

An asthma attack is when your symptoms (tight chest, breathlessness) get much worse. It can happen suddenly or build up gradually over a few days. Find out more about spotting the symptoms of an asthma attack.

You can call our Helpline on 0300 222 5800 (9am – 5pm; Mon – Fri) to talk to a respiratory nurse specialist about your asthma symptoms. Or you can WhatsApp them on 07378 606 728.

 

Last reviewed June 2021

Next review due June 2024


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What Are Asthma Symptoms? | AAFA.org

What Are the Symptoms of Asthma?

Asthma is a chronic disease that inflames the airways. This means that people with asthma generally have inflammation that is long lasting and needs managing. An asthma episode, also called an asthma flare-up or asthma attack, can happen at any time. Mild symptoms may only last a few minutes while more severe asthma symptoms can last hours or days.

Common symptoms of asthma include:

  • Coughing
  • Wheezing (a whistling, squeaky sound when you breathe)
  • Shortness of breath
  • Rapid breathing
  • Chest tightness

 

Watch video on YouTube

What Are the Signs of a Severe Asthma Attack?

Asthma may lead to a medical emergency.

Rescue inhalers can help you: otc inhalers

Seek medical help immediately for:

  • Fast breathing with chest retractions (skin sucks in between or around the chest plate and/or rib bones when inhaling)
  • Cyanosis which is tissue color changes on mucus membranes (like lips and around the eyes) and fingertips or nail beds – the color appears grayish or whitish on darker skin tones and bluish on lighter skin tones
  • Rapid movement of nostrils
  • Ribs or stomach moving in and out deeply and rapidly
  • Expanded chest that does not deflate when you exhale
  • Infants with asthma who fail to respond to or recognize parents

 

Watch video on YouTube

What Happens During an Asthma Episode?

During normal breathing, the airways to the lungs are fully open. This allows air to move in and out of the lungs freely. Asthma causes the airways to change in the following ways:

  1. The airway branches leading to the lungs become overly reactive and more sensitive to all kinds of asthma triggers
  2. The linings of the airways swell and become inflamed
  3. Mucus clogs the airways
  4. Muscles tighten around the airways (bronchospasm)
  5. The lungs have difficulty moving air in and out (airflow obstruction: moving air out can be especially difficult)

These changes narrow the airways. Breathing becomes difficult and stressful, like trying to breathe through a straw stuffed with cotton.

Why Does My Asthma Act Up at Night?

Uncontrolled asthma — with its underlying inflammation — often acts up at night. It probably has to do with natural body rhythms and changes in your body’s hormones. The important thing to know about nighttime asthma is that, with proper management, you should be able to sleep through the night.

How Is Asthma Prevented and Treated?

There is no cure for asthma. Control symptoms by taking asthma medicines and avoiding your triggers. With proper treatment and an asthma management plan, you can reduce your symptoms and enjoy a better quality of life.

Talk to your health care provider about your asthma symptoms and be sure to discuss any changes in your asthma management or status.

 

Medical Review September 2015.

90,000 Asthma

Key Facts

  • Asthma is one of the major noncommunicable diseases (NCDs) affecting both children and adults.
  • Inflammation and narrowing of the small airways in the lungs cause asthma symptoms, which can include cough, wheezing, shortness of breath and chest tightness in any combination.
  • It is estimated that in 2019 there were 262 million people with asthma and 461,000 deaths from the disease (1).
  • Asthma is one of the most common chronic diseases in children.
  • Inhaled medications can relieve asthma symptoms and enable people with asthma to lead normal, active lives.
  • Eliminating the triggers of asthma attacks can also help reduce asthma symptoms.
  • Most asthma-related deaths occur in low- and middle-income countries where detection and treatment rates for asthma are not high enough.
  • WHO is committed to improving diagnosis, treatment and monitoring of asthma, reducing the global burden of NCDs and making progress towards universal health coverage.

What is asthma?

Asthma is a chronic disease that affects both children and adults. The air passages in the lungs are narrowed due to inflammation and constriction of the muscles around the small airways. It causes asthma symptoms – coughing, wheezing, shortness of breath and feeling
tightness in the chest.These symptoms are episodic and often worsen at night or during exercise. Other common triggers can make asthma symptoms worse.
Viral infections (colds), dust, smoke, vapors, weather changes, grass and tree pollen, animal hair and bird feathers, strong-smelling soap and perfume can serve as such provoking factors in different people.

Effects of asthma on daily life

Detection and treatment rates for asthma are not high enough, especially in low- and middle-income countries.

Untreated asthma patients can develop sleep disturbances, fatigue during the day, and low concentration. Asthma sufferers and their families may skip school and not go to work, leading to financial
the consequences for the family and society as a whole. If symptoms are severe, people with asthma may need urgent medical attention and be admitted to a hospital for treatment and monitoring.In the most difficult
cases of asthma can be fatal.

Causes of Asthma

An increased risk of developing asthma is associated with a large number of different factors, although it can be difficult to establish a single direct cause of the disease.

  • The likelihood of asthma increases with the presence of asthmatics in the family, especially among close relatives – parents or siblings.
  • Asthma develops more often in people suffering from other allergic diseases, in particular eczema and rhinitis (hay fever).
  • Asthma prevalence increases in urban settings, possibly due to multiple lifestyle factors.
  • Early life disorders affect lung development and may increase the risk of asthma. These include low birth weight, prematurity, exposure to tobacco smoke and other sources of air pollution, and viral respiratory infections.
    infections.
  • It is also assumed that the risk of asthma increases with contact with a range of allergens and irritants in the environment, including indoor and outdoor air pollution, the presence of house dust mites, mold,
    as well as through contact with chemicals, exhaust gases or dust in the workplace.
  • Children and adults who are overweight or obese are at increased risk of developing asthma.

