Asthma

Introduction

Asthma is a chronic inflammatory disease of the airways, which causes symptoms such as cough, wheezing, shortness of breath and chest tightness. This condition affects approximately 4 to 10% of the population, which represents more than 300 million people worldwide. Well controlled, it allows for a normal life; poorly managed, it can lead to severe attacks and permanently alter respiratory function.

If you suspect an asthma attack or if your symptoms worsen, first contact your primary care physician. If they are unavailable, Docadom offers an emergency consultation by a doctor at home: call 021 845 45 45 or use our application available on the App Store and Google Play.

Who is at risk?

Asthma can occur at any age, but it most often begins in childhood. Children with an atopic background (family history of asthma, eczema, allergic rhinitis or allergic conjunctivitis) are at higher risk. In adults, occupational asthma linked to exposure to flour, animal hair or chemical products is common. Smokers, overweight people, patients suffering from chronic sinusitis or recurrent pharyngitis, as well as pregnant women also represent populations that need to be monitored.

Symptoms of Asthma

Asthma typically manifests in attacks, but can also cause daily symptoms. Recognizing these signs allows you to react quickly and avoid worsening.

Main Symptoms

• Dry cough, often at night or early morning, triggered by exertion, cold air, laughter or an irritant.

• Wheezing, perceived during expiration and sometimes audible from a distance.

• Shortness of breath on exertion, then at rest in severe crises.

• Chest tightness: a feeling of squeezing that must be distinguished from true chest pain of cardiac origin.

• Difficulty speaking, fatigue, anxiety, and in severe forms, cyanosis of the lips or extremities.

• Nocturnal symptoms waking the patient up: a sign of poorly controlled asthma.

When to consult in an emergency?

An emergency consultation is necessary in the following situations:

• Asthma attack not responding to the rescue bronchodilator (Ventoline®) after two closely spaced doses.

• Difficulty speaking, finishing a sentence, or inability to lie down.

• Bluish lips, agitation, drowsiness, sweating or respiratory exhaustion — call 144 immediately.

• Use of the rescue bronchodilator more than twice a week outside of exercise.

• Repeated night awakenings or daily symptoms despite background treatment.

What to do before calling Docadom? First contact your primary care physician, who knows your history and your background treatment. If they are unreachable or if you need a doctor at home outside of opening hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone application (App Store and Google Play). In case of signs of severity (cyanosis, confusion, extreme dyspnea), dial 144 without delay.

Causes and triggers of asthma

Asthma results from an interaction between a genetic predisposition and environmental factors. Several forms are individualized.

Allergic Asthma

This is the most common form in children and adolescents. The main allergens are dust mites, pollens, animal hair, molds and certain foods. Allergic asthma is often associated with allergic rhinitis, eczema or allergic conjunctivitis.

Non-allergic Asthma

More common in adults. It is triggered by viral infections (colds, flu, COVID-19), upper respiratory tract infections, exercise, cold air, stress, pollution and secondhand smoke.

Exercise-induced Asthma

Exercise-induced asthma occurs during or after exertion, especially in cold, dry air. It does not contraindicate sports: physical activity remains recommended, provided there is suitable treatment.

Occupational Asthma

Related to exposure to substances present in the workplace: flour (bakers), persulfates (hairdressers), paints, isocyanates, latex, disinfection products. Diagnosis opens the door to eligibility for recognition as an occupational disease.

Asthma and Comorbidities

Obesity, gastroesophageal reflux disease, sleep apnea, chronic sinusitis and anxiety disorders worsen asthma and complicate its control.

Diagnosis of Asthma

The diagnosis combines suggestive symptoms with evidence of reversible bronchial obstruction.

Diagnostic Methods

• Spirometry with reversibility test: reference examination. The diagnosis is confirmed by an improvement in FEV1 of at least 12% and 200 mL after a bronchodilator.

• Peak expiratory flow rate (peak flow): for home monitoring.

• Bronchial provocation tests with methacholine or exercise.

