Can asthma occur without wheezing. What are the silent symptoms of asthma. How can you recognize asthma without typical signs. When should you seek medical attention for non-wheezing asthma symptoms. What are the treatment options for asthma without wheezing.

The Prevalence of Asthma: A Global Health Concern

Asthma is a widespread respiratory condition affecting millions worldwide. According to the Centers for Disease Control and Prevention (CDC), approximately 1 in 13 people in the United States had asthma in 2020. This prevalence is particularly high among non-Hispanic individuals of multiple races and American Indian and Alaska Native communities.

While asthma is often associated with wheezing, it’s crucial to understand that not all asthma cases present with this characteristic symptom. Many individuals experience what is known as “silent asthma” or asthma without wheezing. This variant of the condition can be just as serious and requires proper diagnosis and management.

Cough-Variant Asthma: When Coughing is the Primary Symptom

One form of asthma that often goes unrecognized is cough-variant asthma. In this type, a persistent cough is the primary or sole symptom. This chronic cough typically doesn’t respond to over-the-counter remedies like cough syrups or lozenges.

How is cough-variant asthma treated? Unlike common coughs, this condition usually requires prescription asthma medications, such as inhalers. There are two main types of inhalers used in asthma treatment:

• Quick-acting bronchodilators: These open the airways during an asthma attack
• Daily-use corticosteroids: These help prevent inflammation and reduce the frequency of symptoms

Silent Symptoms of Asthma: Beyond Wheezing and Coughing

Asthma can manifest in various ways, and some symptoms are less obvious than others. These “silent” symptoms can affect both children and adults with asthma. The two most common silent symptoms are related to airway inflammation:

1. Shortness of Breath

Individuals with asthma may experience difficulty breathing or feel as if they’re gasping for air. During severe asthma attacks, rapid changes in breathing rate can occur, with either faster or slower breathing patterns. In children, this may manifest as a “sucked in” appearance of the skin around the neck.

2. Chest Tightness

Asthma can cause a feeling of tightness in the chest, often described as a band constricting the lungs. This sensation may be accompanied by pain. Children might express this discomfort simply as feeling “sick” if they can’t articulate the specific sensation.

Exercise-Induced Asthma: When Physical Activity Triggers Symptoms

Exercise can cause the airways in the lungs to narrow, a condition known as exercise-induced asthma. This affects 40% to 90% of people with asthma, but interestingly, it also occurs in about 20% of individuals without a formal asthma diagnosis.

What are the symptoms of exercise-induced asthma? While wheezing can occur, the most common symptom is coughing. Other signs include chest tightness and difficulty breathing. These symptoms typically worsen a few minutes after finishing exercise and usually improve within 30 minutes of completing the activity.

Severe Asthma and the Silent Chest Phenomenon

In some cases of severe asthma, particularly during life-threatening episodes, a phenomenon known as “silent chest” can occur. This is a serious condition where there’s no audible wheezing because minimal to no air is moving in or out of the lungs.

Why is a silent chest dangerous? The absence of wheezing in this context indicates an extremely obstructed airway, signaling a medical emergency that requires immediate attention. It’s crucial for individuals with asthma and their caregivers to recognize this as a potential sign of a severe asthma attack.

Diagnosing Asthma Without Wheezing: Challenges and Approaches

Diagnosing asthma without the presence of wheezing can be challenging. If you’re experiencing symptoms such as chronic cough, chest tightness, or breathing difficulties without a prior asthma diagnosis, it’s important to consult a healthcare professional.

How do doctors diagnose asthma without wheezing? Healthcare providers may use a combination of methods, including:

1. Detailed medical history
2. Physical examination
3. Lung function tests (spirometry)
4. Allergy tests
5. Chest X-rays or other imaging studies
6. Trial of asthma medications

Management and Treatment of Non-Wheezing Asthma

The management of asthma without wheezing follows similar principles to traditional asthma treatment. The goal is to control symptoms and prevent exacerbations. Treatment options may include:

• Inhaled corticosteroids for long-term control
• Short-acting beta-agonists for quick relief
• Leukotriene modifiers
• Long-acting beta-agonists in combination with inhaled corticosteroids
• Biologics for severe asthma
• Immunotherapy for allergic asthma

Regular follow-ups with healthcare providers are essential to monitor progress and adjust treatment plans as needed. Patients should also have an asthma action plan to manage symptoms and recognize when to seek emergency care.

