Advancing Asthma Treatment


Living with asthma can be challenging, with the constant worry of triggers, breathing difficulties, and the need for effective treatments. At Convex clinical research site with phase I unit, we understand the impact that asthma has on patients’ lives. That’s why our dedicated clinical research team is strongly focused on conducting clinical trials specifically targeting asthma patients.

We would like to share how our commitment to advancing asthma treatment through clinical trials is paving the way for improved patient care and better outcomes.

Clinical trials are an integral part of medical research, allowing scientists and healthcare professionals to evaluate new treatments, therapies, and diagnostic methods. When it comes to asthma, these trials provide a unique opportunity to explore innovative approaches that can alleviate symptoms, enhance quality of life, and potentially find a cure.

By participating in clinical trials, asthma patients not only gain access to cutting-edge treatments but also contribute to the advancement of medical knowledge and the development of better therapies for future generations.


At Convex research center, we have a dedicated focus on conducting clinical trials specifically for asthma patients. We recognize that asthma is a complex condition with various subtypes and individualized treatment needs. Our research team is committed to addressing these challenges head-on by exploring novel interventions tailored to different patient populations, such as moderate asthma, severe asthma, or asthma with specific comorbidities.

To ensure the highest quality of research and the most up-to-date approaches, we collaborate with leading experts in the field of asthma. Our network includes allergists, pulmonologists, immunologists, and other specialists who bring their expertise and experience to our clinical trials. This collaborative effort ensures that our trials are designed to address relevant research questions, follow rigorous protocols, and generate reliable data that can contribute to evidence-based asthma care.

We firmly believe in placing patients at the center of our clinical trials. Every aspect of our research process, from trial design to participant recruitment and follow-up care, is focused on ensuring the well-being and safety of our patients. We maintain open lines of communication, provide thorough explanations of the trial procedures, and obtain informed consent from participants. Our compassionate and dedicated team supports patients throughout their journey, addressing any concerns and closely monitoring their progress.


Through our clinical trials, we aim to advance asthma treatment by evaluating new interventions, including medications, therapies, and personalized approaches. By rigorously testing these interventions in controlled settings, we can gather data on their safety, effectiveness, and potential side effects. Our ultimate goal is to discover breakthroughs that can transform the lives of asthma patients, offering them improved symptom control, reduced exacerbations, and a higher quality of life.

If you or someone you know is living with asthma and would like to be part of the search for better treatments, consider participating in our clinical trials. Your participation will not only provide you with access to state-of-the-art interventions but also contribute to the advancement of asthma care for millions of people worldwide. To learn more about our ongoing trials and eligibility criteria, please visit our website or contact our research team at 

At Convex, we are committed to advancing medical research and improving the lives of patients with asthma. Our dedicated team of experts has been conducting cutting-edge clinical trials, and we are thrilled to share some of the incredible milestones we’ve achieved!

  • Advancing Asthma Treatment: As a leading clinical research center, we have been at the forefront of groundbreaking studies to develop the latest treatments for asthma. Our commitment to innovation and patient care drives us to explore new avenues in the fight against this chronic respiratory condition.
  • Access to Specialized Patient Care: We are proud to have access to a pool of patients with asthma who voluntarily participate in our clinical trials. Our patients play a crucial role in advancing medical science and paving the way for future generations. We sincerely thank them for their valuable contributions to research.
  • Empowering Patient Lives: At Convex, our mission goes beyond research. We are dedicated to empowering our patients and ensuring their well-being. Under special conditions, we provide personalized and comprehensive care to help them manage their asthma effectively.
  • Groundbreaking Clinical Studies: Our center has been a hub of diverse clinical studies aimed at understanding asthma better. From exploring new treatment modalities to studying the impact of lifestyle interventions, our research is making a significant difference in the lives of asthma patients.
  • Partnering for a Better Future: We extend our gratitude to all the healthcare professionals, researchers, and patients who collaborate with us on this incredible journey. Together, we are breaking barriers and creating a brighter future for individuals living with asthma.


Asthma is a chronic inflammatory disease of the respiratory airways. According to recent statistics, asthma affects millions of people worldwide and is one of the leading socially significant conditions. The disease presents with recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing, especially at night or early in the morning.

A key element in the development of the condition is bronchial obstruction (narrowing of the bronchial tubes), which is caused by specific immunological factors (sensitization and allergy) or non-specific mechanisms.

Bronchial obstruction is a partially or completely reversible process that can spontaneously resolve or be influenced by certain medications. The obstruction of the bronchial tubes may be accompanied by hyperreactivity or increased sensitivity of the airways to various external irritants. With early diagnosis and optimal patient care, the prognosis is usually favorable, leading to good control of symptoms and reduced frequency and severity of exacerbations.

frequency and prevalence of asthma


Asthma is a chronic, widespread condition with a multifactorial ethology, and its frequency and prevalence are influenced by numerous factors. It is challenging to assess the exact prevalence and frequency of asthma due to the lack of consistent diagnostic criteria used to determine the number of affected individuals in the general population. However, estimates suggest that values range between 1 to 18 percent of the population in different countries. It is believed that around 5 percent of adults and between 7 to 10 percent of children suffer from bronchial asthma, with higher rates in developed countries.

Some of the characteristic features regarding the distribution and frequency of the disease include:

  • Age distribution: Asthma can affect people of all ages, but it most commonly begins during childhood. About half of asthma cases start before the age of 10, and one-third of cases develop before the age of 40.
  • Gender distribution: Among children, more boys have asthma compared to girls. In childhood, there is a male-to-female ratio of about 2:1, which persists until around the age of 30. Among adults, more women suffer from the disease than men. It is not clear if and how gender and sex hormones play a role in causing asthma, its progression, and how they influence the risks of developing the condition. In severe forms of asthma, there is no significant difference in the percentage of affected individuals between both sexes.
  • Geographic distribution: Asthma is believed to be more prevalent in developed countries compared to developing ones, and its prevalence is lower in many European, Asian, and African countries. Despite the lower frequency, developing countries report higher rates of disability and mortality due to asthma. The reasons for this are complex, but a major contributing factor is limited access to quality medical services.
  • Distribution based on risk factors: young children, who often experience wheezing and respiratory infections, as well as some other risk factors, are at the highest risk of developing asthma. Although most, but not all, people with asthma have allergies, some individuals develop asthma due to exposure to certain chemical irritants or industrial dust at their workplace (occupational asthma).