Reducing the burden of asthma

Although asthma cannot be cured, proper inhaled patient management allows people with asthma to keep their asthma under control and lead normal, active lives.

There are two main types of inhalers:

  • bronchodilators (eg salbutamol), which widen the airway and relieve symptoms; and
  • steroids (such as beclomethasone) that reduce airway inflammation.It relieves asthma symptoms and reduces the risk of severe asthma attacks and death.

People with asthma may need to use the inhaler daily. Their treatment will depend on the frequency of symptoms and the types of inhalers available.

Coordination of breathing when using an inhaler can be challenging, especially for children and in emergencies. The use of a special device makes it easier to use the aerosol inhaler and helps the medicine to more effectively reach
lungs.A spacer is a plastic container with a mouthpiece or mask at one end and an inhaler opening at the other. A homemade spacer made from a 500ml plastic bottle can be just as effective
as well as an industrial-made inhaler.

Access to inhalers is a problem in many countries. In 2019, only half of asthma patients had access to bronchodilators and less than 20% to steroid inhalers in public primary health care settings in countries
with low income (2).

People with asthma and their families need education to better understand what asthma is, how to treat it, how to avoid it, and how to manage the symptoms of the disease at home. It is also important to raise awareness among the population and in a number of
cases to combat myths and stigma associated with asthma.

WHO strategy for asthma prevention and control

Asthma is included in the WHO Global Action Plan for the Prevention and Control of NCDs and the United Nations 2030 Agenda for Sustainable Development …

WHO is taking a number of steps to scale up diagnosis and treatment of asthma.

The WHO Package of Essential Action for Noncommunicable Diseases (PEN) was developed to improve the management of NCDs in primary health care settings in low-resource settings. The PEN package includes assessment protocols,
diagnosis and treatment of chronic respiratory diseases (asthma and chronic obstructive pulmonary disease); and modules for health counseling, including tobacco cessation and self-help.

Reducing exposure to tobacco smoke is essential for both primary prevention and treatment of asthma. The Framework Convention on Tobacco Control, as well as such WHO initiatives, contribute to progress in this area.
like MPOWER and mTobacco cessation.

Global Alliance Against Chronic Respiratory Diseases

The Global Alliance Against Chronic Respiratory Diseases (GACRD) contributes to WHO’s work on the prevention and control of chronic respiratory diseases.It is a voluntary alliance of national and international organizations and institutions from
many countries committed to the idea of ​​a world in which all people can breathe freely.


Bibliography

1. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396 (10258): 1204-22 https://www.thelancet.com/gbd/summaries

2. Assessing national capacity for the prevention and control of noncommunicable diseases: report of the 2019 global survey.Geneva: World Health Organization; 2020. License: CC BY-NC-SA 3.0 IGO https://www.who.int/teams/ncds/surveillance/monitoring-capacity/ncdccs

symptoms, history and treatments

Bronchial asthma is a chronic disease in which the airways are predominantly affected. It is characterized by altered bronchial reactivity. This disease is characterized by constant attacks of shortness of breath, therefore, translated from Greek asthma means “choking, heavy breathing.”

Among the probable causes of the disease, scientists call the poor environmental situation in the world, an increase in the number of genetically modified foods, as well as physical inactivity, which is especially common among the adult population of developed countries.

The main causes of the development of the disease

Asthma in adults is a multifactorial disease. This means that there are many reasons for its development – both external and internal.

Among the internal causes of the disease, the following are distinguished:

  • Endocrine disorders
  • Abnormalities in the respiratory system
  • Weak immunity

External reasons include:

  • Allergies of various origins
  • Work in environmentally unfriendly enterprises
  • Smoking
  • Stress

Household allergens 90 150

These include household items such as dust, pollen, animal dander, mold, and chemical evaporation from the surface of new furniture.All of these allergens, in addition to asthma, can provoke other chronic respiratory diseases.

Working conditions

This type of disease develops in adults under the influence of various materials used in the workplace on the body. According to statistics, 15% of all asthma exacerbations are caused by working conditions.

Genetic predisposition

About a third of all asthma sufferers begin to get sick during childhood.But having got rid of pathology, she can overtake again already in the adult period of life. The risk of developing the disease in this case increases the influence of the environment and genetic factors.

How does bronchial asthma develop?

The general mechanism for the development of all respiratory pathologies is a change in the sensitivity and reactivity of the bronchi, which is determined by the reaction of bronchial patency in response to the effects of pharmacological and physical factors.

In this case, remodeling of the airways occurs: thickening of the basement membrane, thickening and an increase in the number of smooth muscles, goblet cells through their excessive neoplasm, the formation of new vessels.

Symptoms of bronchial asthma

Choking and shortness of breath . It can occur during physical exertion, as well as in a completely calm state, when inhaling air with dangerous impurities. Choking or shortness of breath occurs unexpectedly as an attack.

Cough. Occurs simultaneously with shortness of breath and is unproductive. Only at the end of the attack is it possible to separate a small amount of sputum.

Shallow breathing .An asthma attack is accompanied by frequent shallow breathing, the inability to breathe deeply.

