Optimal Respiratory treatments for you

Asthma is a chronic and inflammatory disease of the respiratory tract. The word asthma comes from the Greek and means oppression or wheezing. In people with asthma, the airways of the affected person are very sensitive to various stimuli. This so-called bronchial hyperreactivity and the permanent inflammation lead to a constriction of the bronchial tubes via several mechanisms, which causes the typical asthma symptoms.

Forms of asthma

There are two basic forms of asthma: allergic (or extrinsic) asthma and non-allergic (intrinsic) asthma. In addition, there are other forms such as occupational asthma.

Allergic asthma

Allergies are a common trigger, especially in childhood. The allergy triggers can be pollen, animal dander or dust mites, for example. However, in 30 to 50 percent of adults with asthma, no evidence of an underlying allergy is found. However, many adults also have a mixed form of allergic and non-allergic asthma.

Non-allergic asthma

Here, too, there is chronic inflammation and hypersensitivity in the airways. However, this is not caused by allergens, but for example by infections of the respiratory tract or also by taking certain medications, such as acestylsalicylic acid (ASA) (drug-induced asthma).

Unlike allergic asthma, intrinsic asthma almost always begins in adulthood – often in the fourth decade of life. It often occurs after a viral infection of the airways. The severity of the disease often varies less than in allergic asthma, but intrinsic asthma often shows a more severe course right from the start.

Mixed asthma

Many patients have a mixed form of allergic and non-allergic asthma. This means that both allergens and other stimuli can trigger an asthma attack or symptom exacerbation. These include, for example: physical and emotional stress, cold air, cigarette smoke (active and passive), infections, medications and perfumes.

Mixed-type asthma often develops from an originally allergic asthma. As it progresses, the general sensitivity of the bronchial tubes increases and non-allergic triggers increasingly play a role.

Symptoms

A characteristic feature of asthma is that the symptoms occur in attacks. They then resolve and then flare up again during the next attack. Symptoms include:

• whistling breathing (wheezing)
• seizure-like shortness of breath or shortness of breath, especially occurring at night
• extremely strong, usually dry cough
• in the later course of the disease, often also productive coughing
• tightness in the chest
• high heart rate (also triggered by the patient’s anxiety, among other things)
• exhalation requiring great effort 

An acute attack can be triggered by, among other things:

• fog
• wind
• cold ambient air
• physical strain
• stress
• medications
• exhaust fumes and tobacco smoke
• staging

Stages

In the past, asthma was classified according to the severity of symptoms, but today the focus is on how well the asthma is controlled

Three grades are distinguished:

1. controlled asthma
2. partially controlled asthma
3. uncontrolled asthma

To assess how well controlled the asthma is, there are simple, standardized questions that the physician can ask the patient:

• Did symptoms occur more often than twice a week during the day?
• Did on-demand medications need to be taken more often than twice a week (exception: before exercise)?
• Were there nights when patients woke up once or more because of asthma?
• Was activity limited because of the asthma?

If none of the questions is answered with “yes”, the asthma is considered to be well controlled, if one or two criteria are met, the asthma is considered to be partially controlled, if three and four criteria are met, the asthma is considered to be uncontrolled.

Therapy

The therapy depends accordingly on the degree of control of the asthma. There are clear recommendations in the guidelines

The therapy is structured as a so-called graduated scheme, depending on the degree of control. On the one hand, it consists of drug therapy with anti-inflammatory and bronchodilator drugs, as well as non-drug measures. For adults as well as for children and adolescents, there is a separate stage scheme with five and six therapy stages, respectively. From stage to stage, the treatment is intensified, i.e. more medications are usually added.

In addition to asthma medication, non-drug measures are also recommended for the treatment of asthma. These include, for example, asthma training, where patients learn to better assess their symptoms. Non-drug treatment also includes:

• physical exercise
• weight reduction
• tobacco cessation and
• respiratory physiotherapy

In addition, various breathing techniques can help to better manage the disease. Furthermore, common concomitant diseases, such as a chronic cold (rhinitis) or sinusitis, should be treated appropriately.

Medication

Basically, two groups of asthma medications are distinguished:

Bronchodilator relievers are used primarily as a rapid demand medication for acute symptoms. (Demand therapy).

