Asthma

Asthma is a chronic disease of the airways that causes them to narrow. An asthma attack makes breathing difficult. In many cases, asthma first presents during childhood and can be treated effectively with medication. Find more information here about symptoms, prevention, and treatment options.

At a glance

  • People with asthma are not destined to experience a worsening of symptoms over time.
  • With effective treatment, it is possible to enjoy a largely symptom-free life.
  • Treatment comprises medication and supportive measures, such as regular exercise.
  • In Germany, around 10 percent of children and 5 percent of adults have asthma.
  • Experts distinguish between allergic asthma and non-allergic asthma, based on the trigger in each case.
  • Symptoms typically occur in the form of attacks, often at night.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Asthma: woman holding an inhaler in her hand.

What is asthma?

Asthma is a chronic disease that causes a temporary or permanent narrowing of the airways. Asthma attacks usually cause wheezing, coughing, and breathlessness. With inadequate treatment, physical fitness is impacted because the lungs are no longer able to absorb as much oxygen.

Asthma does not automatically worsen over time and can be treated effectively. With medication and supportive measures, such as regular exercise, most people with asthma can enjoy largely symptom-free lives. Over time, people with asthma learn which treatments work best for them and what they can do to avoid asthma attacks.

What are the symptoms of asthma?

In children, asthma symptoms usually consist of coughing and whistling or wheezing sounds when breathing. Teenagers and adults also experience the following additional symptoms:

  • breathlessness (often as part of an attack)
  • shortness of breath during exercise
  • noisy breathing (out) (whistling, wheezing, rattling)
  • chest tightness
  • coughing/feeling an urge to cough

Asthma symptoms typically occur in the form of sudden attacks. An asthma attack may begin with slightly impaired breathing but may progress to severe respiratory distress. People with asthma often suffer attacks at night, leaving them tired and worn-out the next day.

What is asthma?

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What causes asthma?

Asthma is likely to have a certain hereditary component, as it occurs more frequently in some families than others. Risk factors for asthma include:

  • atopic eczema, hay fever, or other allergies in the family
  • low birth weight
  • sex (more boys than girls have asthma)
  • having parents who smoke
Asthma may be caused by a family history of allergies, below-average birth weight; more common in boys than girls; parents who smoke.

In people with asthma, the immune system overreacts very slightly. In order for symptoms to occur, however, an additional irritant or trigger is required. When certain triggers make their way to the mucous membranes lining the bronchial tubes, the immune system then overreacts.

Important: A distinction is made between allergic asthma and non-allergic asthma, based on the trigger in each case. However, this distinction is not always clear-cut.

Allergic asthma is also known as “extrinsic” asthma because the external trigger is breathed into the airways with the air. Typical triggers include:

  • tobacco smoke (from active and passive smoking)
  • plant pollen
  • animal hair
  • dust mite droppings
  • food ingredients
  • cold air
  • perfume
  • exhaust fumes
  • certain chemicals

For more detailed information about diagnosing and treating allergic asthma, visit allergieinformationsdienst.de.

Non-allergic asthma, also known as “intrinsic” asthma, is caused not by foreign bodies that are inhaled from the environment but by irritants from within the body itself. These include:

  • bacterial and viral inflammation of the airways
  • accelerated breathing induced by physical or emotional stress
  • acetylsalicylic acid (ASA) and other painkillers that are classed as NSAIDs (non-steroidal anti-inflammatory drugs), which trigger analgesic-induced asthma.

Effects on the lungs and breathing:

  • Immune system cells are activated in the mucous membrane of the bronchioles.
  • The muscles surrounding the airways tense up.
  • The mucous membranes in the airways become inflamed and swollen.
  • Very sticky mucus is produced.

An asthma attack occurs when the tensed muscles, the swollen mucous membranes, and the sticky mucus cause excessive constriction of the airways.

How common is asthma?

Around 10% of children and 5% of adults in Germany have asthma.

People can get asthma at any age. In most cases, however, the symptoms begin during childhood or adolescence. In Germany, around 10 percent of children and 5 percent of adults have asthma. Asthma is the most common chronic disease among children.

How does the disease progress?

