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Bronchial Asthma – Causes, Symptoms and Treatment

Bronchial asthma is a chronic inflammatory disease of the airways causing recurrent episodes of breathlessness, wheezing, chest tightness, and coughing. The airways are persistently inflamed and hypersensitive to various triggers.

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Things worth knowing about "Bronchial Asthma"

Bronchial asthma is a chronic inflammatory disease of the airways causing recurrent episodes of breathlessness, wheezing, chest tightness, and coughing. The airways are persistently inflamed and hypersensitive to various triggers.

What is Bronchial Asthma?

Bronchial asthma is a chronic inflammatory condition of the airways. The bronchi – the air-carrying tubes within the lungs – become persistently inflamed and overly sensitive to a wide range of stimuli. This leads to recurring episodes of breathlessness, chest tightness, coughing, and a characteristic wheezing sound during breathing. Approximately 300 million people worldwide are affected, making asthma one of the most common chronic respiratory diseases.

Causes and Triggers

Bronchial asthma develops from a combination of genetic predisposition and environmental factors. Two main types are distinguished:

Allergic asthma (extrinsic): Triggered by allergens such as pollen, house dust mites, animal dander, or mold spores. This form commonly begins in childhood.
Non-allergic asthma (intrinsic): Triggered by factors such as respiratory infections, cold air, physical exercise, stress, smoke, or certain medications (e.g., aspirin).

Additional risk factors include a family history of asthma or allergies, early childhood infections, premature birth, and exposure to air pollutants or tobacco smoke.

Symptoms

The typical symptoms of bronchial asthma tend to occur in episodes and can vary in severity:

Episodic shortness of breath (dyspnea), especially at night or in the early morning hours
Wheezing or whistling sounds during breathing
Tightness or pressure in the chest
Dry, persistent cough
Prolonged exhalation phase

In a severe asthma attack (status asthmaticus), the breathlessness can become life-threatening and requires immediate medical attention.

Diagnosis

The diagnosis of bronchial asthma is established through a combination of:

Medical history and physical examination: Assessment of symptoms, triggers, and family background.
Pulmonary function testing (spirometry): Measurement of airflow and lung volumes; a hallmark finding is reversible obstructive airflow limitation after administration of a bronchodilator.
Peak flow measurement: Used to monitor maximum expiratory flow rate over time.
Provocation tests: Controlled exposure to triggers (e.g., methacholine) to confirm bronchial hyperresponsiveness.
Allergy testing: Skin prick tests or blood tests for specific IgE antibodies.

Treatment

Pharmacological Therapy

The treatment of bronchial asthma follows a stepwise approach and includes two main categories of medication:

Reliever medications: Short-acting beta-2 agonists (e.g., salbutamol) are used during acute episodes to rapidly open the airways.
Controller medications: Inhaled corticosteroids (ICS, e.g., budesonide) form the cornerstone of long-term therapy by reducing airway inflammation. If asthma remains poorly controlled, long-acting beta-2 agonists (LABA), leukotriene receptor antagonists, or biologic therapies (e.g., anti-IgE antibodies such as omalizumab) may be added.

Non-Pharmacological Measures

Avoidance of known triggers (allergens, smoke, pollutants)
Breathing physiotherapy and patient education programs
Allergen immunotherapy (desensitization) for allergic asthma
Regular medical follow-up and adjustment of the treatment plan

Prognosis

With consistent treatment and effective trigger avoidance, bronchial asthma can be well controlled in the majority of patients. Children often have a more favorable prognosis, as symptoms may improve during puberty. However, untreated asthma can lead to permanent structural changes in the airway walls, a process known as airway remodeling.

References

Global Initiative for Asthma (GINA): Global Strategy for Asthma Management and Prevention. GINA Report 2023. Available at: https://ginasthma.org
National Heart, Lung, and Blood Institute (NHLBI): Guidelines for the Diagnosis and Management of Asthma (EPR-3). U.S. Department of Health and Human Services, 2007 (updated 2020).
Reddel H.K. et al.: An official ATS/ERS workshop report: novel outcome measures for clinical trials in frequent-exacerbator COPD and asthma. European Respiratory Journal 2021; 58(5).

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