• Fractional exhaled nitric oxide (FeNO): reflects eosinophilic inflammation.

• Allergy tests: prick tests, specific IgE.

• Chest X-ray to rule out other causes.

Alternative Diagnoses

Several conditions mimic asthma and must be systematically ruled out:

• Chronic obstructive pulmonary disease (COPD) in adult smokers.

• Heart failure (cardiac asthma) with nocturnal dyspnea.

• Pulmonary embolism in case of sudden, unexplained dyspnea.

• Panic disorder with hyperventilation.

• Vocal cord dysfunction, gastroesophageal reflux disease, inhaled foreign body in children.

Treatment of Asthma

Treatment is based on three pillars: background treatment, attack treatment and therapeutic education.

Background Treatment

Taken daily to control inflammation:

• Inhaled corticosteroids (budesonide, fluticasone, beclometasone): cornerstone of treatment.

• Long-acting beta-2 agonists (salmeterol, formoterol), always in combination with a corticosteroid.

• Leukotriene receptor antagonists (montelukast), long-acting anticholinergics (tiotropium).

• Biotherapies in severe asthma: omalizumab, mepolizumab, dupilumab, tezepelumab.

Treatment of the Attack

Short-acting beta-2 agonists (salbutamol — Ventoline®, terbutaline) provide relief in a few minutes. A severe attack warrants an emergency consultation. If your primary care physician is not reachable, an emergency doctor from Docadom can intervene quickly at your home: 021 845 45 45. In case of respiratory distress, call 144.

Inhalation Devices and Therapeutic Education

The effectiveness of treatment largely depends on the inhalation technique. A written action plan provided by the doctor allows the patient to manage treatment adjustments themselves according to symptoms or peak flow.

Prevention of Asthma

Environmental Control

• Anti-dust mite covers, washing bedding at 60°C, daily airing.

• Avoidance of animals in case of known allergy, fighting against mold.

• Windows closed during peak pollen times, shower upon returning home, monitoring pollen reports.

• Complete cessation of smoking, active and passive.

Lifestyle and Protective Factors

• Regular physical activity, adapted and well prepared.

• Maintaining a healthy weight, balanced diet.

• Vaccinations against flu, COVID-19 and pneumococcus to limit exacerbations.

• Desensitization (allergen immunotherapy) in certain allergic forms.

• Regular medical follow-up to adapt treatment and check inhalation technique.

Possible Complications

Acute severe asthma is an attack that does not respond to usual treatment. It manifests as intense dyspnea, difficulty speaking, cyanosis, agitation or, on the contrary, drowsiness. It is a vital emergency that requires an immediate call to 144.

Other complications include repeated exacerbations, bronchial remodeling (structural changes of the bronchi), pneumothorax, side effects of long-term oral corticosteroids, psychological impact and, more rarely, death. The majority of these deaths are preventable by early management.

When to contact a doctor for your asthma

Asthma requires regular monitoring and a rapid reaction in case of worsening. Here is what you should do:

• As a first resort: contact your primary care physician. They alone know your background treatment, history and personalized action plan.

• If your primary care physician is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation by a doctor at home. Call 021 845 45 45 or make your request via our mobile application, available for free on the App Store and Google Play.

• In case of signs of severity (cyanosis, inability to speak, drowsiness, loss of consciousness), call 144 without delay.

Conclusion: controlled asthma means a normal life

Asthma is a common chronic inflammatory disease, the severity of which varies from one patient to another. It is characterized by a cough, wheezing, shortness of breath and chest tightness, which can lead to complications like acute severe asthma or bronchial remodeling. Well-conducted management — inhaled corticosteroids, bronchodilators, therapeutic education, environmental control — allows the vast majority of patients to lead a completely normal life.

In case of doubt or worsening, first seek advice from your primary care physician. If they are not available, Docadom provides you with an emergency doctor at home 7 days a week: call 021 845 45 45 or use our mobile application (App Store, Google Play) to request an emergency consultation.