Asthma in adults

Asthma is a common lung disease, characterised by chronic inflammation of the smaller airways. This causes them to become easily irritated. This can cause symptoms such as shortness of breath, chest tightness and coughing. The triggers can be nonspecific, such as exercise, cigarette smoke and cold air, as well as specific allergens like pollen or dust mites. This is called bronchial hyperreactivity. There may also be increased mucus production, and the airways can become less patent.

• Symptoms of uncontrolled asthma include shortness of breath, a tight feeling in the chest, coughing, and/or wheezing. The severity of symptoms and airway narrowing (obstruction) varies over time.
• An asthma attack (also known as an asthma exacerbation) is an acute worsening of symptoms and airway narrowing compared to the usual symptom pattern.
• Asthma is diagnosed according to information provided by the patient. The decision is then made to perform a pulmonary function test (a breathing test). Asthma is diagnosed when reversible airway obstruction is demonstrated on such a test. However, a normal lung function test does not rule out asthma.
• The goal of asthma treatment is to achieve good control of symptoms and minimise the risk of asthma attacks. With asthma, there may be periods when you have few symptoms, alternating with periods when you have a lot of symptoms. The foundation of treatment is a healthy lifestyle: not smoking, avoiding irritants and allergens, getting enough exercise, and keeping your weight in check.
• The most commonly prescribed medications for asthma are inhalers (puffers) that contain bronchodilators and/or inhaled corticosteroids to treat airway inflammation locally.

There are different types of asthma. Asthma can be classified in several ways.

• By severity: from mild to severe asthma
• By type of inflammation: eosinophilic (a certain type of white blood cell) versus non-eosinophilic asthma
• Types of triggers: allergic asthma versus non-allergic asthma.

Fortunately, severe asthma is the least common. Severe asthma is difficult to control with conventional inhalers. Because of this, the patient continues to have many symptoms and/or has to visit the hospital regularly for treatment. The physician may decide to initiate treatment with biologic therapies.

Biologics consist of animal or human protein. They target the immune cells and inflammatory proteins that contribute to the development of asthma. In severe asthma, these inflammatory responses in the body are often more intense than in people without severe asthma. The goal of medication is to inhibit those immune cells and inflammatory proteins. Because biologics suppress part of your immune response, they also inhibit a step in the inflammatory process in severe asthma.

Whether treatment with biologicals is possible depends on the type of asthma you have and its severity. Biologicals are administered by syringes or a pen. There are also several types of biologicals; each one is administered for a different type of asthma.

Latest publication date: 02/08/2024
Supervising author: Dr Lamont Jan