Breathing is one of the essential life-sustaining processes for living organisms, involving the intake of oxygen from the air, its transportation, delivery to the tissues, and the removal of generated carbon dioxide outside the body. All of these processes are facilitated by the intricate regulation between the different elements or components of the respiratory system.

The respiratory system consists of the airways, the lungs, the central nervous system that signals between the various elements, the chest wall (including the diaphragm and intercostal muscles), and pulmonary circulation.

The central nervous system is the controlling system that regulates the activity of the muscles of the chest wall, which act as the pump of the respiratory system.

As a result of the coordinated actions of the different components of the respiratory system, gas exchange occurs in the lungs. Impairments in respiratory function due to bronchial asthma can involve disruptions in ventilatory function, alterations in pulmonary circulation, and/or gas exchange abnormalities. Depending on the specific changes, various types of alterations occur, and in many cases, these alterations are complex in nature.

respiratory function impairments


The main function of the respiratory system is to exchange oxygen and carbon dioxide between the external environment and the body’s cells during breathing. The first stage of breathing is known as pulmonary ventilation. Pulmonary ventilation involves the exchange of air between the external environment (atmosphere) and the alveoli of the lungs through the processes of inhalation and exhalation.

Inhalation is an active process accomplished by the contraction of inspiratory muscles (diaphragm, external intercostal muscles) in response to impulses from the respiratory center located in the brainstem. Exhalation at rest is a passive process and is facilitated by the elastic forces of the respiratory system, while forced exhalation is achieved through the contraction of expiratory muscles (abdominal and internal intercostal muscles).

Ventilation, in general, is the process by which the lungs allow air access to the alveoli, and disruptions at various levels can provoke different responses in the body. There are two main types of ventilatory function impairments:

  1. Obstructive Ventilatory Syndrome: This is characterized by reduced expiratory airflow volumes. It involves difficulty in exhaling air due to narrowed airways, leading to increased resistance to airflow during exhalation.
  2. Restrictive Ventilatory Syndrome: This is caused by impairments in both inspiratory and expiratory lung function, resulting in reduced lung volumes. It is characterized by difficulty in inhaling air due to weakened respiratory muscles or restriction of lung expansion.

Both types of ventilatory function impairments can be associated with various respiratory conditions, including bronchial asthma, chronic obstructive pulmonary disease (COPD), interstitial lung diseases, and neuromuscular disorders, among others. Proper diagnosis and management are crucial to address these conditions and maintain adequate respiratory function.

 impairments in ventilatory function

In routine diagnostic practice, the measurement of ventilatory function involves determining the amount of air contained in the lungs under specific circumstances and the speed at which air can be exhaled from them. Ventilatory function impairments can be investigated using a spirometer, a device that measures the volume of inhaled and exhaled gas. This method allows for the measurement of vital capacity (VC), expiratory reserve volume (ERV), and inspiratory capacity (IC).

Another method used for the functional assessment of ventilatory function is body plethysmography. With this method, other lung volumes, particularly residual volume (RV), functional residual capacity (FRC), and total lung capacity (TLC), can be measured.


Disorders of pulmonary circulation refer to abnormalities in the blood flow within the lungs, primarily affecting the exchange of gases between pulmonary capillaries and alveolar spaces. Pulmonary blood vessels possess specific characteristics, such as being shorter, more stretchable, wider, and having lower overall vascular resistance, which are essential for fulfilling their main physiological functions. Maintaining optimal gas exchange and pulmonary circulation requires an appropriate amount of interstitial fluid in the lungs.

In patients with asthma, disruptions in pulmonary circulation may occur during an asthmatic attack, leading to hypoxemia (low oxygen levels in the blood) and increased pulmonary vascular resistance. Alveolar hypoxia acts as a powerful stimulus for constriction of pulmonary blood vessels. Deviations from normal pulmonary circulation can create conditions for severe damage and complications, underscoring the importance of monitoring and implementing appropriate therapeutic measures when signs of impairment are present.

The evaluation of pulmonary vascular system’s circulatory function relies on measuring pulmonary vascular pressures and cardiac output. In clinical practice, these measurements are typically performed in intensive care units where invasive monitoring is feasible.

disorders of pulmonary circulation


Gas exchange in the human body involves the diffusion of oxygen and carbon dioxide through the walls of the capillaries and alveoli, as well as their diffusion from the capillaries to the tissues and vice versa. The main functions of the respiratory system are to remove carbon dioxide from the blood passing through the pulmonary circulation and to provide an adequate supply of oxygen. Gas diffusion in the respiratory tract occurs through the respiratory membrane, also known as the alveolar-capillary barrier.

During the processes of gas exchange in the lungs, oxygen passes from the alveoli into the plasma through a process of diffusion, driven by its concentration gradient. From the plasma, oxygen enters the red blood cells, where a specific cascade of processes takes place, ultimately resulting in the delivery of oxygen to the tissues and the release of carbon dioxide.

To prevent disorders of gas exchange, it is essential to supply sufficient fresh air to the alveoli to ensure an influx of oxygen and the removal of carbon dioxide. This process is achieved through pulmonary ventilation. Other critical conditions for preventing disorders of gas exchange include adequate circulation of blood through the pulmonary vascular system or perfusion, sufficient gas exchange between the alveoli and the pulmonary capillaries, as well as adequate contact between alveolar gas and blood in the pulmonary capillaries (referred to as the ventilation-perfusion ratio).

disorders of gas exchange


From an etiological perspective, bronchial asthma is a heterogeneous condition (a disease caused by multiple factors) and can be divided into two broad groups:

  • Allergic bronchial asthma: There is a family history of allergic diseases such as rhinitis, urticaria, and eczema, elevated levels of IgE in the serum, positive skin reactions to subcutaneous injection of airborne allergens.
  • Idiosyncratic (non-allergic) bronchial asthma: In this form, there is no family history of allergic diseases, skin tests are negative, and serum IgE levels are normal. Many patients with this form may develop a typical clinical picture following upper respiratory tract infections. The triggering event may be a common cold, but after a few days, they can experience episodes of breathlessness lasting from days to months.

