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Living with asthma - it's all about control

Photo: djd (german journalists services)

Expert Interview

The WUNDERWEIB expert for pulmonology and allergology: Prof. Dr. med. med. Winfried Randerath

Prof. Dr. med. Winfried Randerath is chief physician and medical director of the hospital Bethanien, Clinic for Pulmonology and Allergology in Solingen. He is also Director of the Scientific Institute of Pulmonology at the University of Witten / Herdecke.

In the large WUNDERWEIB interview, the expert explains what is important in a life with asthma and explains the importance of good and regular control of asthma and asthma symptoms.

More and more people complain of hay fever. The so-called allergic rhinitis is the most common allergy. Why is this and who is affected?

Prof. Randerath : Everyone can be affected by allergies. However, the risk is higher if there are already allergies in the family. Also, our Western lifestyle, where children often grow up in a sterile environment and have little contact with animals, and the intensive hygienic measures common in our latitudes favor the development of allergies. New plants introduced worldwide, such as ambrosia, play a role as well as climate change, which starts the pollen season earlier and lasts longer.

Research shows that there is a hitherto underestimated connection between hay fever and asthma. What is this interaction based on?

Prof. Randerath : It is now believed that asthma and hay fever are different manifestations of the same respiratory disease, which were considered separately for a long time. For the nose was the ENT doctor, responsible for the bronchi of the pulmonary specialist. But today one knows: Although with the hay fever the upper respiratory tracts and the asthma are affected the lower respiratory tracts, both diseases underlie the same inflammatory processes. Hay fever can develop asthma. Therefore, one should also be examined in a seemingly harmless hay fever by an allergist.

How do patients know if they have hay fever or asthma symptoms?

Prof. Randerath : The classic allergic rhinoconjunctivitis (hay fever) is associated in certain months with symptoms such as itchy eyes, runny nose and sneezing. Asthma, on the other hand, is a chronic disease that usually presents with symptoms year-round, but in many patients it may increase in allergy months. The concomitant symptoms are shortness of breath and coughing. Frequently, breathing difficulties occur at night when the airways are narrower than during the day.

How to prevent asthma from developing from hay fever?

Prof. Randerath : Whether that can really be avoided is not clear. However, it is important to treat the hay fever early and properly.

What can happen if asthma is not treated effectively?

Prof. Randerath : If asthma is not treated effectively in the long term, there may be permanent restrictions on lung function. Part of the lung tissue loses its ability to function and so-called chronic obstructive bronchitis develops, which permanently narrows the airways and restricts their ability to perform.

How is asthma treated? Do you treat the whole year or only in an acute attack?

Prof. Randerath : One basic rule is that asthma treatment should never be limited to the treatment of acute respiratory distress alone. Today, there is a wide range of medications that can often control the condition so well that the sufferer has few limitations in everyday life. The treatment should always consist of two components: a so-called "Reliever" - an emergency medication that can quickly eliminate an acute respiratory distress - and a "controller" that suppresses long-term inflammation in the airways. The Reliever is an active ingredient that expands the bronchi and dissolves the spasm. Anti-inflammatory drugs, such as. As cortisone-containing substances and so-called leukotriene antagonists fight in the long term, the inflammation in the airways and thus help to get the symptoms permanently under control.

There is a vaccine against hay fever - can it also prevent asthma?

Prof. Randerath : So far, the expert opinions on how the vaccine tablet is to evaluate at all, far apart. The hyposensitization by a syringe treatment under the skin, a so-called subcutaneous application, has, however, proven very well. If a good diagnosis precedes it, it is very effective and may also reduce the risk of developing asthma.

What is a leukotriene antagonist and how does it work?

Prof. Randerath : The leukotriene antagonist montelukast blocks certain messengers of asthmatic inflammation, the so-called leukotrienes, and ensures that they can do no more harm. So the inflammation is contained. The drug is used in asthma once a day as a pill in addition to cortisone long-term therapy and can improve the treatment of asthma and reduce the dose of cortisone. Patients suffering from exercise-induced asthma may be treated alone with a leukotriene antagonist.

Many drugs for hay fever make tired - with what side effects must be expected in the treatment of asthma?

Prof. Randerath : Fatigue is not one of the common side effects of asthma medications. For anti-inflammatory cortisone sprays you have to pay attention to the correct application. Hoarseness, fungal attack in the mouth and irritation in the neck are possible, but usually preventable side effects. No significant side effects were noted with leukotriene antagonists. Brochure-expanding emergency sprays can cause palpitations, inner agitation, cardiac arrhythmias and high blood pressure, especially if they are overdosed.

Not infrequently, children are already affected by asthma. Can childhood asthma disappear again?

Prof. Randerath : Asthma should also be taken seriously in childhood and treated accordingly. Of course, there are different degrees of progression. In infancy there is some chance that the asthma will disappear again. Many children, however, keep the complaints. Sometimes a decline in puberty can be observed, but the disease can return at a later date. In these cases, one must start with symptom-free intervals, which patients repeatedly describe. However, the readiness of the bronchi to be hypersensitive and to develop inflammation remains for life.

Often, asthma gets worse through sports. Should you do without it? Or are there sports that are well suited for asthmatics?

Prof. Randerath : When asthma symptoms are triggered by sports, this is almost always a clear indication of inadequate treatment. Therefore, an anti-inflammatory long-term therapy here is the appropriate therapy. Under no circumstances should therefore be waived physical activity. A bronchodulant spray, which should be used 10-15 minutes before exercise, can prevent asthma attacks. For children who give in to their natural desire to move, however, this is usually not a workable solution - they need comprehensive protection. Permanently over 24 hours protects z. B. the leukotriene antagonist montelukast. In the choice of sport are winter sports in which the airways are exposed to cold air, as well as swimming in strongly chlorinated water, which may favor the inflammation of the mucous membranes, less recommended.

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