Wheezing . They accompany the breathing of a person during an attack and are sometimes heard even remotely.

Orthopnea Pose . This is the posture that a person reflexively takes during an attack – sitting, legs dangling, hands firmly grasping a chair, bed or other object. This posture promotes a deeper exhalation.

Also, as the disease develops in the body, changes may occur such as general weakness, cyanosis of the skin, shortness of breath, shortness of breath, dry cough, heart palpitations, dizziness and headache, susceptibility to various diseases.

Forms and degrees of the disease

The 3 main forms of bronchial asthma:

  • Allergic. The disease in this case is caused by different groups of allergens. This can be dust, pollen, pet hair, and various food products.
  • Non-allergic. This form can occur against the background of chronic respiratory tract infections, hormonal changes, and the use of certain medications, such as aspirin.
  • Mixed.Combines the features of the two previous forms.

According to the degree, each form is divided into:

  • First stage. Attacks occur no more than once a week during the day and no more than twice a month at night.
  • Second stage. Symptoms occur every week, but not every day, and at night, twice a month or more.
  • Third step. Attacks occur daily during the day, and also at night – more often than once a week.
  • Fourth step.It is characterized by constant attacks during the day, as well as frequent exacerbations at night.
  • 90,023 90,000 early symptoms, causes, treatments

    Bronchial asthma is a chronic inflammatory disease of the respiratory system. It is expressed by the narrowing of the lumen of the bronchi, caused by their pathological sensitivity to external influences. During an attack, a spasm of the mucous membrane occurs, breathing becomes difficult.

    Why does the disease occur

    The mechanisms of asthma are not fully understood.But a number of factors have been identified, the combination of which affects the development of the disease.

    1. Internal causes: decreased immunity, frequent acute respiratory infections, endocrine disorders, respiratory diseases, obesity.
    2. External causes: allergies, work in unfavorable conditions, living in regions with poor ecology, smoking, constant anxiety and stress.

    It has been proven that there is a hereditary component in the occurrence of bronchial asthma.Every third patient has or had relatives suffering from this disease.

    How to recognize bronchial asthma at an early stage

    The first signs appear before serious attacks begin. Moreover, asthma can manifest itself in early childhood, or it can make its debut in an adult state, after 40 years. Alarming symptoms:

    • Prolonged cough, more than two to three weeks. It intensifies when a person lies, after physical exertion or while laughing.Feelings that the urge to cough is coming from the lower part of the lungs or even from the stomach.
    • Constant lack of air. Involuntary deep sighing or yawning begins. So the body tries to make up for the lack of oxygen.
    • Sleep disturbance, constant lethargy on awakening. The coughing fits are worse during sleep. Due to lack of air, the brain cannot fully rest and recover.
    • Constriction in chest, feeling of heaviness. With such symptoms, cardiac problems must be excluded.If the heart is healthy, then the discomfort is caused by developing asthma.
    • Breathing becomes shallow and rapid, wheezing and wheezing appear in the chest.

    How to help during an attack

    • If asthma is of an allergic nature, immediately remove the allergen and provide fresh air.
    • Take a comfortable position (preferably sitting), loosen the collar to make it easier to breathe.
    • If you have a medication inhaler, use it.It did not become easier – to inhale the drug again after 20 minutes.
    • Do not panic, try to breathe evenly.
    • If it doesn’t get better, call an ambulance.

    Diagnostic Procedures

    Diagnosis is based on patient interview and spirometry data. This basic study is carried out using a special apparatus – a spirometer.

    The patient makes the deepest exhalation into it, and the system calculates the parameters of breathing and their deviation from the norm.Important values ​​are expiratory volume per second and velocity. Repeated spirometry is performed after inhalation of the bronchodilator drug, and the results obtained are compared.

    In severe forms of the disease, an X-ray is taken. In the early stages, such research is not very informative.

    To make a diagnosis, it is also necessary to carry out laboratory tests: general clinical analyzes of urine and blood, plus biochemistry. And also a number of specific ones – sputum examination, detection of special antigens in blood serum, determination of viral antigens in the nasopharyngeal mucosa.

    Treatment and preventive measures

    Bronchial asthma is a chronic disease. The goal of therapy is to achieve stable remission, prevent recurrence of seizures and ensure the patient’s return to a full-fledged lifestyle.

    The patient is assigned:

    • Symptomatic medicines. They are designed to relieve an attack. They are applied as needed and have a temporary effect. Do not abuse such inhalers, otherwise addiction sets in.
    • Basic control drugs.Aimed at eliminating the cause of the disease, they reduce inflammation and swelling in the bronchi. They are taken in courses, such drugs have a cumulative delayed effect. Among them are glucocorticoids in inhalers, leukotriene antagonists, inhaled M-anticholinergics.

    Walking in the fresh air, trips to the sea, breathing exercises have a positive effect on the patient’s condition. It is important to permanently quit smoking and the use of harsh household chemicals.

    At the medical center “Harmony”, a pulmonologist with 10 years of experience is receiving treatment.The clinic conducts all the necessary research, analyzes and tests that will clarify the diagnosis and determine the nature of the disease. Consultation of other narrow specialists is possible. The sooner you start treating bronchial asthma, the more chances you have to return to a full healthy life.

    Bronchial asthma – inflammation of the bronchi .: causes, complaints, diagnosis and treatment methods on the website of the clinic “Alpha-Health Center”

    Inflammatory lesion of the respiratory tract, characterized by narrowing of the lumen of the bronchi, manifests itself in periodic attacks of coughing, shortness of breath, wheezing.