Unfortunately, many patients do not fit clearly into either of the mentioned groups.

Various factors leading to increased airway reactivity are known to contribute to the development of bronchial asthma, but the mechanisms of their impact remain unclear. The most widely accepted hypothesis today is related to inflammation of the airways. After exposure to specific allergens, mast cells, basophils, and macrophages are activated, leading to the production of various mediators that affect the smooth muscle of the airways and capillary permeability. This triggers a powerful local reaction that may be followed by a chronic process, affecting the entire tracheobronchial tree.

Factors that increase airway reactivity can be classified into several main categories:

Heredity: Several diseases show a hereditary nature, where specific genes, mutations, or combinations of factors are inherited, leading to the development and manifestation of the respective disease under favorable conditions, and sometimes even spontaneously. Heredity or genetic predisposition plays a leading role in the development of bronchial asthma.

Through extensive analysis, it has been found that in about one-third of patients with bronchial asthma, the disease has a hereditary character. In cases where one parent is affected, the probability of children developing asthma is estimated to be about 20 to 30 percent. If both parents suffer from asthma, the risk to their offspring increases and reaches approximately 70 percent.

In the presence of genetic predisposition, active preventive measures should be taken from an early age to reduce the risk of developing the disease, delay its onset over time, or limit the severity of the disease process.


Environmental factors that contribute to the development of bronchial asthma are typically related to climatic conditions that promote the accumulation of pollutants and allergens in the air. The quality of life of the population and access to medical services also play a significant role. Such conditions are most commonly observed in industrialized or densely populated areas. They often involve temperature inversions accompanied by stagnant air masses, smog, frequent fogs, acid rain, and rapid changes in temperature conditions. Global climate changes also have their impact and can exacerbate existing asthma or trigger the condition in combination with other factors.

Ozone, nitrogen dioxide, and sulfur dioxide are considered the most common air pollutants. They can also provoke asthma attacks. Air pollution is one of the reasons for the higher prevalence of asthma in developed countries, as industrial processes, infrastructural characteristics, and densely populated large cities create conditions for significant air pollution and exposure to strong allergens from early childhood.

factors for the development of bronchial asthma

Bronchial asthma triggered by various allergens is dependent on the response of IgE, which is controlled by T lymphocytes and B lymphocytes and is activated by the interaction between antigens and IgE molecules bound to mast cells. Most agents that trigger bronchial asthma originate from the air, and in order to provoke a state of hypersensitivity, they need to be present in large quantities in the inhaled air mixture.

Allergic bronchial asthma is a seasonal condition and is most commonly observed in children or young individuals. The non-seasonal form can be triggered by allergies to dust, feathers, animal dander, mold, and other allergens that are constantly present in the environment. Prolonged exposure to these agents on the respiratory system can lead to obstruction of the airways, which develops within minutes. In about 40 percent of patients, a second wave of bronchospasm, the so-called late reaction, occurs six to ten hours later.

Released mediators, mainly histamine, bradykinin, leukotrienes C, D, and E, platelet-activating factor, prostaglandins PGG2, PGF2a, and PGD2, and thromboxane A2, lead to a powerful inflammatory reaction with bronchospasm, vascular stasis, and edema formation. In addition to their ability to cause prolonged contraction of the smooth muscles of the airways and mucosal edema, leukotrienes can induce increased mucus production and disruption of mucociliary clearance mechanisms.

Eosinophil degranulation can disrupt the integrity of the mucosa, causing shedding of cells into the bronchial lumen. The allergic form of the disease is a specific type that requires identification of the specific allergen provoking the immune response, allowing for targeted therapy and the necessary preventive measures when encountering the allergen in the future.


Occupational asthma related to workplace factors is an important health issue that affects individuals working in specific fields and industries, especially when exposed to relevant factors for extended periods of time. Bronchospasm and consequently asthma, including asthma attacks, can be triggered by prolonged contact with some of the following factors:

  • Metal salts: Platinum, chromium, and nickel pose the highest risk.
  • Wood and vegetable dust: Oak, western red cedar, wheat, flour, beans, green coffee beans, acacia gum, and many others.
  • Pharmaceuticals: Production of antibiotics, piperazine, cimetidine, and others.
  • Industrial chemicals and plastics: Toluene diisocyanate, phthalic anhydride antihydride, trimellitic anhydride, persulfates, ethylenediamine, paraphenylenediamine, and various dyes.
  • Biological enzymes: Production of certain laundry detergents, pancreatic enzymes, and others.
  • Others: Close contact and work with animal and insect dust, as well as in some laboratories dealing with sera and secretions.

If the occupational environment factors do not elicit a rapid or delayed allergic reaction (or a combination of both), then these patients feel fine upon arriving at the workplace, and symptoms begin to develop towards the end of the workday. Absence from work leads to temporary remission and significant improvement in symptoms. In cases of proven occupational asthma, it is necessary to discontinue the activity and take all necessary measures to control the disease process and potential complications it may present.

medications for asthma

All medications carry a certain (sometimes high, sometimes insignificant) risk of causing side effects, and in some cases, they can even provoke the development of asthma.

Medications most commonly associated with triggering asthma attacks include aspirin (known as aspirin-exacerbated respiratory disease), dyes such as tartrazine, certain beta-adrenergic blockers, and various sulfite-containing agents (potassium and sodium bisulfite, potassium metabisulfite, sodium sulfite, widely used in the food, flavoring, and pharmaceutical industries).

