Asthma - severity in adults

Asthma can be divided into certain degrees of severity, depending on how often and how severely one suffers from the asthmatic disease.

Since bronchial asthma is one of the most common chronic diseases (10 percent of children and 5 percent of adults suffer from it in Germany), there are already very good treatment options. Nevertheless, asthma is a disease that cannot be cured in adulthood. In asthmatic diseases in children, a cure can be found. In childhood, however, bronchial asthma is also one of the most common chronic diseases.

Inflammatory mechanisms are central to the development of asthmatic disease. These inflammations remain an important factor in the disease even during asthma, because asthma is a chronic, inflammatory disease of the respiratory tract. In addition, one also suffers from bronchial hypersensitivity (hyperreactivity).

History, clinical examination and pulmonary function analysis may reveal asthmatic disease. Noticeable symptoms are chest tightness, seizure-like cough and shortness of breath. After diagnosis, the form of the disease and its severity must be assessed.

There are three subtypes of bronchial asthma:

• 1. allergic bronchial asthma: allergies to environmental factors lead to asthmatic reactions of the body. This occurs in 50 to 70 percent of the population. Here, one reacts allergically to certain allergens such as pollen, house dust mites, animal hair and numerous other allergens.
• 2. non-allergic bronchial asthma: here, no allergy is detectable. This may arise due to respiratory diseases.
• 3. mixed forms: These result from a combination of allergic and non-allergic asthma.

The severity of the disease can be measured by the frequency and severity of attacks. In general, asthmatic disease is characterized by attacks of coughing, which leads to shortness of breath and secretion of mucus. More severe degrees of the disease also lead to a bluish tinge to the face due to acute shortness of breath, anxiety and even loss of consciousness.

• Severity I, also called intermittent asthma: Here there is less than one complaint a week and less than two attacks a month. Lung function is not impaired during sleep. One can go about a normal daily life.
• Severity II, also known as low-grade persistent asthma: The symptoms are more frequent and occur more than once a week, but less frequently than once a day. The patient suffers from nocturnal attacks at least twice a month. The asthmatic's sleep is impaired, physical activities are no longer possible without restrictions, as breathing difficulties occur during exertion or these can lead to attacks. In addition, the situation continues to worsen (exacerbation). Although lung function is not impaired (one can breathe), signs of increased airway sensitivity can be seen.
• Severity III, also known as moderate persistent asthma: In this case, there are already daily complaints and nocturnal attacks that occur more frequently than once a week. The condition worsens acutely (exacerbation). The patient is significantly restricted in his activities. Physical exertion leads to breathing difficulties and seizures. The patient is dependent on daily treatment with medication. The lung function is restricted
• Severity IV, also known as severe, persistent asthma: In this severity level, there are constant complaints and persistent symptoms. There are also frequent nocturnal attacks and a massive impairment of physical activity. The lung function is severely restricted.

To treat an asthmatic condition, one can resort to two basic methods. So-called controller drugs, anti-inflammatory drugs, and relievers, airway-opening drugs. Relievers are mainly taken for acute symptoms, i.e. when an attack occurs or is imminent. Controllers are control medications that prevent a seizure from occurring in the first place and are intended to reduce long-term symptoms. A combination of both medications is usually used.

Stepwise therapy for asthmatic disease is based on the severity of the condition and is intensified in stages. A short-acting β2-sympathomimetic as an on-demand medication is the basis of treatment. The inflammatory response may persist from type II asthma onwards, even if patients appear symptom-free, so continuous therapy with inhaled glucocorticoids should be given from stage II onwards. This not only controls symptoms but also prevents loss of lung function.

Staged treatment of asthma

• Treatment Stage I Intermittent mild asthma is most successfully treated with a short-acting β2-sympathomimetic as an as-needed medication. Whenever symptoms occur, this can be taken to relieve the symptoms. Type I asthma does not require long-term therapy.
• Treatment Stage II Persistent, mild asthma is also treated with a short-acting β2-sympathomimetic as an on-demand medication. Here, however, these demand medications should be combined with continuous therapy of inhaled steroids administered at low doses.
• Treatment level III In persistent moderate asthma, one resorts to the proven short-acting β2-sympathomimetics as needed. Inhaled steroids should be taken in moderate doses. Again, one should discuss a combination of the two medications with the physician.
• Treatment Stage IV Severe stage IV asthma should be treated with inhaled steroids (ICS) at high doses including long-acting β2-sympathomimetics. Retarded theophylline may also be considered or, for allergic asthma, omazilumab, as well as systemic glucocorticosteroids at the lowest dose still effective.

In all severities of asthma, care should be taken to follow a healthy lifestyle. Abstain from nicotine altogether. Be careful not to overexpose yourself to negative environmental factors. Fine dust pollution in cities and breathing polluted air with too many harmful substances can have a negative effect on asthmatic symptoms. Try to avoid these factors as much as possible.

As an alternative, you can also resort to homeopathic remedies in addition to the medicines prescribed by your doctor. It is best to combine these with the medications you need to take. However, be sure to check with your doctor before taking the homeopathic remedies.