Anti-inflammatory controllers must be taken over a longer period of time and achieve a long-term effect. (long-term therapy)

Other medications: in addition to controllers and relievers, there are other medications used to treat asthma, but they are only used in certain groups of patients. These include:

• leukotriene antagonists
• chromones
• aminophyllines
• anticholinergics and
• various antibodies (biologics, for severe, uncontrolled asthma)

Hyposensitization

In the case of allergic asthma, hyposensitization can also be a supportive measure. In this case, patients receive the allergy-causing substances (allergens) in increasing doses either sublingually, i.e. under the tongue, or as an injection under the skin. The aim is for the body to become accustomed to the allergen so that allergic reactions do not occur. Studies show that hyposensitization reduces exacerbations and improves asthma control. In children and adolescents, specific immunotherapy can help reduce the dose of cortisone spray needed. However, the procedure should only be used in patients with stable asthma and does not replace standard drug therapy.

Acute asthma attack

An asthma attack is an extremely threatening and frightening situation for the patient, as it is accompanied by severe shortness of breath and chest tightness.

Therefore, it is important above all to take non-medication measures and to be sure to control them well:

• Keep calm! Fear and panic only lead to even more shortness of breath, which can then possibly lead to serious oxygen deficiency
• adopt a posture that facilitates breathing (coachman’s seat, rider’s seat, goalkeeper’s posture )
• adopt a breath-easing technique (lip-brake) that can be used to breathe effectively despite shortness of breath
• take reliever medication
• if necessary, call a doctor

Asthma is unfortunately still not curable, but it can be managed well thanks to the now very good variety of therapeutic options available.

The term COPD comes from the English and stands for “chronic obstructive pulmonary disease”. This means chronic obstructive pulmonary disease. Chronic because the changes in the lungs cannot be cured – on the contrary, they usually continue to progress. The term “obstructive” stands for narrow, i.e. a narrowing of the airways that does not completely disappear even after the administration of appropriate medication.
In Germany, about ten percent, or eight million people, suffer from COPD, and it is estimated that this number will rise to ten million by 2020. COPD is one of the most frequent causes of death.

Cause
The main risk factor for developing COPD is smoking. Only ten to twenty percent of all people with COPD have never smoked in their lives. Basically, the risk of disease is increased by factors that can trigger and fuel inflammation in the lungs. In addition to tobacco smoke – whether active or passive – these include:

• genetic predispositions (e.g., alpha1-antitrypsin deficiency)
• occupational inhalation of dusts (e.g. mining)
• air pollutants
• infections of the respiratory tract in childhood
• premature birth

Forms
There are two different forms of COPD, one focusing on chronic bronchitis and the other on emphysema. In addition, there are also mixed forms.

Chronic bronchitis
Chronic bronchitis is present when cough and sputum (productive cough) persist for two consecutive years for at least three months each. “Simple chronic bronchitis” is when cough and sputum occur only once due to overproduction of mucus in the lungs. At this stage, the changes in the lungs can still recede if the cause (for example, smoking) is eliminated. If this does not happen, chronic bronchitis can develop into COPD.

Pulmonary emphysema
Experts understand emphysema as the overinflated lungs. In the course of COPD, the wall structure of the alveoli can be destroyed. This irreversibly expands the air spaces. The lungs then no longer look like a vine with grapes (as in a healthy person), but like a large balloon.

Diagnosis
In addition to the medical history, i.e. the detailed conversation with the doctor, there are some special lung/ and breathing tests that can confirm the presence of COPD or also differentiate it from other respiratory diseases such as asthma.

Pulmonary function testing (also called Lufu or spirometry):
Lufu is a procedure to measure and record lung or respiratory volume. It is used to record personal ventilation variables. The examination is not painful, but requires good cooperation from the patient: The patient breathes through a mouthpiece into a device called a spirometer, with his or her nose closed with a nose clip. In doing so, the spirometer measures the volume of air the patient inhales and exhales and the velocity of the exhaled air. The device graphically maps the volumes of air moved during these breaths, allowing direct comparison of your readings from different tests.