The typical respiratory syndrome of aspirin sensitivity most commonly affects adult patients, although it can rarely be found in childhood as well (the use of acetylsalicylic acid is contraindicated in young children and adolescents due to the risk of developing Reye’s syndrome, which involves severe liver and neurological damage).

The condition begins with persistent rhinitis and the formation of nasal polyps. Gradually, it evolves into a progressing bronchial asthma. Even exposure to very small amounts of aspirin can lead to severe asthma attacks in affected individuals. Cross-reactivity between aspirin and other non-steroidal anti-inflammatory drugs is frequently observed and should be considered in these patients.


Respiratory infections are the most common trigger for exacerbating bronchial asthma, and recurrent respiratory infections are often one of the main provokers for the onset of the disease, especially in early childhood, particularly when there is a predisposition. In young children, the most important infectious agents are the respiratory syncytial virus and the influenza virus, while in older children and adults, the predominant pathogens are rhinovirus and the influenza virus.

The exact mechanism by which viruses trigger bronchial asthma is not fully understood. It is presumed that the inflammatory changes caused by respiratory infections disrupt the protective mechanisms of the body and render the tracheobronchial tree more susceptible to infections and the impact of various allergens and pathogens. Supporting this hypothesis are observations that even in healthy individuals, respiratory viral infections transiently increase the reactivity of the respiratory airways, which may last from two to eight weeks.

For at-risk groups of patients (children with a genetic predisposition, adults exposed to various harmful influences), timely prophylaxis against seasonal respiratory infections is recommended. This prophylaxis can be general (boosting immune defenses, maintaining high personal hygiene) and specific (receiving influenza vaccination).

physical exertion or physical activity

Bronchial asthma can be triggered, especially in the presence of other underlying risk factors, and can worsen with significant physical exertion. For some patients, this may be the sole triggering mechanism leading to the appearance of symptoms.

The mechanism through which physical exertion provokes asthma exacerbations is related to the temperature changes that occur in the airways when heat and water transfer from the mucosa to the inhaled air, adapting it to the body’s conditions before reaching the alveoli. The more intense the breathing and the colder the inhaled air, the lower the temperature of the airways becomes.

Therefore, with the same air quality, running may cause a more severe asthma attack compared to walking. Conversely, with the same level of exertion, inhaling cold air can exacerbate the disease. Warm and humid air can reduce the severity or even prevent an asthma attack.

During physical exertion in the cold months of the year, regardless of whether it is done recreationally or professionally, taking appropriate measures to reduce the harmful effects of cold air is recommended.


The exact causes and numerous factors that contribute to the development and progression of the disease are not fully understood, but there is a presumed influence of several triggering factors. Besides the ones mentioned above, many specialists also recognize the role of the following factors in the development of asthma:

Tobacco smoking: Both active smoking and exposure to secondhand smoke put patients at a higher risk not only for developing asthma but also for various other respiratory conditions, including chronic obstructive pulmonary disease (COPD), lung cancer, and others.

Stress: Chronic stress, especially in combination with certain mental disorders, including frequent depressive episodes, may play a role in the development of asthma. In patients with diagnosed asthma, stress has been shown to exacerbate its course and even trigger asthmatic attacks.

Hormonal factors: The role of hormonal factors is not fully clarified, but in women with asthma, worsening symptoms are observed before the menstrual cycle and during pregnancy, while some improvement in symptomatology is noted after menopause.

Overweight and obesity: Patients with excess weight and obesity are at an increased risk of developing various diseases, including asthma. However, the exact mechanisms for this are not fully understood, and it is believed that weakened immune activity may be involved.

Underlying allergic conditions: Having an underlying allergic condition, such as atopic dermatitis, exposes patients to a higher risk of developing asthma, especially when other risk factors are also present.


Asthma causes constriction of the airways, disrupting the normal movement of air in and out of the lungs. It primarily affects the bronchi and does not involve the alveoli or lung tissue. The constriction that occurs in asthma is caused by three main factors: inflammation, bronchospasm, and hyperresponsiveness.

Asthma is a respiratory condition that can be classified physiologically as variable and partially reversible airflow obstruction, and pathologically with an overdevelopment of mucous glands, thickening of the airways due to damage and inflammation, bronchoconstriction, and narrowing of the airways in the lungs due to the tightening of the surrounding smooth muscles.

Bronchial inflammation also contributes to the narrowing of the airways in the lungs due to swelling and edema caused by an immune response to allergens. During an asthma attack, the inflamed airways react to environmental triggers such as smoke, dust, or pollen. The airways constrict and produce more mucus, making breathing difficult. Essentially, asthma is the result of an immune response in the bronchial airways.

The airways of patients with asthma are hypersensitive to certain triggers, also known as stimuli, a phenomenon typically classified as Type I hypersensitivity. In response to exposure to these stimuli, the bronchi contract in spasms (an asthma attack occurs). Inflammation occurs, leading to further narrowing of the airways and excessive mucus production, resulting in coughing and other breathing difficulties.

Bronchoconstriction may subside spontaneously within one to two hours, and in about half of the patients, it may be part of a late-phase reaction, where an initial asthmatic episode is followed later by further bronchoconstriction and inflammation.


The first and most important factor that causes narrowing of the bronchi in asthma is inflammation. The bronchi become red, inflamed, and swollen (edematous). This inflammation increases the thickness of the bronchial walls, creating a narrower pathway for the passage of air.

Inflammation occurs in response to an allergen or irritant and is a result of the action of chemical mediators (histamine, leukotrienes, and others). The inflamed tissues produce an excessive amount of sticky mucus in the bronchi. The mucus can provoke the formation of plugs or blockages that can obstruct the smaller airways.

Specialized allergic and inflammatory cells (eosinophils and white blood cells) accumulate at the site and cause tissue damage. These damaged cells deposit in the airways, contributing to their narrowing.