    The human respiratory system is arranged like a tree: air passes from the trachea of ​​the bronchi, first into large ones, and then into ever smaller ones (small bronchi are called bronchioles) and then they enter the alveoli, from where oxygen is already absorbed into the blood.

    Bronchial asthma is a disease based on increased sensitivity of the bronchi to various irritants (in particular, allergens). In response to the action of these stimuli, narrowing (obstruction) of the bronchi develops.This process is due to several reasons: an increase in the tone of the bronchi, excess discharge into the lumen of the bronchi and their inflammation. In asthma, attacks most often occur sporadically, for example after contact with an irritant. In severe asthma, bronchial obstruction often persists between attacks.

    One of the most dangerous complications of bronchial asthma is status asthma – a life-threatening attack that does not respond to conventional treatment. Such patients require immediate admission to the intensive care unit.

    Bronchial asthma is a very common disease, affecting about 5% of the population. The prevalence of asthma is even higher among children, and in many cases it will go away in children. Bronchial asthma in adults is a chronic disease that requires constant treatment under the guidance of a specialist.

    An important role in the occurrence of asthma is played by heredity: if one of the parents suffers from asthma, then the probability that the child will develop it is almost 50%, and if both – 65%.

    Types of asthma

    Many patients with bronchial asthma develop antibodies to one or more allergens. This form is called allergic bronchial asthma. It is often combined with skin diseases (neurodermatitis) and allergic rhinitis (runny nose). Allergic bronchial asthma is also called exogenous, in contrast to endogenous bronchial asthma, in the development of which neither a predisposition to allergies nor allergens from the environment play a role.

    Allergic bronchial asthma usually develops in childhood and young age. The most common allergens include pollen, molds, cockroaches, house dust, and the epidermis (outer layer of the skin) of animals, especially cats.

    Food allergens are less likely to cause asthma than airborne allergens, but certain foods and supplements can cause severe attacks. Often, in patients with bronchial asthma, reflux esophagitis (reflux of the acidic contents of the ventricle back into the esophagus) is found, and its treatment can reduce the severity of bronchial asthma.

    In bronchial asthma, the sensitivity of the respiratory tract to a number of irritants, including cold air, perfumes, and smoke, is increased. A choking attack can be triggered by heavy physical exertion and rapid, excessive breathing (caused by laughing or crying).

    Medicines are responsible for about 10% of asthma attacks. The most common type of drug asthma is aspirin asthma. Intolerance to aspirin and other non-steroidal anti-inflammatory drugs usually develops in 20-30 years.

    An attack of bronchial asthma can be triggered by beta-blockers (propranolol, metoprolol, timolol), including those that are part of the eye drops.

    Complaints

    The main complaints are shortness of breath (a feeling of suffocation, shortness of breath), cough, wheezing.

    Shortness of breath periodically increases and decreases. Often it intensifies at night, and it may turn out that it appeared after an acute respiratory illness (cold) or inhalation of an irritating substance.Although obstruction of the bronchi increases the resistance to air flow on exhalation, patients usually complain of difficulty breathing (caused by fatigue of the respiratory muscles).

    Cough is sometimes the only complaint, then the disappearance or weakening of it after the appointment of bronchodilators (means that dilate the bronchi) helps to confirm the diagnosis. The appearance of a cough with phlegm during an attack portends its end. An asthma attack usually develops within 10 to 30 minutes after exposure to an allergen or irritant.

    Diagnostics

    The main method for diagnosing bronchial asthma is spirometry (examination of the function of external respiration). Spirometry consists in the fact that the patient makes a forced (enhanced) exhalation into the apparatus, and that calculates the basic parameters of breathing. The main ones are the forced expiratory volume in 1 second and the peak volumetric velocity. Spirometry almost necessarily includes a study of the reaction to bronchodilators: for this, the patient is given several (usually four) breaths of salbutamol or another rapid-acting bronchodilator and spirometry is repeated.

    Spirometry is also necessary to monitor the course of asthma treatment: it is necessary to focus not only on the presence or absence of complaints during treatment, but also on the objective indicators that spirometry gives. There are simple devices (peakfluometers) for independent use by asthma patients.

    During the interictal period, lung function may be normal; sometimes in these cases, provocative tests are performed, usually with methacholine. A negative test with methacholine excludes bronchial asthma, but a positive test does not yet confirm this diagnosis.The methacholine test is positive in many healthy people; it can be positive, for example, for several months after a respiratory viral infection.

    Chest X-ray is mandatory for severe attacks, as it reveals hidden complications that require immediate treatment.

    Treatment

    Treatment is prescribed in accordance with the severity and duration of the disease. The course of bronchial asthma cannot be predicted, and its treatment requires an individual approach to each patient from the doctor.It has been shown that hospitalization rates are lower among those patients who are closely monitored and trained to use drugs correctly.

    The form of prescribing anti-asthma drugs is different: inhalers (individual and compressor – the so-called nebulizers) and turbuhalers (for inhaling powdered drugs) are widely used. The advantage of inhalation in comparison with oral (oral) and parenteral (intravenous) routes of administration is that a higher concentration of the drug is achieved in the lungs, and the number of side effects is minimal.Sometimes it is advisable to prescribe the drug by mouth or, less often, parenterally, since these routes of administration allow the drug to reach those parts of the lungs into which the aerosol cannot penetrate due to severe bronchospasm and bronchial blockage with sputum.

    inhaled beta-adrenostimulants are widely used, including salbutamol, terbutaline, bitolterol and pirbuterol. These drugs last longer than their predecessors and are less likely to cause cardiovascular complications.Salmeterol has the longest effect. It can be used to prevent nighttime attacks. However, the effect of salmeterol develops slowly, and the drug is not suitable for the treatment of seizures.

