Bronchial intrinsic asthma J45.1

Variable, intermittently occurring, fully or partially reversible airway obstruction due to inflammation and hyperreactivity of the airways. Clinically, bronchial asthma is characterized by a sudden shortness of breath due to bronchoconstriction. Status asthmaticus is a severe asthma attack that is refractory to treatment and lasts at least 24 hours.

A distinction is made between non-allergic bronchial asthma:

Infection-induced asthma (infants and toddlers often have an infection-induced, possibly recurrent, obstructive ventilation disorder which may subside during the first years of life).

Drug-induced (e.g. analgesic-induced asthma = Analgesic Asthma Syndrome

Toxin- or chemical-induced (irritative) asthma

exercise induced asthma

Late-onset asthma (first manifestation in adults, women are preferred)

Asthma with obesity (obese women can suffer from particularly severe asthma)

Note: Mixed forms (with allergic asthma) are possible, so in initial allergic asthma the intrinsic, non-allergic component may dominate the clinical symptoms.

Prevalence in adults about 5%; in children up to 10%.

m:w=2:1

About 15% of the population suffer from unspecific bronchial hypersensitivity.

Pathogenesis: The cause of the non-specific hypersensitivity of the airways, which is present in all forms of extrinsic as well as intrinsic asthma, is largely unexplained. The sometimes very different triggers cause a release of inflammatory mediators from mast cells, basophilic leukocytes and macrophages. These induce epithelial damage to the mucosa, contraction of the bronchial muscles, mucous membrane edema and a secretion of tough mucus.

Triggering (or co-triggering) factors that may induce asthmatic reactions:

Respiratory infections: Viral, bacterial and mycotic infections can induce an asthma attack in both extrinsic and intrinsic asthma.

Drug-induced: NSAID (aspirin) triggered (so-called pseudoallergic) intrinsic asthma

Chemical stimuli: Smoke and dust; Chemicals

Situational factors: whereabouts, activities (e.g. workplace, hobbies);

Physical stress (exercise induced asthma)

Other factors: Temperature influences such as cold, psychological stress.

People with polymorphisms in the ORMDL3 gene have a 70% increased risk of developing bronchial asthma.

First manifestation in middle adulthood (>40 years)

The diagnosis "asthma" is a clinical diagnosis. It is based on characteristic complaints and symptoms and evidence of airway obstruction and/or bronchial hyperreactivity. It is characterised by the repeated occurrence of attacks of breathlessness and/or chest tightness and/or coughing with or without sputum, often at night.

The symptoms may be intermittent or continuous.

Auscultatory: Dry background noises (wheezing, whistling, humming) during auscultation, possibly provoked by forced expiration; prolonged expiration.

In case of severe obstruction with pulmonary hyperinflation or pronounced emphysema often very quiet breathing sounds (silent lung).

During the seizure, the patient sits upright and breathes with the aid of the respiratory muscles

In case of severe respiratory distress (especially in children): thoracic retractions (especially jugulum, intercostal, epigastric);

If the patient becomes exhausted, possibly respiratory alternans (alternation between thoracic and abdominal breathing)

Proof of the signs of airway obstruction may be missing in the symptom-free interval.

Chronic cough without asthma (as asthma equivalent) may be an indication of bronchial asthma.

Tachycardia: possible pulsus paradoxus (inspiratory blood pressure drop >10mmHg)

Staging of the airway obstruction

Stage I (mild): Low dyspnoea, diffuse gushing

Stage II (moderate): dyspnea at rest, use of accessory respiratory muscles, loud gushing, normal or restricted gausal exchange

Stage III (severe): severe dyspnoea, cyanosis, use of accessory respiratory muscles, gulling or absence of breathing sounds (silent lung), pulsus paradoxus (with the over-inflation of the lungs, at a capacity of <1.25 l per second, a drop in systolic blood pressure during inspiration runs parallel; RR expiratory 10 mm Hg higher than inspiratory). Gaussian exchange significantly restricted.

Stage IV (acutely life-threatening): severe dyspnoea, cyanosis, lethargy, confusion, pulsus paradoxus (drop in systolic blood pressure during inspiration >30-50mm Hg).

Detailed anamnesis

Proof of variable and/or stress-induced airway obstruction by a pulmonary function test (Lufu)

Lufu (see spirometry below): FEV1, FEV1/VC, PEF decreased, increased airway resistance, improved after inhalation of a beta-sympathomimetic (broncholysis test). Methacholine test to detect bronchial hyperreactivity.

Allergological stepwise diagnosis to exclude sensitization (prick test, specific IgE in serum, eosinophilic granulocytes and ECP in blood and sputum increased in allergic asthma, see below). bronchial extrinsic asthma)

ECG: signs of right heart strain

Lab. CBC, chem panel, SGS (CRP). Sputum test

S.u. bronchial asthma (overview)

S.u. bronchial asthma (overview)

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