During an asthma attack, the muscles around the bronchi contract, causing a muscular constriction of the airways known as bronchospasm, leading to additional narrowing of the air passages. The main triggering factors causing muscle constriction are chemical mediators and nerves in the bronchi.

When afferent nerve endings (e.g., from the bronchial mucosa) are stimulated by triggers in the environment, such as dust, cold air, or smoke, impulses are transmitted to the vagus center in the brainstem, then through vagal efferent pathways, and again reach the small bronchial airways.

Acetylcholine is released from the efferent nerve endings, leading to excessive formation of inositol 1,4,5-triphosphate in the bronchial smooth muscle cells. This cascade of reactions results in muscle contraction and initiates bronchospasm. Bronchospasm can occur in all individuals and may be caused by inhaling cold or dry air, but in asthma patients, much weaker stimuli are usually needed to trigger the response.

Hyperreactivity (Hypersensitivity)

In patients with asthma, chronically inflamed and constricted airways become highly sensitive or reactive to triggers, such as allergens, irritants, and infections. Exposure to these stimuli can lead to increasing inflammation and constriction, posing a risk for various complications. The combination of these three factors leads to difficulties during exhalation.

As a result, air must be forcefully exhaled to overcome the constriction, producing the typical wheezing sound. People with asthma also frequently cough in an attempt to clear the thick mucus. Reduced airflow can lead to decreased oxygen passing into the blood, and in severe cases, dangerous accumulation of carbon dioxide in the blood can occur.

Triggers that can cause an asthmatic attack include:

Environmental allergens: Natural allergens in the air include household pest waste and pollen from grass, mold spores, and epithelial cells from pets. Indoor pollutants: Indoor air pollutants from volatile organic compounds, including perfumes and fragrance products, such as soap, dishwashing detergent, laundry detergent, fabric softener, paper tissues, paper hand towels, toilet paper, shampoo, hairspray, hair gel, cosmetics, facial cream, sunscreen, deodorant, perfume, aftershave lotion, air fresheners, candles.

Medications: Several medications, including aspirin, beta-adrenergic antagonists (beta-blockers), penicillin, and others. Food allergens: Food allergens such as milk, peanuts, eggs. Ingesting or inhaling sulfites added to food and wine as preservatives can also trigger a reaction. Industrial pollutants: The use of fossil fuels associated with air pollution, such as ozone, nitrogen dioxide, and sulfur dioxide, is considered a major factor in the high prevalence of asthma in urban areas. Various industrial compounds (e.g., toluene diisocyanate) and other chemicals, specifically sulfites, generated by chlorinated pool chloramines (monochloramine, dichloramine, and trichloramine), can also trigger hyperreactivity reactions.

Frequent respiratory infections: Infections in early childhood, especially viral upper respiratory infections. Children with frequent respiratory infections before the age of 6 are at higher risk of developing asthma, especially if they have a parent with the condition. However, people of any age can develop asthma triggered by colds and other respiratory infections.

Hormonal changes: Hormonal changes in adolescent girls and older women related to the menstrual cycle can lead to worsened asthma. Some women experience worsened asthma during pregnancy, while others may not experience significant changes, and in some women, asthma improves during pregnancy.

Stress: Severe psychological stress can modulate the immune system, leading to an increased inflammatory response to allergens and pollutants.

Distinct Pathophysiological Features of Bronchial Asthma

Some general changes in the characteristics of the respiratory system and its individual components distinguish bronchial asthma from various other respiratory disorders with different etiologies. The distinct pathophysiological features of bronchial asthma include:

  1. Anatomical changes: Decreased diameter of the airways due to the contraction of smooth muscles.
  2. Edema: Characteristic swelling of the bronchial walls.
  3. Presence of secretions: Usually, thick and sticky secretions are present.
  4. Changes in respiratory capacity: Increased resistance in the airways, decreased forced expiratory volumes and flows, hyperinflation of the lungs, and chest.
  5. Functional changes: Alterations in the function of the respiratory muscles, pathological redistribution of pulmonary ventilation and blood flow, changes in arterial blood gases.

Although bronchial asthma is considered a primary condition, during an acute attack, virtually all aspects of respiratory function are affected. Some patients may present with electrocardiographic evidence of right ventricular hypertrophy, and signs of pulmonary hypertension may be observed. Data shows that when a patient consults a physician and begins treatment, their vital capacity (the volume of air exhaled during a maximum deep breath) is below or equal to 50 percent of the normal value. The forced expiratory volume in one second (FEV1), which is the volume of air exhaled in one second, is around 30 percent of the predicted values.

Hypoxia (oxygen deficiency) is a common finding during an acute attack. Manifest ventilatory failure is a relatively rare phenomenon and is observed in 10 to 15 percent of patients seeking medical help. Most asthmatic patients exhibit hypocapnia and respiratory alkalosis (low levels of carbon dioxide in the blood due to hyperventilation of the lungs). The restoration of normal carbon dioxide levels in arterial blood is often associated with a very severe degree of obstruction and should be considered as a manifestation of advancing respiratory insufficiency.


Asthma is characterized by inflammation of the bronchial tubes and increased production of mucus (sticky secretion) in the airways. People with asthma do not experience symptoms all the time but only when the airways narrow, become inflamed, or fill with mucus, usually due to exposure to various allergens and/or pathogens. Asthma symptoms can range from mild to severe, varying among individuals.

An exacerbation of the disease, whether after a long period of remission (no complaints) or in the context of mild to moderate complaints, is referred to as an asthma attack and requires urgent medical intervention. Asthma is classified based on the frequency and severity of symptoms and the presence or absence of asthma attacks, as well as the results of pulmonary function tests, as follows:

  • Intermittent, mild form of the disease: Approximately one-third of affected patients experience mild, occasional (two or fewer episodes per week) asthma symptoms with normal pulmonary function test results.
  • Mild to moderate form of the disease: Approximately one-third of affected patients have mild, persistent (two or more episodes per week) asthma symptoms with normal or some deviations in pulmonary function test results.
  • Moderate to severe form of the disease: Affected patients experience moderate or severe, persistent (daily or continuous) asthma symptoms with significant deviations in the corresponding pulmonary function test results.
  • Severe, persistent asthma: Patients suffer from severe manifestations of the disease daily with complaints present during nighttime, showing significantly worsened pulmonary indicators.