    There is a fear that addiction develops to adrenostimulants. And although this process is reproduced in an experiment on laboratory animals, the clinical significance of addiction is not yet clear. In any case, the patient’s need for more frequent use of the drug should prompt the patient to immediately consult their doctor, as it may be a sign of the transition of asthma to a more severe form and the need for additional treatment.Previously, inhalation adrenostimulants were recommended to be used regularly (for example, 2 breaths 4 times a day), but due to frequent cardiovascular complications and addiction, at present, in case of mild bronchial asthma, less frequent use is allowed, as well as use as needed.

    Inhaled glucocorticoids are widely used in bronchial asthma. They are designed to achieve maximum local effect with minimal absorption and the least complications.They can be used to discontinue glucocorticoids after prolonged use, to reduce adrenostimulant dependence and to reduce the frequency of seizures during exercise. Candidal stomatitis can be eliminated or prevented by rinsing your mouth thoroughly after inhaling the drug. It should be borne in mind that inhaled glucocorticoids do not give a quick effect. In order for the condition to begin to improve, they must be used regularly for several weeks, and in order to achieve the maximum effect, within several months.

    Methylxanthines (theophylline, aminophylline) are almost never used for the treatment of bronchial asthma.

    Leukotriene antagonists – drugs that block leukotriene receptors (zafirlukast, montelukast), as a rule, are used for mild to moderate asthma, usually in combination with other drugs.

    Inhaled M-anticholinergics (for example, ipratropium bromide) are used mainly in chronic obstructive bronchitis, but in some cases – and in bronchial asthma.

    In bronchial asthma caused by allergies to mites and certain types of pollen, in the absence of help from conventional drug treatment, desensitization can help, although it is most effective still for allergic rhinitis.

    90,000 symptoms, treatment and prevention measures

    Bronchial asthma (BA)

    • All types of examination, personalized therapy according to modern international protocols, teaching a patient to live with a disease.
    • An integrated approach with the participation of doctors of related specialties (pulmonologist, general practitioner, otolaryngologist, rehabilitation therapist, psychotherapist, etc.).
    • Modern and effective methods of treatment, including allergen-specific immunotherapy (ASIT).
    • Round-the-clock emergency and ambulance assistance in the clinic for adults and children: all the necessary examinations (spirometry, pulse oximetry), removal of an acute condition.
    • The long-term expert experience of EMC allergists allows each patient to successfully fight the disease and maintain the quality of life.

    Bronchial asthma (BA) has become one of the most common respiratory diseases, and its prevalence in all countries is increasing every year. This led to the creation of a joint report by the World Health Organization and the National Heart, Lung and Blood Institute (USA) called the Global Strategy for the Treatment and Prevention of Bronchial Asthma (GINA). The report is updated annually, and its main goal is to integrate scientifically proven research results into improved BA treatment standards.

    Bronchial asthma is a heterogeneous disease characterized by chronic airway inflammation, the presence of respiratory symptoms such as wheezing, shortness of breath, chest congestion and cough that vary in time and intensity, and manifest with variable airway obstruction. This definition of this disease is accepted throughout the world. It most accurately reflects the changes taking place in the patient’s body.

    The goal of therapy is to achieve a stable remission and a high quality of life in all patients, regardless of the severity of the disease.

    A stepwise approach to asthma therapy quite clearly defines which drugs can be selected for a particular patient, taking into account the age, frequency of attacks, timing of diagnosis, and previous treatment. The volume of basic therapy is determined by the severity and level of control of bronchial asthma, the age of patients, and the nature of concomitant pathology. The severity of the disease varies from mild to severe, and the degree of control is from complete, in which there are no symptoms, to no symptoms.

    Good AD control can be achieved in most patients with the help of deliberate pharmaceutical intervention, which is one of the important components of the AD therapy strategy, which also includes inhaler skills, adherence to therapy, as well as non-pharmacological components (regular monitoring, creating a hypoallergenic environment) and allergen management. -specific immunotherapy.

    When prescribing treatment, general and individual questions should be answered: which drug is preferred to achieve control; How does this particular patient differ from the “average” BA patient? This is especially important when basic therapy is prescribed to children, since the right tactics can significantly change the long-term prognosis of the disease.

    Symptoms of bronchial asthma

    Characteristic signs of bronchial asthma:

    • wheezing rales;
    • 90,050 shortness of breath;

    • a feeling of congestion in the chest;
    • cough.

    Symptoms vary in time and intensity and are often worse at night or early in the morning. The attack and clinical manifestations of asthma can provoke respiratory viral infections, exercise, weather changes, contact with allergens and nonspecific irritants.

    In children, typical clinical symptoms are wheezing, coughing, shortness of breath, often worse at night or upon waking. With the development of exacerbation of bronchial asthma in children, an obsessive dry or unproductive cough (sometimes up to vomiting), noisy wheezing may appear.

    Diagnostics of bronchial asthma

    The diagnosis of asthma is established on the basis of complaints and data from the patient’s medical history, the results of functional examination methods, specific allergological examination and the exclusion of other diseases.

