Asthma

Introduction

Asthma is a chronic inflammatory disease of the airways, causing symptoms such as coughing, wheezing, shortness of breath and chest tightness. This condition affects approximately 4 to 10% of the population, representing more than 300 million people worldwide. When 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 treating physician. If they are unavailable, Docadom offers an emergency consultation by a home doctor: call 021 845 45 45 or use our application available on the App Store and Google Play.

Who is at risk of suffering from it?

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 related to exposure to flour, animal hair, or chemicals is common. Smoker, overweight individuals, patients with chronic sinusitis or recurrent pharyngitis, as well as pregnant women also constitute populations to be monitored.

Symptoms of Asthma

Asthma typically manifests through attacks, but can also cause daily symptoms. Recognizing these signs allows for quick action and prevents worsening.

Main Symptoms

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

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

• Shortness of breath during exertion, then at rest during severe attacks.

• Chest tightness: a squeezing sensation that must be differentiated 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: a sign of poorly controlled asthma.

When to seek emergency consultation?

An emergency consultation is necessary in the following situations:

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

• Difficulty speaking, completing 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 nighttime awakenings or daily symptoms despite maintenance treatment.

What to do before calling Docadom? First contact your treating physician, who knows your medical history and maintenance treatment. If they cannot be reached or if you need a home doctor 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 serious signs (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 identified.

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 (cold, flu, COVID-19), upper respiratory tract infections, exercise, cold air, stress, pollution, and passive smoking.

Exercise-Induced Asthma

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

Occupational Asthma

Related to exposure to substances in the workplace: flour (bakers), persulfates (hairdressers), paints, isocyanates, latex, disinfection products. The diagnosis opens the right to recognition as an occupational disease.

Asthma and Comorbidities

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

Diagnosis of Asthma

The diagnosis combines suggestive symptoms with the demonstration of a reversible bronchial obstruction.

Diagnostic Methods

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

• Peak expiratory flow (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 pathologies 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, inhaled foreign body in children.

Asthma Treatment

Treatment is based on three pillars: preventive/maintenance treatment, acute attack treatment and patient education.

Preventive / Maintenance Treatment

Taken daily to control inflammation:

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

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

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

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

Acute Attack Treatment

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

Inhalation Devices and Patient 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 based on 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, control of mold.

• Closed windows during pollen peaks, showering upon returning home, monitoring pollen forecasts.

• Complete cessation of active and passive smoking.

Lifestyle and Protective Factors

• Regular, appropriate, and well-prepared physical activity.

• 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 adjust treatment and check inhalation technique.

Possible Complications

Severe acute asthma is an attack that does not respond to usual treatment. It manifests as intense dyspnea, difficulty speaking, cyanosis, agitation or, conversely, drowsiness. This is a vital emergency that requires an immediate call to 144.

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

When to Contact a Doctor for Your Asthma

Asthma requires regular monitoring and a quick response in case of worsening. Here is the course of action:

• First-line resource: contact your treating physician. Only they know your maintenance treatment, history, and personalized action plan.

• If your treating physician is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation by a home doctor. 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 serious signs (cyanosis, inability to speak, drowsiness, loss of consciousness), dial 144 without delay.

Conclusion: Well-Controlled Asthma Means a Normal Life

Asthma is a common chronic inflammatory disease whose severity varies from one patient to another. It is characterized by coughing, wheezing, shortness of breath, and chest tightness, which can lead to complications such as severe acute asthma or airway remodeling. Well-conducted management — inhaled corticosteroids, bronchodilators, patient 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 treating physician. If they are not available, Docadom provides you with an emergency home doctor 7 days a week: call 021 845 45 45 or use our mobile application (App Store, Google Play) to request an emergency consultation.