Whole-body plethysmography
Whole-body plethysmography is a pulmonary function test that provides a graphical representation of measured circumferential changes in the body. Whole-body plethysmography determines respiratory resistance and intrathoracic gas volume in one measurement procedure. During the measurement, the patient sits in an airtight cabin in which the pressure changes during inhalation and exhalation. In this way, the total gas volume in the chest, the total lung capacity, can also be determined.

Reversibility test
The reversibility test with bronchodilator medication helps to distinguish COPD from bronchial asthma, in which the airways are also narrowed.

Severity levels
COPD severity levels are based on the annual report of the Global Initiative for Chronic Obstructive Lung Disease, the so-called GOLD Guidelines. This distinguishes between four degrees of severity and also includes the treatment of exacerbations.
The severity levels according to GOLD are assessed using the FEV1, the so-called one-second capacity. This value indicates how much air a patient can exhale as quickly as possible within one second after taking a full breath.

• GOLD I (mild) FEV1 ≥ 80% of the set point
• GOLD II (moderate) FEV1< 80 % and ≥ 50 % of set point
• GOLD III (severe) FEV1 < 50% and ≥ 30% of set point
• GOLD IV (very severe) FEV1 < 30% of set point

Symptoms
Classically, COPD is manifested by the following symptoms:

• shortness of
• breath
• cough
• sputum

Especially in the advanced stage, however, other organs are also affected, so that COPD develops into a disease of the whole body and secondary diseases occur. This affects the heart, muscles, skeleton and metabolic organs. Thus, many patients with chronic obstructive pulmonary disease also suffer from anemia, muscle wasting and weight loss.

Therapy
Unfortunately, a cure for COPD is not yet possible. Therefore, the goals of COPD therapy are:

• to reduce the progression of the disease
• to improve the physical resilience of those affected
• to relieve symptoms and improve the general health of patients
• to prevent and treat exacerbations, complications and concomitant diseases
• to maintain as high a quality of life as possible

To achieve this, various drug and non-drug treatment options are available. The most important therapeutic measure is still smoking cessation.

Medications
Bronchodilator drugs (so-called bronchodilators) form the basis of therapy. They widen your airways and improve airflow. Short- and long-acting preparations are used.
Acute worsening of COPD can be reduced with inhaled cortisone (ICS). However, the current guideline recommends the permanent use of cortisone in COPD only if treatment with a combination of two long-acting bronchodilators is not successful.

For the treatment of acute respiratory tract infections, mucolytic drugs (mucopharmaceuticals) with the active ingredients N-acetylcysteine, ambroxol or myrtol can help to liquefy stuck secretions. However, the guideline does not generally recommend the use of these drugs.

Training
Important content of COPD training is the disease, its self-control, as well as correct inhalation technique and proper breathing, for example, breathing with pursed lips (lip braking). In COPD training, patients also learn to recognize and treat an acute deterioration (exacerbation) in time. In fact, patient education has been shown to improve quality of life in people with mild and moderate COPD, as well as reduce the number of exacerbations and thus hospitalizations per year.

Respiratory/ and physical therapy
Here, COPD patients learn to ease difficult breathing at rest and under stress with special breathing techniques as well as certain postures. They learn how to make the chest more mobile and cough up stuck mucus more easily. This improves ventilation of the lungs. At the same time, optimal breathing prevents respiratory infections that COPD patients often suffer from. The slack abdominal muscles are also systematically exercised. Correct breathing behavior is important because it takes away the feeling of anxiety when breathing is difficult, raises self-confidence and increases performance.
Regular exercise is also of enormous importance for people with COPD. Especially for patients with severe COPD, a little physical activity is always better than no exercise at all. This is because being active on a regular basis has a positive effect on the course of COPD: Muscle tone is maintained, sufferers need to be hospitalized less often, and mortality is reduced.

Long-term oxygen therapy
In cases of severe COPD and chronic oxygen deficiency in the blood (hypoxemia), long-term oxygen therapy (LTOT) is recommended. The administration of supplemental oxygen provides sufficient oxygen to the body and also relieves the respiratory muscles.

Lung volume reduction and transplantation
In patients who are very severely ill and in whom the lungs are severely overinflated (pronounced emphysema), it may – in individual cases – make sense to “reduce the size” of the lungs. Various endoscopic and surgical lung volume reduction procedures (LVRS) are available for this purpose.
If all other treatment options have been exhausted, lung transplantation may also be possible.