In summary, asthma symptoms can range from occasional mild symptoms with normal test results to persistent severe symptoms with significant pulmonary abnormalities. Asthma classification is crucial in determining the appropriate treatment and management plan for individuals with the condition.

symptoms of asthma


The symptoms of asthma may be subtle and resemble those observed in other conditions involving respiratory impairment. All the classic symptoms of asthma listed below can also be present in the course of other respiratory diseases, and in some cases, even in certain heart conditions. This potential for confusion makes the identification of conditions in which these symptoms appear, as well as diagnostic investigations, crucial in recognizing this condition.

Early recognition of the disease, differentiation from other possible causes of symptoms, and the prescription of appropriate, highly individualized treatment are essential for controlling the disease process, reducing the risk of complications, and decreasing the frequency of asthma attacks.

The main classic symptoms of asthma include:

  • Shortness of breath: A feeling of breathlessness, especially during physical exertion or at night.
  • Wheezing: Presence of wheezing (dry whistling sounds) during expiration (normally or during exertion), often seen in children with asthma.
  • Cough: Chronic cough, usually worsening at night and early morning, may manifest after physical activities, including climbing stairs or exposure to cold, dry air.
  • Chest discomfort: Tightness in the chest, which may or may not accompany the above symptoms. This symptom can often worry patients and initially point to a cardiac problem rather than a respiratory issue.
  • Others: Many patients experience sleep disturbances due to frequent waking from shortness of breath, coughing, or chest discomfort. In some patients, nausea, speech difficulties, anxiety, and panic attacks may occur due to breathlessness and chest discomfort. In small children and adolescents with severe forms of the disease and inadequate therapy, deviations in normal growth and physical development are possible.

Early Symptoms of Asthma

Prodromal or early alarming signs of disease exacerbation occur shortly (hours or minutes) after the onset of an asthma attack and signal worsening of the disease process. These signs are often overlooked as they are mild, do not cause significant discomfort, and may go unrecognized as indicators of deteriorating condition. Knowing and timely responding to these early symptoms can alleviate the manifestations and prevent a full-blown asthma exacerbation. The early warning signs of asthma exacerbation typically include some of the following (or a combination of them):

  • Worsening of classic symptoms: Frequent cough, especially at night, noticeable shortness of breath, presence of wheezing after mild physical exertion or during routine, everyday activities.
  • Fatigue and weakness: Feeling excessively tired or weak during activities that are usually easy and have not caused difficulty for the patient.
  • Mood Changes: Easily experiencing anxiety, irritability, or a low mood, having unstable emotional states, with these changes being more characteristic in childhood.
  • Changes in Respiratory Indicators: Decrease or alteration in respiratory function measured by peak expiratory flow rate.
  • Signs of Rhinitis or Allergies: After exposure to triggering factors, characteristic symptoms of rhinitis or allergies may occur, such as sneezing, nasal congestion, cough, inflamed throat, headache.
  • General Manifestations: Sleep problems, frequent panic attacks, pronounced nausea with or without vomiting, general discomfort, and other symptoms.

Symptoms of Asthmatic Attack

An acute, sudden asthmatic attack or exacerbation of asthma is usually triggered by exposure to allergens or upper respiratory tract infections. The severity of the attack depends on how well asthma is controlled, as well as the characteristics of the triggering factor. An acute attack can be potentially life-threatening, as it may persist despite using the usual quick-relief medications (rapid-acting inhaled bronchodilators). Asthmatic attacks cannot self-limit and do not stop on their own without treatment. Therefore, if the patient ignores early warning signs and does not take appropriate measures, they are at risk of developing status asthmaticus.

An asthmatic attack is an episode of disease exacerbation where the muscle groups surrounding the airways begin to contract. During the attack, the airway lining becomes swollen (edematous) and/or inflamed, and the cells covering the airways produce more and much denser mucus than usual. All these factors, namely bronchospasm, inflammation, and increased mucus production, lead to characteristic manifestations, including difficulty breathing, wheezing, coughing, shortness of breath, and impaired performance of normal daily activities.

In an asthmatic attack, these manifestations are significantly more pronounced, and various other signs add up, severely affecting the comfort of the affected individuals and exposing them to serious complications.

The classical symptoms of an asthmatic attack include:

  • Marked classical manifestations of asthma: Significantly intensified difficulty breathing, heavy wheezing during inhalation and exhalation, persistent cough, rapid breathing, pronounced and constant chest pain and/or tightness.
  • Retractions: Contracted (drawn-in) muscles in the neck and chest area, known as retractions.
  • Impaired speech and mental state: Difficult speech (due to severe shortness of breath), feelings of anxiety or panic, agitation, confusion, inability to concentrate.
  • Skin and mucosal changes: Due to difficult breathing, characteristic manifestations of hypoxia and cyanosis occur, such as pale and sweaty skin, changes in lip color (turning bluish or grayish), changes in nail color (showing a bluish hue).

The presence of wheezing or cough alone is not a reliable criterion for assessing the severity of an asthmatic attack. Very severe attacks can cause airway obstruction to such an extent that the lack of air movement to and from the lungs fails to produce wheezing or coughing. Prolonged asthma attacks (lasting several hours) that are not responsive to bronchodilator treatment are categorized as urgent medical conditions and require timely medical intervention, and in some cases, hospitalization of the affected individuals until stabilization of their condition.


diagnosis and investigations for asthma

Establishing and confirming the diagnosis in patients with asthma often requires conducting multiple and diverse investigations to demonstrate characteristic markers of the disease and clarify its etiology, severity, and risk of complications. Currently, there is no specific test or examination that can definitively diagnose or confirm asthma, but there are numerous methods available to clarify the differential diagnosis and confirm the presence or absence of asthma in specific patients.