When to Seek Medical Attention for Non-Wheezing Asthma Symptoms

Recognizing when to seek medical help is crucial for managing asthma, especially when typical symptoms like wheezing are absent. Immediate medical attention is necessary if you experience:

• Rapid worsening of symptoms
• Significant changes in breathing rate (faster or slower)
• Shallow breathing
• Severe shortness of breath
• Difficulty walking due to breathing problems
• An expanded chest that doesn’t deflate upon exhaling

These signs may indicate a severe asthma attack, even in the absence of wheezing. Prompt medical intervention can be life-saving in such situations.

Understanding the various manifestations of asthma, including those without wheezing, is essential for proper diagnosis and management. By recognizing these silent symptoms and seeking appropriate medical care, individuals with asthma can better control their condition and improve their quality of life. Regular check-ups, adherence to treatment plans, and awareness of emergency signs are key components of effective asthma management, regardless of whether wheezing is present or not.

Asthma Without Wheezing: Causes and Silent Symptoms

Wheezing is a hallmark symptom of asthma, but not everyone experiences it. You may have a cough or more silent symptoms of asthma. In rare cases, the absence of wheezing could suggest severe asthma.

Asthma is a lung condition that can make it hard to breathe. The passages that carry air into your lungs can become narrow and inflamed.

People with asthma can have attacks where they experience shortness of breath and coughing. Many manage their asthma with quick-acting and long-term controller medicines.

According to the Centers for Disease Control and Prevention (CDC), about 1 in 13 people in the United States had asthma in 2020. It’s most common among non-Hispanic people of multiple races and American Indian and Alaska Native communities.

Wheezing is a common, but not universal, symptom of asthma. Many people with asthma don’t wheeze while breathing. In some cases, people have “silent” asthma symptoms.

You also may not wheeze if you have an extremely obstructed airway. This could be a sign of severe asthma.

Cough-variant asthma happens when a chronic cough is the only sign you have asthma.

Typically, the cough doesn’t get better with over-the-counter remedies like syrups or drops. Instead, you may need a prescription for an asthma inhaler.

There are different kinds of inhalers. Quick-acting bronchodilators open your airways during an attack. Daily-use corticosteroids help prevent inflammation.

Children and adults with asthma may experience symptoms that don’t include cough or wheezing. These are silent symptoms of asthma.

The two most common silent symptoms are due to airway inflammation: shortness of breath and chest tightness. Muscles around the airways in your lungs become constricted, narrowing the passages into the lungs. This makes it hard to breathe and makes your chest feel tight.

Shortness of breath

You may struggle to breathe or feel like you’re gasping for air. People having a severe asthma attack may also experience rapid changes in breathing rate, exhaling and inhaling either more quickly or slowly. Children may have a “sucked in” appearance of their skin around the neck.

Severe asthma attacks require a quick-acting inhaler and medical attention if symptoms don’t improve.

Chest tightness

If you have problems getting air into your lung, it could lead to a tight feeling in your chest. It might feel as if there’s a band around your lungs. You may also feel pain along with chest tightness.

Children with asthma may not be able to express this feeling in these terms. Instead, they may say that they’re feeling sick.

You can often manage asthma with inhaled or oral corticosteroids. If you have mild to moderate asthma, a doctor may adjust your medications to help keep your symptoms in check. But if changes in treatment don’t work, you may have severe asthma.

In some cases of severe asthma and in life threatening asthma, you may have a silent chest. There’s no wheezing sound because minimal to no air is going in or out of your lungs. This is a serious situation that requires medical attention.

Exercise may also cause the airways in your lungs to narrow. This happens to between 40% to 90% of people with asthma. But it also occurs in about 1 in 5 people without asthma.

Exercise-induced asthma can cause wheezing, but not always. The most common symptom is coughing. Other symptoms include tightness in the chest and trouble breathing.

Your symptoms may become worse a few minutes after you finish exercising. They usually get better within 30 minutes of completing your exercise.

If you don’t have an asthma diagnosis but are experiencing symptoms like chronic cough, chest tightness, and trouble breathing, you may want to see a doctor.

If you live with asthma, you may want to see a doctor regularly for checkups. They can help you review your asthma action plan.

If you have new or worsening symptoms, you may want to discuss them with a doctor. It may be possible to adjust your medications or take other steps to get your asthma under control.