    EMC allergists carry out the necessary examination in consultation – an important part of it is taking anamnesis. In a patient with suspected bronchial asthma, it is necessary to find out the causes of the onset, the duration of clinical manifestations and the resolution of symptoms, the presence of allergic reactions in the patient himself and his close relatives, the cause-and-effect characteristics of the onset of signs of the disease and its exacerbations. In addition, spirometry is performed at the consultation as an initial test to identify and assess the severity of airway obstruction.

    All patients with suspected bronchial asthma undergo a bronchodilation test. The study is necessary to determine the degree of obstruction reversibility under the influence of bronchodilator drugs.

    EMC allergists are monitoring the peak expiratory flow rate. Peak flowmetry is used as an additional diagnostic test. Multiple peak expiratory flow (PEF) measurements taken at home over at least 2 weeks to confirm airflow variability can help establish a correct diagnosis.

    Laboratory tests include: a clinical blood test, a total IgE test, a clinical sputum test, a biochemical blood test, an allergy examination – skin prick tests and a study of total and specific IgE in blood serum, a study of the level of eosinophilic cationic protein, measurement of blood gas composition.

    Instrumental examinations: spirometry, peak flowmetry, bronchoscopy, radiography or computed tomography of the lungs, electrocardiography, ultrasound of the heart.

    Treatment of bronchial asthma

    Therapy includes two main schemes – basic therapy and therapy for exacerbations of bronchial asthma.

    The goal of treating exacerbations is to eliminate bronchial obstruction as quickly as possible and prevent further relapses (attacks). In some cases, with severe exacerbations, such assistance is possible only in a hospital setting. At the EMC clinic, such therapy can be performed at any time of the day.

    Basic therapy, according to the Global Strategy for the Treatment and Prevention of Bronchial Asthma, is prescribed using the principle of a stepwise approach to the treatment of this disease. The higher the level of therapy, the more control drugs that the patient receives and / or the higher their dosage. Inhalation administration of drugs is the main method of treating bronchial asthma.

    For all inhaled drugs, one of the essential ingredients for success is the device by which the drug reaches its target.The selection of the optimal inhalation device for each individual patient is the task of the physician prescribing the basic therapy.

    Basic therapy is an important component in achieving control over the symptoms of bronchial asthma. The drug treatment regimen is reviewed at least once every 3 months, this allows you to achieve control over the disease without using unnecessary drugs.

    Successful management of asthma requires close collaboration between the patient and the physician providing care.The patient must be confident that his participation plays a major role in the treatment process. Education of patients in the field of bronchial asthma can also help – it allows you to recognize the symptoms of the disease, complications, seek medical help in time and strictly follow the doctor’s prescriptions.

    Allergen-specific immunotherapy (ASIT) occupies an important place in the treatment of allergic bronchial asthma. The allergist conducts a comprehensive examination, identifies the allergen, interaction with which leads to an exacerbation of the disease, and makes the most optimal regimen for allergen-specific immunotherapy.Then, increasing doses of the allergen are sequentially introduced into the body. Over time, the immune system becomes resistant to allergens. A successfully performed ASIT allows you to maintain a long-term remission of the disease or significantly reduce the amount of basic therapy.

    Rehabilitation

    In case of bronchial asthma, it is recommended to include training and methods of physical rehabilitation in the rehabilitation program for all patients. The patient education program should include providing information about the disease, drawing up an individualized treatment plan for the patient, and training in guided self-management techniques for bronchial asthma.

    Physical rehabilitation improves cardiopulmonary function. As a result of exercise during physical activity, the maximum oxygen consumption increases and the maximum ventilation of the lungs increases. According to the available observations, training with aerobic load, swimming, training of the inspiratory muscles with a threshold dosed load improve the course of asthma. EMC rehabilitation doctors will help you draw up an individual training plan, taking into account the characteristics of the patient’s health status, and will teach the technique of breathing exercises.

    Prevention of exacerbations of bronchial asthma

    The key to the success of asthma treatment is the disciplined adherence to the doctor’s recommendations in full. General health promotion activities are also important – fighting smoking, overweight, nasal diseases, exercise, influenza vaccination.

    The main advantage of bronchial asthma therapy at EMC is the possibility of remote patient support in any situation using the most modern technologies (TytoCare), training in the technique of using modern inhalation devices, and ASIT.The attending physician regularly monitors the patient’s condition. For each patient, individual support methods are provided, which allows you to quickly cope with all difficulties.

    You can sign up for a consultation with an EMC allergist by phone: +7 495 933 66 55.

    Bronchial asthma: symptoms, diagnosis and treatment

    Bronchial asthma is a chronic non-infectious inflammatory airway disease.It is characterized by a violation of bronchial patency upon contact with allergens. It is accompanied by a spasm of smooth muscles in response to environmental irritants. Absolutely different substances can act as allergens. Starting from food products and ending with plant pollen and household chemicals. Some people develop asthma even with exercise.

    Possible types of allergens: eggs, chocolate, fish, honey, strawberries; odorous substances, flowers, pet hair.

    Fact: A research team at the University of Virginia Allergy and Asthma Center has concluded that if the child is not allergic to cat hair, then it is necessary to have a pet. Then the baby will be able to get used to potential allergens and develop an immune response to them. A similar conclusion, but for dogs, was reached by German scientists at the National Research Center for Health in the Context of the Environment.

    Who is most susceptible to the disease?

    Fact: According to WHO, 235 million people suffer from asthma.Bronchial asthma is also one of the most common chronic diseases in children.

