Asthma is a chronic disease most often manifested by attacks interspersed with periods when breathing is normal. In some people, however, asthma induces permanent respiratory discomfort that interferes with daily activities.

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1. What is asthma?

Asthma is a chronic inflammation of the bronchial tubes, which manifests itself by attacks. This disease affects more than 4 million French people. Every year in France, 60,000 people are hospitalized because of asthma attacks, and 1,000 people die. Worldwide, 262 million people suffer from asthma, and 461,000 deaths are related to this disease, according to the WHO in 2019.

Apart from the attacks, this disease is rather silent and a little symptomatic, the patients breathe normally. But there are several types of asthma, some patients will be regularly bothered (persistent asthma), others only at certain times of the year (intermittent asthma), or only in the presence of triggers.

Asthma is generally a lifelong disease, but there may be quieter periods, especially during puberty.

2. What is an asthma attack?

An asthma attack is an episode of wheezing, also called dyspnea. In these moments, there is an inflammation of the bronchial tubes, but also a contraction of the muscles surrounding the bronchial tubes, and a secretion of mucus by the mucous membranes.

It becomes more difficult to breathe (especially to breathe out) and the airflow is more difficult to pass. These attacks are more frequent at night or in the early morning.

When an attack is repeated, it is called an asthma exacerbation. This can lead to severe acute asthma, if not treated properly. This is acute respiratory distress that requires emergency assistance, as it can lead, in some cases, to sudden death.

3. What causes asthma?

There is a hereditary predisposition to develop asthma. But this is coupled with an additional cause, which triggers the asthma attack.

It can then be:

viral asthma: following viral infections;
allergic asthma: triggered by contact with an allergen, such as pollen, dust mites, animal hair, pollution, tobacco, etc.;
Exercise-induced asthma: caused by exertion during physical activity;
asthma caused by intolerance to aspirin or non-steroidal anti-inflammatory drugs;
or asthma caused by gastroesophageal reflux disease.

4. What are the symptoms of asthma?

In the event of an attack, asthma is characterized by the following symptoms

shortness of breath, breathing difficulties, because the bronchial tubes are narrowed;

a wheezing, due to the fact that the air passes by a narrowed duct;

a dry cough, because the mucous membranes are irritated;

And a feeling of tightness in the chest, which causes anxiety.

As the attack worsens, the person has difficulty speaking and the skin may turn blue (cyanosis).

5. How is asthma diagnosed?

If you have an episode that feels like an asthma attack, it's important to see your doctor. He or she will be able to ask you about your symptoms, the context, the frequency of the attacks, and prescribe treatment, or more likely, refer you to a fellow pulmonologist for further tests.

The pulmonologist will do a check-up, with functional respiratory tests (FRT), which measure, among other things, the maximum flow of air exhaled, the volume of air remaining in the lungs after maximum exhaling, etc.

6. How is asthma treated, especially in the event of an attack?

Asthma treatment usually requires a daily or even twice-daily background treatment in the form of tablets or inhalers. It is important to take this treatment over the long term, following the doctor's prescription carefully.

An antihistamine treatment is associated with this background treatment, in case of allergic asthma.

In the event of an attack, you should not wait before taking your relief treatment (most often a short-acting beta-2-mimetic bronchodilator, such as Ventolin, in a metered-dose inhaler or powder inhaler form). At the first signs of shortness of breath, persistent cough, or chest tightness, the patient should take two puffs of his bronchodilator.

After ten to fifteen minutes, if the discomfort persists, he can take two more puffs.

Ten to fifteen minutes later, two to four puffs of the bronchodilator can be taken again. A total of six to eight puffs may therefore be necessary. Most attacks stop with this treatment and last no more than 20 to 30 minutes.

If the attack persists despite the use of the bronchodilator, or if it starts again shortly afterward, it is a severe attack that requires a doctor to be seen quickly. In the meantime, the patient can also renew the doses of bronchodilator, and take corticosteroids in tablets if they have been prescribed by his doctor, according to his dose weight.

Be careful, with many puffs of bronchodilator, the patient may feel tremors and palpitations, which are symptoms of overdose, but without danger. It is important to discuss with your doctor the maximum number of puffs that should not be exceeded during an attack.

In the presence of serious respiratory symptoms, such as a feeling of suffocation, it is necessary to call the SAMU at the number 15! Once brought to the hospital, the patient can be given corticosteroid injections.

In some difficult cases, bronchial thermoplasty may be considered. This consists of heating the walls of the bronchial tubes by endoscopy in order to enlarge them and thus increase the respiratory volume.

7. Is it possible to prevent an asthma attack?

A person with asthma is likely to have more attacks when exposed to cigarette or fireplace smoke, cold air, viruses, mold, solvents, or certain allergens (pollen, dust mites, animal hair, etc.), but also to stress and strong emotions. The main prevention is therefore to avoid these triggers.

It is also essential to take one's medication correctly and regularly so that the asthma is controlled and stabilized. Annual appointments with your pulmonologist are recommended to ensure that your asthma is stable on medication.

Finally, it may be necessary to take Ventolin puffs as a preventive measure, ten to fifteen minutes before intense sports activities.

When you have asthma, it is important to always have a short-acting bronchodilator with you.

What should I know about asthma in infants and children?

Asthma can develop in childhood or in adulthood. When there is an atopic family background (i.e. a predisposition in the family to react to allergens, and thus develop asthma, eczema, hives, allergic rhinitis, etc.), the infant is also at risk of becoming asthmatic.

A child without asthmatic parents has a 10% risk of becoming asthmatic, this rate rises to 25% with one asthmatic parent, and to 50% with two asthmatic parents.

If a child has had three bouts of bronchiolitis (with respiratory discomfort and wheezing) before the age of one, the diagnosis of infant asthma is considered to have been made, and the child is then treated for this disease, with a background treatment via an inhalation device, and an attack treatment. An action plan, adapted to the child, is also given by the doctor, to know how to act in case of a new attack. A consultation with a pediatrician may be recommended, especially if the asthma is severe.

Asthma in infants up to the age of 3 is called asthma, and particularly affects boys. After 3 years of age, in the vast majority of cases, this asthma disappears. But it persists in some cases, about one child in four, these children are called "persistent wheezers", and their asthma may continue throughout their lives. However, until the age of 4 or 7, children do not have real asthma attacks like adults, but rather bronchitis or coughing.

In children with asthma over the age of 3, the doctor performs a clinical examination and may request additional tests: chest X-ray to identify the source of infection during an asthma attack, functional respiratory tests, allergological tests (skin prick tests and blood tests), etc.

In some cases, a child's asthma may be recognized as a long-term condition (ALD), which allows for 100% coverage of asthma-related care and tests.

To help your child avoid attacks, you can apply the following advice: avoid feather pillows and comforters, rugs, carpets, curtains, stuffed animals, forbid pets to enter the room, wash bedding frequently at 60°C, use dehumidifiers in case of excessive humidity, clean the home regularly, do not smoke, use a steam broom, limit chemical pollutants inside the home, evacuate cooking and chimney fumes, etc.