Medical emergency

Seek emergency medical care if you have an onset of asthma symptoms that don’t get better with quick-relief medications. Signs of a serious asthma attack may include:

• rapid worsening of symptoms
• change in breathing rate (faster or slower)
• shallow breathing
• shortness of breath
• trouble walking
• expanded chest that doesn’t deflate upon exhaling

Asthma causes your airways to constrict during an attack. Asthma symptoms often include wheezing, but not every person with asthma has this.

In some cases, asthma without wheezing, or a silent chest, is a sign that no air is entering or leaving your lungs. This could mean you have severe asthma. There are several treatments for severe asthma, including immunotherapy and biologics.

Asthma Without Wheezing: Causes and Silent Symptoms

Wheezing is a hallmark symptom of asthma, but not everyone experiences it. You may have a cough or more silent symptoms of asthma. In rare cases, the absence of wheezing could suggest severe asthma.

Asthma is a lung condition that can make it hard to breathe. The passages that carry air into your lungs can become narrow and inflamed.

People with asthma can have attacks where they experience shortness of breath and coughing. Many manage their asthma with quick-acting and long-term controller medicines.

According to the Centers for Disease Control and Prevention (CDC), about 1 in 13 people in the United States had asthma in 2020. It’s most common among non-Hispanic people of multiple races and American Indian and Alaska Native communities.

Wheezing is a common, but not universal, symptom of asthma. Many people with asthma don’t wheeze while breathing. In some cases, people have “silent” asthma symptoms.

You also may not wheeze if you have an extremely obstructed airway. This could be a sign of severe asthma.

Cough-variant asthma happens when a chronic cough is the only sign you have asthma.

Typically, the cough doesn’t get better with over-the-counter remedies like syrups or drops. Instead, you may need a prescription for an asthma inhaler.

There are different kinds of inhalers. Quick-acting bronchodilators open your airways during an attack. Daily-use corticosteroids help prevent inflammation.

Children and adults with asthma may experience symptoms that don’t include cough or wheezing. These are silent symptoms of asthma.

The two most common silent symptoms are due to airway inflammation: shortness of breath and chest tightness. Muscles around the airways in your lungs become constricted, narrowing the passages into the lungs. This makes it hard to breathe and makes your chest feel tight.

Shortness of breath

You may struggle to breathe or feel like you’re gasping for air. People having a severe asthma attack may also experience rapid changes in breathing rate, exhaling and inhaling either more quickly or slowly. Children may have a “sucked in” appearance of their skin around the neck.

Severe asthma attacks require a quick-acting inhaler and medical attention if symptoms don’t improve.

Chest tightness

If you have problems getting air into your lung, it could lead to a tight feeling in your chest. It might feel as if there’s a band around your lungs. You may also feel pain along with chest tightness.

Children with asthma may not be able to express this feeling in these terms. Instead, they may say that they’re feeling sick.

You can often manage asthma with inhaled or oral corticosteroids. If you have mild to moderate asthma, a doctor may adjust your medications to help keep your symptoms in check. But if changes in treatment don’t work, you may have severe asthma.

In some cases of severe asthma and in life threatening asthma, you may have a silent chest. There’s no wheezing sound because minimal to no air is going in or out of your lungs. This is a serious situation that requires medical attention.

Exercise may also cause the airways in your lungs to narrow. This happens to between 40% to 90% of people with asthma. But it also occurs in about 1 in 5 people without asthma.

Exercise-induced asthma can cause wheezing, but not always. The most common symptom is coughing. Other symptoms include tightness in the chest and trouble breathing.

Your symptoms may become worse a few minutes after you finish exercising. They usually get better within 30 minutes of completing your exercise.

If you don’t have an asthma diagnosis but are experiencing symptoms like chronic cough, chest tightness, and trouble breathing, you may want to see a doctor.

If you live with asthma, you may want to see a doctor regularly for checkups. They can help you review your asthma action plan.

If you have new or worsening symptoms, you may want to discuss them with a doctor. It may be possible to adjust your medications or take other steps to get your asthma under control.

Medical emergency

Seek emergency medical care if you have an onset of asthma symptoms that don’t get better with quick-relief medications. Signs of a serious asthma attack may include:

• rapid worsening of symptoms
• change in breathing rate (faster or slower)
• shallow breathing
• shortness of breath
• trouble walking
• expanded chest that doesn’t deflate upon exhaling

Asthma causes your airways to constrict during an attack. Asthma symptoms often include wheezing, but not every person with asthma has this.