Medical History and Physical Findings: Characteristically, asthma is characterized by chronic inflammation and reversible, variable airway obstruction provoked by specific triggers. These changes lead to recurring episodes of shortness of breath, wheezing, chest tightness, and cough, and their persistence is suspicious for asthma and necessitates diagnostic clarification. The initial steps in diagnosing the disease include a detailed medical history and comprehensive physical examination:

  • Medical history: Particular attention is paid to the patient’s general condition, subjective complaints, duration of symptoms, association with specific factors and exposures, as well as family history (presence of asthma in family members).
  • Identification of underlying risk factors: Clarifying the presence of relevant risk factors is crucial, such as air pollution exposure, including occupational exposure, medication use, known allergies, contact with animals, recent respiratory infections, exposure to cold air, intense physical exertion, and others.
  • Clinical examination: The physical examination usually involves examining the upper airways, auscultating the lungs, overall assessment of the patient’s condition, signs of allergic reactions, clinical signs of hypoxia, and others.

Pulmonary Function Testing: One of the most important investigations for proving asthma and differentiating it from other similar conditions is the so-called pulmonary function testing. This category includes various studies that provide a complex, objective, quantitative assessment of respiratory function.

The main pulmonary function tests include:

  • Spirometry: This is one of the most important tests for obstructive respiratory diseases, providing information on the functional capacity of the lungs, the amount of air passing through the airways, and the processes of inhalation and exhalation. It is used in adults and children over 5 years old and involves deep inhalation and forceful exhalation into a special tube connected to a spirometer. Spirometry measures several important lung function indicators, such as forced vital capacity, forced expiratory volume in one second, and the ratio between them.
  • Bronchial Reactivity Testing: This functional test is particularly valuable in diagnosing asthma and involves using various provocations (medications, cold air, physical exertion).
  • Bronchodilator Test: This test involves inhaling a specific medication that acts as a bronchodilator (a medication routinely used in the treatment of asthma and other obstructive diseases), most commonly salbutamol, and monitoring for the presence of reversibility of bronchial obstruction (a positive test points to asthma).
  • Arterial Blood Gas Analysis: Determining the partial pressure of oxygen and carbon dioxide in arterial blood through arterial blood gas analysis provides valuable information about the efficiency of pulmonary gas exchange. It is highly informative in assessing respiratory function.
  • Pulse Oximetry: Pulse oximetry measures the level of oxygen in arterial blood (known as oxygen saturation) and the heart rate. In healthy individuals, oxygen saturation is typically above 95 percent, while in patients with obstructive respiratory diseases, it may be lower.

Additional investigations

Additional investigations of various nature are usually prescribed in cases of difficulties in diagnosis and differential diagnosis, as well as suspicions of other underlying pathological processes with different etiology. Depending on the specific case, some of the following investigations are commonly ordered:

Imaging studies: To differentiate between certain respiratory diseases and to specify any complications that may have developed during the course of the illness, it may be necessary to perform X-rays of the lungs, computer tomography (CT) scans, and, in rarer cases, magnetic resonance imaging (MRI) or some specialized tests.

Laboratory studies: To assess the overall condition of the patient, laboratory investigations are often ordered, monitoring levels of inflammation markers, hematopoietic indicators, and others, depending on the specific case.

Sputum examination: In many cases, microbiological examination of sputum material is useful to establish the presence of an infectious (usually bacterial) process and to determine appropriate additional diagnostic and therapeutic approaches.

Allergy testing: In several instances, detailed investigations for existing allergies are useful, as knowing the triggers of the disease and the individual resistance of the patient helps in implementing targeted measures to limit their impact.

Classifying asthma When diagnosing asthma, it is essential to further specify certain characteristics concerning its etiology (the factors that provoke exacerbations) and the severity of the disease process, in order to optimize the therapeutic approach and provide an individual treatment plan.

Asthma is most commonly classified as follows:

  1. Based on etiology: Determining the type of asthma based on its etiology and triggers is extremely important to take necessary preventive measures. Different types include classic bronchial asthma, exercise-induced asthma, aspirin-induced asthma, alcohol-induced asthma, non-atopic or non-allergic asthma (which can affect up to one-third of patients and usually starts at a later age), infectious asthma (provoked by respiratory infections), and occupational asthma due to exposure to harmful factors in the workplace.
  2. Based on symptom severity: According to the severity of symptoms, four main stages of the disease are distinguished – mild intermittent (symptoms present for two days or less per week, with no significant changes in lung function), mild persistent (symptoms are mildly frequent, including at night, with slight deviations in lung function), moderate persistent, and severe persistent, where the patient’s general condition is affected, significant lung function deviations are present, and in some cases, routine medications may not have the desired effect.


The differential diagnosis of asthma is often challenging due to the similar course and overlapping symptoms with various other diseases that have diverse etiology and localization of the primary pathological process. The differential diagnosis of asthma most commonly involves distinguishing it from the following conditions: [Proceed with listing the conditions commonly considered in the differential diagnosis of asthma.