    In childhood, it is more common in boys. After 10 years, this trend mostly disappears. And during puberty, medical specialists find the ailment to a greater extent in girls. In adulthood, the tendency manifests itself again in the weaker sex.

    The risk category includes smokers; people leading a sedentary lifestyle; as well as those who work in production and are in contact with a large number of antigens.

    Fact: A group of medical experts led by Dr. Alan Baptist of the University of Michigan Medical School concluded that asthma attacks are directly related to weather changes and changes in air humidity. The researchers in their analytical summary relied on information obtained from the Michigan Children’s Hospital. They tracked the frequency of visits to the clinic in 25 thousand cases. And they found that a 10% change in moisture in the atmosphere led to an obligatory increase in the flow of patients with manifest asthma.

    Symptoms of bronchial asthma

    • cough with viscous sputum and loud wheezing
    • a feeling of shortness of breath, attacks of suffocation with shortness of breath. These attacks are most often seen at night. They start spontaneously. They may be preceded by a runny nose, itchy skin, and tickling in the nose and throat.
    • severe shortness of breath even with physical exertion

    During the attack:

    The patient needs to go to the open window.He tries to lean on surrounding objects in order to facilitate the work of the auxiliary respiratory muscles. Sweating increases.

    At the initial stage, there may be no coughing fit. But at its peak, it appears dry and painful. Then phlegm appears. Sputum – transparent, slimy, viscous, sometimes difficult to separate. The pulse quickens.

    An attack lasts an average of 2 hours, but it can turn into a so-called asthmatic state or status and drag on for several days.

    What causes status asthmaticus?

    • acute bronchospasm
    • the appearance of mucous plugs in the bronchi
    • serious edema of the bronchial mucosa

    Classification of bronchial asthma . Physicians differentiate the phenotypes (by external manifestations and properties) of bronchial asthma. Consider the clinical and biophenotypes of bronchial asthma.

    Biophenotypes show how the process of airway inflammation proceeds.Based on sputum research. Varieties of bronchial asthma according to biophenotypes:

    • neutrophilic asthma – increased concentration of neutrophils in sputum (a type of leukocyte)
    • eosinophilic asthma – increased concentration of eosinophils in sputum (a type of leukocytes)
    • mixed – increased content in sputum and eosinophils, and neutrophils
    • low-granulocytic – inflammation is not associated with an increase in the number of eosinophils and neutrophils in sputum

    The scientific community also identifies clinical asthma phenotypes:

    • allergic asthma – its appearance is influenced by a hereditary factor, passes simultaneously with other allergic diseases, carries signs of eosinophilic inflammation
    • non-allergic asthma – no relationship with allergens
    • obesity asthma – it is accompanied by mild eosinophilic inflammation of the respiratory tract
    • asthma with recurring, the same obstruction (impaired air permeability through the bronchial tree) – has a “protracted” character; bronchi gradually change their structure with this form
    • asthma with late onset – more often manifests itself in women in adulthood, also has no connection with allergens, but differs from a non-allergic reaction to a group of glucocorticosteroid drugs (the substance of these drugs is produced by the adrenal cortex)

    Who can come to the rescue?

    At the Medical House Odrex , a general practitioner or pulmonologist and allergist will come to your aid.They will carry out the necessary diagnostic examination and prescribe the appropriate course of therapy. Professionals work here, ready to provide timely assistance.

    Diagnostics of bronchial asthma

    Today, the Odrex Medical House has all the technologies to take allergy tests in any season, regardless of the course of the allergy.

    Allergy tests is a screening diagnostic that helps to find out which allergen the skin reacts to.

    To determine the allergic status, the patient also undergoes laboratory tests. These are skin tests for sensitivity to household, pollen and fungal allergens. The doctor may also take a sputum test. In order to check if there is a high concentration of eosinophils (a subtype of blood leukocytes) in it.

    Another subspecies of diagnostics – the study of respiratory function – spirography. It takes place with the use of inhalation with a special substance that affects the receptors, which makes it possible to assess how much the patient’s forced expiratory volume (FEV) increases.The change in FEV indices indicates the nature of the restrictions on air flow through the bronchial tree.

    In addition, the doctor will prescribe a number of laboratory tests, such as:

    • general blood test
    • biochemical blood test
    • analysis for the determination of specific antibodies developed to the allergen
    • general urinalysis
    • analysis of feces for the presence of helminths
    • CT (computed tomography)

    Treatment of bronchial asthma

    First of all, it is necessary to eliminate the effects of irritating allergens on your own.During an attack, a person must be freed from squeezing clothes so that nothing constrains the movements of the chest. But at home, the cause of the disease cannot be eliminated. Antihistamines (antiallergic) drugs can only relieve an episode of exacerbation of allergies. Therefore, you should immediately consult a doctor.

    The pulmonologist will prescribe drug therapy , which may include not only antihistamine, but also bronchodilator, anti-inflammatory, detoxification therapy, as well as symptomatic therapy if indicated.

    To keep the air in the room fresh, doctors recommend using atmospheric cleaners.

    Question-answer

    Are there factors (other than inhalation of allergens) that can cause an exacerbation of bronchial asthma?

    Yes. Of course, they are, we will list the main ones:

    • respiratory viral infections
    • inadequate physical activity
    • meteorological factors
    • inhalation of toxic substances

    What should be done to provide first aid for an attack of bronchial asthma?