In some cases, asthma without wheezing, or a silent chest, is a sign that no air is entering or leaving your lungs. This could mean you have severe asthma. There are several treatments for severe asthma, including immunotherapy and biologics.

Asthma Facts and Misconceptions

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Asthma Facts by Dr. Teofilo Lee Chiong

Head of Medical Research Information and Third Party Relations, Philips Home healthcare Solutions (Consumer Health Products)*

Warning: The information on this website is for reference only and should not be used as a substitute for the advice of a therapist.

How dangerous is bronchial asthma?

Misconception:

Asthma is a psychosomatic disease.

Fact:

Asthma is not related to the emotional state of a person. This is an inflammatory disease that causes swelling of the bronchi. Strong emotions and stress act as precipitating factors that can lead to worsening or an attack in a person with asthma ^{1, 2} .

Error:

My child has asthma and should not play sports.

Fact:

Sport is not just an exciting activity, but an important part of a healthy lifestyle. Many athletes manage to effectively control the disease and achieve great success in their sports ^{1, 2, 3} .

Error:

Because of asthma, the child will never be able to lead a normal life.

Fact:

Today there is no cure for asthma, but the disease can be controlled. Every child diagnosed with asthma can lead an active lifestyle ¹ . With effective control of the disease, there are no restrictions for the child, and he can engage in any kind of activity. An active lifestyle helps to maintain good physical shape and control excess weight.

How is asthma diagnosed?

Delusion:

I can’t have asthma because I only cough at night.

Fact:

Nighttime wheezing, shortness of breath and cough are common symptoms of asthma ¹ . Do not ignore them and contact your doctor who will conduct the necessary tests to make a final conclusion.

Error:

There is no need to take asthma medicine unless I have wheezing, coughing, or chest tightness.

Fact:

Even if there are no symptoms of asthma, there may still be inflammation or swelling in the bronchi. It is necessary to take control medications regularly to relieve inflammation in the bronchi and control symptoms of the disease ³ . In addition, for effective control, try to avoid exposure to provoking factors.

Misconception:

All people with asthma experience the same symptoms.

Fact:

Asthma symptoms vary from person to person ¹ : some patients may have wheezing, others only cough. Asthma attacks can worsen symptoms. It is necessary to clearly understand how the disease manifests itself in you personally in order to develop an effective preventive plan and quickly stop the attacks.

Are asthma drugs dangerous?

Misconception:

Steroids used to treat asthma are dangerous.

Fact:

The National Institutes of Health (NIH) has developed a treatment program that directs people with persistent asthma to take inhaled corticosteroids or steroids to prevent inflammation and swelling in the bronchi. These steroids are NOT related to anabolic steroids used for muscle growth ^{1, 5, 6} . Steroids are injected into the respiratory tract, so only a small amount of the drug reaches other parts of the body ¹¹ . A metered dose inhaler (PMI) or aerosol inhaler can be used with a spacer to minimize the amount of medication deposited in the mouth ⁵ . At the right dosages, steroids are an effective and safe drug to keep asthma under control.

Misconception:

If you take asthma medication every day, it can become addictive.

Fact:

Regular use of asthma medications is not addictive. Asthma is a long-term disease, so it is important to follow the treatment program prescribed by your doctor ³ .

Misconception:

It is possible to stop taking asthma medications if the symptoms are gone.

Fact:

Stop taking medications only after consulting with your doctor. Otherwise, the symptoms may worsen or an asthma attack may begin ^{3, 6} .

Misconception:

Inhaled steroids used to treat asthma affect a child’s growth.

Fact:

When used correctly, inhaled steroids do not affect the growth of the child ¹ . It is important to know that it is asthma that can slow down a child’s growth if it is not properly controlled ^{1, 5} . Be sure to consult a doctor and develop a suitable treatment program.

Delusion:

If the child takes the medicine every day for a long time, it will not work in case of an asthma attack.

Fact:

There are two types of drugs that are used to treat asthma. The control drug is taken daily to prevent edema formation ³ . Relief drug relieves symptoms during an asthma attack ³ . Make sure you understand exactly which medication your child should take each day and which medication to take when symptoms flare up.

Misconception:

Asthma medications are dangerous for pregnant women.

Fact:

It is very important to control asthma during pregnancy ^{4, 5} . Talk to your doctor about changing your medication to a safer one. If asthma gets out of control during pregnancy, it can negatively affect your body and the development of the fetus.

