Bronchial asthma-diagnosis and treatment


Bronchial asthma is a very common disease of the respiratory system. What epidemiological data?

Epidemiological assessment of any chronic disease is difficult enough, it depends on how much detail we investigate it. It is believed that asthma is a disease that in our circle of cultural and geographical concerns up to twenty percent of the population. A large ECAP (Epidemiology of Allergic Diseases in Poland) study was conducted in Poland. It follows from this study that in the General population we have several percent of asthma, depending on the city, region. This is roughly in line with world data. And if we expand the question and ask, ” has the Lord ever had whistling, shortness of breath?”that is, we will include a self-diagnosis of asthma in this, then you can find that it affects up to 40 percent.

Do we know what pathomechanisms underlie the development of this disease?
To a considerable extent, Yes. Bronchial asthma is a disease in its main atopic part, that is associated with atopy-overproduction of class IG antibodies, although 15-20% of asthma patients have neither atopy nor allergies. We know the genetic basis of this disease. We have identified loci where proteins important for the development of asthma, cytokines, are encoded. We also know, to a large extent, the consequences of preserving the genetic meaning that occurs in our body. We know that a very characteristic inflammatory reaction develops. We know which cells coordinate it, which cytokines are important, on which mechanism it leads to narrowing of the Airways. As elements of inflammation, there are: swelling, discharge, parallel spasm of smooth muscles and bronchial, which is the cause of sudden attacks of suffocation in the patient. I wouldn’t use the term that we know everything, but we know most of the pathophysiological basis of this disease.

To make the picture even more complex, asthma is not a homogeneous unit of lesion. The problem is therefore the division of asthma into subgroups. So there were phenotypes, ie subgroups of asthma characterized by the same feature. Of these phenotypes, we have built endtype. This is beginning to lead to clinical symptoms of asthma and may lead to personalized treatment. For example, recently we have the first biological therapy for asthma: monoclonal antibodies against IgE. Treatment with this antibody is an example of targeted therapy for the atopic phenotype of asthma. Therefore, patients should be properly qualified before including treatment.

What are the other symptoms of bronchial asthma, in addition to sudden shortness of breath? What diseases can be confused with bronchial asthma?

Chronic cough, paroxysmal shortness of breath, which can occur both at rest and during exercise, but this is not a typical shortness of breath, a feeling of tightness in the chest – inability to breathe) are the main symptoms. There are many other symptoms, marginal, and, on the other hand, a number of diseases that can mimic asthma and/or hinder its effective therapy, for example, common in the population of gastro-esophageal reflux manifested, in particular, baking behind the sternum, a feeling of tightness in the chest and often chronic cough. Another disease is obesity, which, on the one hand, contributes to the development of asthma because one type of adipose tissue is endocrine active and the adipokines produced in it can contribute to the development of asthmatic inflammation. It can be such “complicity” at the stage of formation of bronchial asthma, and on the other-obesity can cause exacerbation of symptoms in a patient who is treated already with asthma. Chronic obstructive pulmonary disease (COPD) is often diagnosed, but is often confused with asthma. The differentiation as well as the co-occurrence of these two units of the disease, i.e. overlay syndrome (asthma-COPD overlay syndrome, ACOS), has long been discussed. Imagine, for example, a patient who had asthma since childhood, then smoked cigarettes and, as a consequence, developed his features

Asthma, what does it look like? Do I need spirometry?

Diagnosis of bronchial asthma is very simple: interview (duration, characteristic symptoms and their reversibility), confirmation of atopic background, examination… and already. COPD cannot be diagnosed without spirometry, whereas it is not currently required to diagnose asthma. Of course, during treatment, we repeatedly conduct PEF-measurements, as well as complete spirometric studies to assess the patient’s reserves, the effectiveness of treatment.

This is important information for the doctor: in the patient’s card should not be spirometrii to confirm asthma and for this disease to cure it, and therefore to prescribe medication reimbursed. On the other hand, in COPD, if we don’t have spirometry to confirm the diagnosis, then we can’t write prescriptions.

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