The progression of asthma may differ greatly between individuals. Some children or teenagers experience hardly any problems once they reach adulthood and can live almost normal lives. In other cases, however, the symptoms may persist or worsen. It is important to identify the irritants that trigger an attack and to avoid these. The way in which the disease progresses also depends to a large degree on timely treatment and on how the disease is managed by individuals themselves. It is important that medication be taken consistently and that supportive measures (such as exercise) be undertaken also, in addition to the use of special breathing techniques.

Asthma frequently occurs in individuals who have previously had problems with allergies, such as hay fever, conjunctivitis, or atopic eczema. The symptoms of asthma may vary depending on the season or other factors. They may recede into the background at times or temporarily disappear altogether.

How is asthma diagnosed?

Respiratory complaints can be caused by various diseases. Therefore, a number of different tests are required in order to arrive at a definitive diagnosis of asthma. The following are essential elements of the diagnostic process:

Asthma is diagnosed by a detailed medical history, physical examination and pulmonary function tests.
  • An in-depth discussion with the doctor, in which the doctor examines the patient’s medical history, lifestyle, and the precise nature of the symptoms.
  • A physical examination, looking at the patient’s general health and the functioning of the lungs, heart, and circulatory system.
  • Lung-function tests (peak flow measurement and/or spirometry) to check lung capacity. A peak flow meter measures the speed of airflow as air is exhaled. Spirometry measures how much air is inhaled and exhaled.

If the results are not definitive, further testing of the airways or allergy tests will follow.

For more detailed information, e.g., on the symptoms and diagnosis of asthma, see gesundheitsinformation.de.

How is asthma treated?

The treatment of asthma seeks primarily to minimize the frequency and severity of the symptoms. The goal is to make daily life as normal as possible. Effective medications with minimal side-effects are available for the long-term treatment of asthma and prevention of asthma attacks. These are even suitable for use during pregnancy. The doctor and patient will discuss and agree on the most suitable medication.

Two main groups of medication are used to treat asthma:

  • fast-acting medication to be taken as needed (relievers)
  • slow-acting medication to be taken on a regular basis (controllers)
Woman with asthma using an inhaler.

For those with mild asthma, it may be sufficient to use relievers only. These are only taken when acute symptoms occur.

However, more severe asthma requires ongoing treatment with controllers, as the airways are always slightly inflamed. Taking medication on a regular basis is the only way to control the asthma and prevent attacks.

Important: It may help to avoid asthma triggers as much as possible – even if this is not always easy to do on a daily basis. It is useful to know whether the trigger is animal hair, house dust, or cold air. The most important thing, however, is to use the medication correctly.   

To keep the symptoms under control, sport and exercise as well as special breathing techniques also help. These measures can all serve to support treatment with medication.

What is everyday life like with asthma?

Asthma is a chronic disease that can impact many areas of life. Asthma attacks at night can lead to fatigue and difficulty with concentration during the day. Physical fitness may also be reduced.

It takes time to learn how to handle a chronic condition like asthma. This applies to sufferers and their families alike. The better educated everyone involved is about the topic, the better they can support one another.

Being well informed about their own condition will help people with asthma to cope with an asthma attack or other critical situations. This, in turn, can help prevent emergencies and avoid hospital admissions.

What information is available for people with asthma?

Reliable support from a doctor, the best-possible treatment, and asthma training will all help a person with asthma to become an expert in managing the condition. Asthma training is offered by pulmonary specialists and by some rehabilitation clinics, for example.

The aim of asthma training is to teach participants:

  • how the condition arises and how it can be treated.
  • how to detect the early symptoms of an asthma attack.
  • tips for avoiding triggers.
  • what to do in the event of an emergency.

Another option is to join an asthma support group. These meet regularly to allow people with asthma and their families to share information and experiences and to support one another.

  • Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlich Medizinischen Fachgesellschaften (AWMF). Asthma. Nationale Versorgungsleitlinie (S3-Leilinie). AWMF-Registernummer nvl-002. 09.2018. Aufgerufen am 29.04.2020.
  • Dennis RJ, Solarte I, Rodrigo G. Asthma in adults. BMJ Clin Evid 2011. Aufgerufen am 29.04.2020.
  • Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention (2017 update). 2017.
  • Turner SW, Friend AJ, Okpapi A. Asthma and other recurrent wheezing disorders in children (chronic). BMJ Clin Evid 2012. Aufgerufen am 29.04.2020.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen – IQWiG). As at:

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