Why monitor peak expiratory flow?

Misconception:

The peak flow meter is difficult to use and its readings are inaccurate.

Fact:

A peak flow meter measures the rate at which air leaves the lungs and should be used in moderate to severe disease to monitor changes in bronchial conditions. As symptoms worsen, peak flow readings decrease. Early detection of a decrease in lung performance will allow you to adjust the drug regimen and prevent the disease from reaching a critical state ⁷ . Check with your doctor to see if you need to use a peak flow meter regularly.

Delusion:

I can independently determine the best personal peak expiratory flow rate

Fact:

During the development of an asthma treatment program, your doctor will give you recommendations for your personal best peak expiratory flow rate ⁷ .

Error:

No need to measure peak expiratory flow every day

Fact:

Measure peak expiratory flow twice a day if asthma is not well controlled ⁸ . This will help you understand how effective the chosen preventive treatment is and whether your condition is improving ⁸ . Try to strictly adhere to the recommendations and regularly follow them. Keep your peak flow meter close to your toothbrush so you don’t forget to use it in the morning and evening.

What is a spacer and camera?

Misconception:

When using an inhaler, I like to feel the taste of the medicine in my mouth and throat, so I understand that the medicine is being taken into the body.

Fact:

For the medicine to be effective, it must not remain in the mouth or throat, but must be inhaled ⁹ . The taste of medicine in the mouth or throat indicates that it does not reach the lungs completely. This can cause side effects such as a scratchy throat, hoarseness, or infections. With proper use of the inhaler, only a small amount of medicine remains in the mouth ⁹ . Review your inhaler technique with your doctor.

Misconception:

The spacer and valve chamber are the same instrument.

Fact:

No. Spacers are used to deliver medication through the mouth and throat directly into the lungs. A spacer is a tube that holds the medicine inside until you breathe in. It is made of antistatic material, preventing the drug from settling on the walls of the spacer, it is equipped with easy-acting valves and does not require special breathing effort ^{9, 10} .

DISCLAIMER.
The information on this website is for reference only and should not be used as a substitute for advice from a therapist.

FOOTNOTE:
[1] health.utah.gov. Asthma/pdfs/factsheets/myths_facts_asthma.pdf

[2] everydayhealth.com. News/common-myths-about-asthma. Accessed October 2017

[3] chop.edu. News/asthma-myths-and-facts. As of October 2017

[4] breathefree.com. Asthma-treatment-and-control/asthma-in-special-situations. Accessed October 2017

[5] nhlbi.nih.gov. Health/health-topics/topics/asthma/treatment. Accessed October 2017

[6] asthma. org.uk. Advice/inhalers-medicines-treatments/common-concerns. Accessed October 2017

[7] lung.org. lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managingasthma/measuring-your-peak-flow-rate. As of October 2017

[8] asthma.org.uk. Advice/manage-your-asthma/peak-flow. Accessed October 2017

[9] asthma.org.uk. Advice/inhalers-medicines-treatments/inhalers-and-spacers/spacers. Accessed October 2017

[10] lung.org. Lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managingasthma/valved-holding-chambers. As of January 2016

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Mixed bronchial asthma

ICD 10 code: J45.8, ICD 11 code: CA23.2

Mixed asthma is a combination of allergic and non-allergic asthma. Along with a group of allergens that cause a disturbed immune response in a patient, there are internal sources for the production of biologically active substances that lead to spasm of the bronchial muscles. It is possible that mixed bronchial asthma is the most common variant of the disease. But, due to insufficient knowledge of mankind, most cases are attributed to allergic or non-allergic asthma.

Features of the course of the disease

Relatives and the patient usually have a tendency to allergic diseases with various manifestations. Over time, various manifestations of respiratory disorders in the presence of allergens are revealed. However, attempts to avoid contact with allergens do not always prevent the onset of an attack. Some attacks occur suddenly or in response to inhalation of cold air, exercise, or aspirin.

Frequent complaints

A common manifestation of mixed bronchial asthma is sudden shortness of breath: a person suddenly suffocates for unknown reasons. Cough is dry, paroxysmal, it also occurs suddenly and goes away on its own. Occasionally, when coughing, a small amount of sputum is secreted, transparent and thick. Dry wheezing, as well as whistling in the lungs, is another sign of mixed asthma, which occurs in other forms of it.