    One of the earliest ways to treat a sudden asthma attack is to use a mini-inhaler, a fast-acting beta antagonist (bronchodilator that relieves spasms) that relaxes the muscles in the airway.It will resume the flow of air into the respiratory system. And after this, it is necessary to urgently consult a doctor.

    To anticipate the impending threat of a new bronchial attack, it is important to independently conduct daily monitoring of the peak expiratory flow rate. The patient does this using a peak flow meter, which shows the state of the airway patency.

    Peak flow meter – portable device for measuring air velocity during exhalation (caption for the picture)

    Can bronchial asthma be cured?

    You can achieve long-term remission of the disease and avoid serious complications if you follow all the doctor’s recommendations and constantly monitor your health.

    90,000 bronchial asthma – Treatment of allergies and asthma in Allergomed

    Bronchial asthma is a disease based on inflammation of the airways, accompanied by changes in the sensitivity and reactivity of the bronchi and manifested by asthma attacks, status asthmaticus or, in the absence thereof, respiratory discomfort (paroxysmal cough, distant wheezing, shortness of breath), accompanied by reversible bronchial obstruction on background of a hereditary predisposition to allergic diseases.

    The risk of developing an allergic disease in families where there is no allergic predisposition is about 20%, increasing to 50% in families where one of the parents suffers from allergic diseases, and exceeds 66% if both parents suffer from allergic diseases.

    Two types of factors are involved in the formation of the disease – external and internal . Congenital predisposition forms internal causes of the disease – biological defects that can be genetically determined, as well as form during pregnancy and childbirth.There are four well-studied classes of genes associated with bronchial asthma.

    environmental factors also participate in the formation of the disease : allergens, viral infection, stress, occupational hazards, chemical irritants, unfavorable meteorological conditions.

    Allergens that are significant for the provocation of bronchial asthma, as in other allergic diseases, can be divided into the following groups:

    • Household
    • Pollen
    • Epidermal
    • Medicinal
    • Food
    • Insect
    • Professional

    According to G.B. Fedoseeva (1982) identified ten types of bronchial asthma:

    1. Atopic – the occurrence of asthma attacks upon contact with allergens. Allergens cause inflammation in the bronchi.
    2. Infection-dependent – the main role in the development of the disease is played by a bacterial, viral, fungal infection. It is the direct cause of infectious inflammation as well as a trigger for allergic inflammation that causes bronchial obstruction.
    3. Autoimmune – a type of asthma when the patient’s own lung tissue becomes an allergen. A rare type of asthma (0.5-1% of patients), characterized by a very severe course, hormonal dependence and severe complications from hormone therapy.
    4. Dyshormonal (hormone-dependent variant) – asthma associated with impaired production of glucocorticoid hormones and / or corticosteroid resistance (the body’s immunity to hormones that reduce the level of inflammation).
    5. Disovarial – associated with the functioning of female sex hormones.An exacerbation occurs during certain phases of the menstrual cycle.
    6. Adrenergic imbalance is a disturbance in the balance of receptors in the bronchial tree. Asthma is characterized by the absence or opposite effect on the use of bronchodilator drugs. This type of asthma often leads to the development of status asthma.
    7. Cholinegic – asthma associated with dysfunction of the autonomic nervous system, in particular with increased activity of the parasympathetic nervous system.
    8. Neuropsychic – occurs with disorders in the central nervous system, when neuropsychic factors contribute to provocation and fixation of attacks of suffocation.
    9. Aspirin – associated with intolerance to anti-inflammatory drugs (aspirin, paracetamol, etc.). Bronchial asthma, aspirin intolerance and nasal polyps make up the “aspirin triad”.
    10. Physical exertion asthma is an attack of breathlessness or respiratory discomfort that develops in patients during or after physical exertion. As an independent option, it is observed in 3-5%, when there are no signs of allergies, infections, dysfunctions of the endocrine and nervous systems.

    Identification of the types of bronchial asthma made it possible to understand in more detail and individually the development of the disease and, therefore, to more adequately treat each patient.

    Diagnosis of bronchial asthma:

    1. Identification of an allergic history in a patient
    2. Study of the function of external respiration (FVD) with a bronchodilator for all types of asthma)
    3. Determination of the level of total immunoglobulin E
    4. Determination of specific immunoglobulins (mainly for children)
    5. Preparation of skin tests (for atopic asthma)
    6. Radiograph of the lungs and sinuses; sowing from the contents of the bronchi; determination in blood serum of antibodies to bacteria, viruses and fungi (with an infectious-dependent type)
    7. Detection of antipulmonary antibodies, increased concentration of circulating immune complexes and acid phosphatase activity in blood serum (with autoimmune variant)
    8. Determination of the level of cortisol in the blood, some hormones in the urine, diagnostic tests, etc.(for dyshormonal asthma)
    9. Determination of the level of sex hormones in the blood by radioimmunoassay (for disovarial asthma)
    10. Psychological testing (with neuropsychic type)

    Treatment of bronchial asthma:

    Elimination of allergens or causally significant disease factors.

    Drug treatment – prescribed by a doctor depending on the type of asthma.

    Non-drug treatment is the use of acupuncture, osteopathy, homeopathy, breathing exercises, psychotherapy, SIT.The methods are chosen depending on the type of asthma and the stage of the disease. Most often, one or two types of non-drug therapy are used.

    Drug treatment in combination with non-drug first aid methods is usually prescribed in the acute period. In the future, the number of drugs decreases against the background of increasing the mass of non-drug therapy. The effectiveness of this approach is 95-98% of good and excellent results.