Bronchial asthma is a painful condition, the main symptom of which is a special form of severe shortness of breath. A characteristic feature of shortness of breath in bronchial asthma is in part that it appears or, at least, is aggravated by attacks. These features of shortness of breath are explained by the fact that real bronchial asthma always owes its origin to a very widespread, rather quickly, in most cases, the onset of narrowing of the small and smallest bronchi.
Symptoms and course of the disease
In its purest form, “nervous” bronchial asthma really consists of separate attacks of shortness of breath that appear with different frequencies and different durations in completely healthy people, partly after some special occasions, and partly for no specific reason. During the free intervals, patients feel quite satisfactory, and in particular do not present any signs of a disease of the respiratory organs. But in most cases of “bronchial asthma” attacks, as already mentioned, represent only a more or less sudden deterioration.
An asthmatic attack starts either quite suddenly, or it is preceded by a longer period of time for some precursors, namely: general malaise, abnormal sensations in the larynx or epigastric region, sometimes unusually frequent yawning, often also a runny nose, combined with profuse separation and frequent sneezing. In most cases, the attack itself begins at night. Patients awaken with a feeling of great fear and tightness in the chest. Sometimes they complain of a chest pain sensation. They are forced to assume a sitting position, and in severe cases even get out of bed. Sometimes they run up to the open window, “in order to get their own air.” The face has a frightened expression. The skin becomes pale cyanotic. Sometimes cold sweat comes out. An objective study immediately strikes the characteristic change in breathing. Not only inhaling, breathing in and out is almost always accompanied by audible, even at a distance, high, whistling noise. Both phases of breathing occur with great effort, with the assistance of accessory muscles. During inhalation, only the upper parts of the chest wall rise mainly. Inspiratory tension of the sternoclavicular-nipple, scalene and other muscles is seen on the neck. But even more striking is the very difficult, prolonged exhalation, in which the abdominal muscles become very tense and become hard as a board. Therefore, respiratory distress in asthma is predominantly expiratory dyspnea. Respiratory rate in some cases is normal or even slightly reduced.
Cough and sputum can be almost absent with short attacks. But in most cases of real asthmatic bronchiolitis, and especially in more protracted cases, a very small amount of viscous-mucous sputum is coughing up. This latter, in addition to the usual constituents found in it in simple bronchitis, contains in a greater or lesser number very characteristic yellow plugs. They are usually very viscous, often formed by crimped threads, and consist of swollen and fatty-degenerated purulent bodies.
With regard to other features of sputum in bronchial asthma, then, first of all, it should be mentioned that it almost always contains an extremely large number of eosinophilic cells.
The duration of asthmatic attacks varies greatly in individual cases. Sometimes seizures last only a few hours, and in other cases several days or even weeks. Usually, noticeable improvements and worsening of the disease alternate. The frequency of attacks in ordinary asthma is also extremely variable. Sometimes they appear almost every night, and sometimes there comes a free time from attacks, lasting months and years, so that general indications cannot be given regarding the course of the disease.
The prognosis depends on the age at which the development of the disease and its type began. In many cases, asthma is a lifelong illness, alternating with exacerbations and remissions.