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Treatment of mixed bronchial asthma

Description of the treatment process
Treatment consists of prescribing drugs that inhibit inflammation in the walls of the bronchi – they are called basic drugs. They must be inhaled periodically. Another group of drugs is aimed at expanding the bronchi during an attack, and only relieves the manifestation, but does not affect the inflammation in the bronchi. Inhalation of exclusively drugs to expand the bronchi in the absence of basic therapy contributes to the progression of mixed bronchial asthma and the development of complications.

Terms of treatment
Depend on the severity of the course of the disease, the completeness of the examination, the effectiveness of drugs and the desire to be treated in an adult patient. The selection of an effective treatment regimen for mixed bronchial asthma takes up to 3 months. If the patient wants to try ASIT (antigen-specific immunotherapy) or therapy against chronic infections, treatment may continue for longer.

Prognosis
The prognosis for complete recovery from mixed asthma is usually negative. The disease continues and requires treatment for life, manifestations reappear when treatment is stopped. However, there are various experimental therapies, such as ASIT, antibiotic therapy, immunotherapy, that can reduce the need for maintenance medications.

Why is running mixed bronchial asthma dangerous?

Mixed bronchial asthma is dangerous due to a number of possible complications. Respiratory failure is a decrease in the supply of oxygen to the blood. At first, it appears only during asthma attacks. However, over time, it begins to be felt constantly, preventing a person from living a full life. Complications of mixed bronchial asthma can be emphysema – the formation of blisters, swelling of the lungs. In the absence of basic therapy, cicatricial changes gradually increase in the walls of the bronchi and lungs, deepening respiratory failure. In the worst case, an asthma attack can lead to death on its own, or stimulate the onset of a heart attack or stroke.

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Modern methods of treatment of bronchial asthma

Treatment of asthma in adults

In adults, the treatment of bronchial asthma is carried out according to a stepwise scheme adopted throughout the world. This scheme is adjusted depending on the form and degree of control of asthma manifestations. The main drugs in it are basic drugs: inhaled glucocorticoids (budesonide, beclomethasone dipropionate, fluticasone propionate, fluticasone furoate, flunisolide), antileukotriene drugs (zafirlukast, montelukast), antibodies to immunoglobulins E (omalizumab). To stop and prevent attacks, drugs that dilate the bronchi are prescribed: these are inhaled beta-2-agonists (salbutamol, fenoterol, salmeterol, formoterol, vilanterol), m-anticholinergic ipratropium bromide, theophylline. There are multiple ready-made formulations, where at the same time there are means of basic therapy and means of dilating the bronchi. They may be especially useful in the treatment of asthma in adults who neglect basic therapy.

At the first stage, short-acting inhaled beta-2-agonists (salbutamol, fenoterol) and / or m-anticholinergic ipratropium bromide are prescribed. That is, only drugs that relieve seizures.

At the second stage, the basic preparations of inhaled glucocorticoids in low doses or antileukotriene agents are added to the drugs for seizures.

At the third stage of treatment of bronchial asthma in adults, various combinations of drugs are used: low doses of glucocorticoids + long-acting beta-2-agonists; medium and high doses of glucocorticoids + short-acting beta-2-agonists; low doses of glucocorticoids + antileukotriene agents; low doses of glucocorticoids + long-acting theophylline.

In the fourth stage of asthma treatment in adults, medium and high doses of glucocorticoids + long-acting beta-2-adrenergic agonists are used and either antileukotriene agents or long-acting theophylline are added to them.

At the fifth stage, either glucocorticoid tablets or antibodies against immunoglobulin E (omalizumab) are added to the drugs from the fourth stage.

In addition to assessing the number of attacks, their severity, functional respiratory tests, which are carried out in the clinic on spirometers, are of great help in determining the effectiveness of asthma treatment. For home use, much simpler, but affordable, peak flow meters are suitable.

Antigen-specific immunotherapy (ASIT) is an asthma treatment method aimed at developing tolerance (addiction) to allergens. It has the potential to reduce the amount and dosage of asthma drugs consumed in cases of allergic or mixed asthma. For ASIT with skin tests, blood tests for specific immunoglobulins E determine the group of allergens for this case. Purified allergens in increasing concentrations are injected subcutaneously or under the tongue so that an adult or child becomes addicted to them, that is, less biologically active substances are released.

Antibacterial and antiviral treatment may help with mixed or non-allergic asthma. A lot of evidence has been obtained that hidden infections in the respiratory tract contribute to the production of biologically active substances that cause asthma symptoms. The main task is to identify these infections. For this, PCR diagnostics of sputum and bronchial washings, determination of the level of antibodies to infectious agents in the blood, and bacteriological examination (crops) can be used. When ARVI, herpes, adenoviruses are detected, immunomodulators are prescribed: inosine pranobex, cycloferon, arbidol and others. Staphylococcal bacteriophage and antibiotics help against Staphylococcus aureus. Mycoplasma or chlamydial infection is treated mainly with macrolide antibiotics, less often with a tetracycline group.

Treatment of an asthma attack

In the event of a sudden increase in pre-existing manifestations of bronchial asthma, one should always, first of all, be guided by instructions received from an allergist or pulmonologist. It is the attending physician who will best select the treatment in case of exacerbation of symptoms.

In the case of ongoing attacks of bronchial asthma, intensive ventilation of the room to stop contact with the allergen may help. If a connection with the flowering of plants is supposed, then such ventilation can do harm.

Keeping calm helps in the fight against an attack. The best posture is sitting, lying down is prohibited.

The maximum number of inhalations of the asthma remedy used by an adult patient is discussed with the attending physician in advance.

In addition to the maximum dose of bronchial dilators (beta-2-agonists or others), there is a maximum dose of the basic drug used (inhaled glucocorticoid or other). They can be combined in one inhaler and this must also be taken into account when treating an attack.

If there are drugs with a different mechanism of action in the first-aid kit, they can also be added to the used arsenal of drugs for the treatment of an attack of bronchial asthma. However, this option should be discussed with your doctor in advance.

If instructions in case of a severe attack from the attending physician are not understood, lost or forgotten, then the most rational thing is to call an ambulance. This will be even more relevant in case of increased choking, shortness of breath or cough, despite the ongoing measures. And also in case of confusion of speech, drowsiness, increased heart rate over 100 beats per minute, blue extremities or lips, retraction of the skin on the neck.

Frequent manifestations in bronchial asthma

• Persistent coughing – nothing but a dry cough, not associated with a cold, without fever. It occurs due to a sharp narrowing of the smooth muscles in the airways. Serves as a manifestation of allergic asthma if it begins in response to contact with an allergen. Dry coughing can occur at night, in the cold and during physical exertion, then it can be a manifestation of non-allergic asthma.
• Lack of air when breathing – usually, in bronchial asthma, exhalation is first of all difficult. Then a lot of air remains in the lungs, which the adult cannot exhale to the end. When asthma is associated with respiratory tract infections, emphysema, fibrosis, breathing is also difficult. Then already the person does not have enough air when breathing.
• Sudden shortness of breath may also be a manifestation of heart disease (cardiac asthma). However, it most often occurs due to allergens entering the respiratory tract (allergic asthma). These allergens compress the muscles of the bronchi, there is a sudden
• Adult suffocates in sleep – along with other diseases, this may be a manifestation of asthma. At night, due to a change in the mode of functioning of the body, the production of substances that contribute to the narrowing of the airways (with non-allergic bronchial asthma) may increase. At night, bed bugs, cockroaches, which are a source of strong allergens in allergic asthma, can become more active.
• Wheezing during exhalation – also appear due to the narrowing of the lumen of the bronchi on exhalation. With asthma, wheezing is most often dry. Large bronchi give dry low rales. Small bronchi, which are predominantly narrowed in asthma, give dry high rales – whistling, which is especially audible in thin and short adults. When an infection is attached, wheezing can become wet, appear both when inhaling and when exhaling.
• It’s hard to breathe in the morning – in case of asthma, a lot of mucus and biologically active substances accumulate in the lungs in the morning. By the end of the evening, the highest respiratory rates are usually observed.
• It is difficult to breathe in the cold, shortness of breath in the cold – such manifestations are noted by adults with bronchial asthma in the allergic cold variant. Against the background of pathological internal processes in the lungs, frosty air triggers the release of histamine, which, in turn, narrows the bronchi and makes it difficult to exhale, it becomes difficult to breathe in the cold.
• Heaviness in the lungs during breathing is more a manifestation of inflammatory or cicatricial processes in the lungs, emphysema. May develop in the absence of treatment of bronchial asthma. The sudden appearance and disappearance of heaviness in the lungs, combined with a cough, may indicate manifestations of bronchial asthma.