differential diagnosis of asthma
  • Alpha-1 antitrypsin deficiency: It represents a rare genetic disorder resulting from a deficiency of the protease inhibitor alpha-1 antitrypsin. It manifests with respiratory symptoms resembling asthma and various manifestations in the lungs.
  • Aspergillosis: An infectious disease with a mycotic etiology (caused by fungi from the genus Aspergillus), primarily affecting immunocompromised patients and impacting the respiratory tract, sometimes mimicking asthma.
  • Bronchiectasis: Characterized by irreversible and chronic dilation (expansion) of the bronchi due to structural changes. The clinical presentation closely resembles asthma, and imaging methods (computer tomography) are crucial for differentiation.
  • Bronchiolitis: Diffuse panbronchiolitis, common in Japan and the Far East, can mimic bronchial asthma with wheezing, cough, exertional dyspnea, and sinusitis.
  • Chronic obstructive pulmonary disease (COPD): Often, it is necessary to differentiate between asthma and COPD in clinical practice, as both diseases have similar clinical manifestations and certain similarities in etiology, requiring comprehensive and in-depth investigations for an accurate diagnosis in each patient.
  • Chronic sinusitis: In some cases, this condition can complicate the clarification of underlying asthma. Many patients may have a combination of both conditions, resulting in a higher risk of complications.
  • Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome): A rare disease characterized by asthma, eosinophilia, and vasculitis, often starting with allergic rhinitis and asthma, which can complicate the diagnosis of classical asthma.
  • Cystic fibrosis: The diagnosis of cystic fibrosis is typically established at an early age due to characteristic clinical, imaging, and laboratory findings, making the differential diagnosis from asthma relatively straightforward.
  • Foreign body aspiration: Aspiration of a foreign body can cause not only localized wheezing but also diffuse wheezing. Additionally, the aspirated foreign body may be radiolucent and not visible on chest X-rays, further complicating the diagnosis.
  • Gastroesophageal reflux disease (GERD): Cough, recurrent bronchitis, pneumonia, and wheezing may be associated with gastroesophageal reflux.
  • Heart failure: Congestive heart failure causes pulmonary congestion and interstitial lung edema, contributing to the sensation of dyspnea and wheezing. Cardiac asthma, characterized by wheezing due to bronchospasm in congestive heart failure, is related to paroxysmal nocturnal dyspnea and nocturnal cough.
  • Upper respiratory tract infection: Chronic and recurrent upper respiratory tract infections, especially in children, can mask underlying asthma, leading to frequent and repetitive infections.
  • Vocal cord dysfunction: Vocal cord dysfunction may exist independently or in combination with asthma. Patients present with chronic asthma-like symptoms, normal spirometry, and a poor response to asthma medications. The diagnosis is usually confirmed with direct laryngoscopy during symptomatic periods or after physical exercise.
  • Respiratory tract neoplasms: A variety of respiratory tract tumors have been reported to present with symptoms similar to asthma. These tumors include endobronchial carcinoid and mucoepidermoid tumors, and differentiation is often made based on bronchoscopy results. Other tracheal lesions may include bronchocentric granulomatosis, subglottic stenosis, tracheal hamartoma, bronchogenic cysts, and leiomyoma. All these tracheal lesions have been reported with asthma-like symptoms.


therapeutic approach to asthma

There is no single, universal, and equally effective treatment for all patients with asthma. However, modern medicine allows for symptom control and maintaining prolonged remission without exacerbation. The treatment for asthma is complex and strictly individualized for each patient, depending on the characteristics and severity of the disease process, age, overall health status, and other additional factors.

In general, the therapy includes the use of methods and medications for rapid symptom relief and long-term control of the disease, including prevention of asthma attacks. Some patients may also require additional measures based on their specific condition.

• Quick-Relief Medications: Quick-relief medications are used when there is an acute worsening of the condition, exposure to triggers, or before encountering known allergens. The goal of these medications is to quickly alleviate symptoms and prevent or control an asthma attack. In some cases, their use can be life-saving, and patients with asthma are advised to carry them at all times. Commonly used medications in this category include:

  • Short-acting beta-agonists: These are usually the first choice for quickly controlling asthma symptoms during an attack and are administered through inhalation. Examples include albuterol and fenoterol.
  • Corticosteroids: Corticosteroids may be used in hospital settings for severe cases, and their intravenous use can lead to rapid stabilization. They are limited and short-term due to the risks of systemic side effects they pose.
  • Anticholinergics: These are slower-acting alternatives to short-acting beta-agonists, and a commonly preferred agent is ipratropium bromide.
  • Combination medications: Ready-made combinations containing medications from different groups, usually beta-agonists and antiallergic agents, are available and have a very good effect and tolerability in some patients.

• Long-Term Control Medications: Proper long-term control of the disease, combined with avoiding exposure to triggers, is the best measure for controlling symptoms and significantly reducing the frequency and severity of asthma attacks. Some of the most effective and frequently prescribed long-term control medications include:

  • Inhaled corticosteroids: Inhaled corticosteroids are considered the most effective long-term control medications for asthma. Unlike oral and parenteral forms, inhaled corticosteroids pose minimal risks of side effects, especially when used correctly. Commonly used agents include budesonide, fluticasone, beclomethasone, mometasone, and others.
  • Long-acting beta-agonists: Due to certain considerations regarding monotherapy with long-acting beta-agonists, specialists recommend their combined use with inhaled corticosteroids (available in various ready-made combinations). Commonly used agents include formoterol and salmeterol.
  • Leukotriene receptor antagonists: Also known as leukotriene modifiers, these are an alternative choice when there is no effect or contraindications for inhaled corticosteroids. They are taken orally, and some well-known representatives are zileuton, zafirlukast, and montelukast. Their use is associated with frequent side effects, particularly related to mental health (hallucinations, depression, suicidal thoughts).
  • Theophylline: Although less commonly used in recent years due to better alternatives, theophylline is included in the complex therapy for some patients. It is a classic bronchodilator and is taken orally, with rare occurrences of severe adverse effects.
  • Others: Other medications from various groups, such as antiallergic agents, biologic therapies, and immunotherapy, cromolyn, combinations of different medication groups, are used for long-term treatment and control of specific forms of asthma to achieve optimal results.
  • Other Treatments and Methods: For some patients, some less commonly used methods and treatments are applied in clinical practice to influence the disease process of asthma. These additional measures may be used in conjunction with the main therapy to optimize effectiveness or when the primary treatment fails to control symptoms adequately. Some of the less common additional treatments for asthma include:
  • Breathing exercises: Some therapeutic breathing exercises and techniques, including relaxation techniques, can have a very positive effect on long-term asthma control.
  • Bronchial thermoplasty: A relatively rare method of bronchodilation using thermal energy. This manipulation falls under minimally invasive procedures and is usually performed within several (two to four) outpatient visits.
  • Oxygen: In rare cases, periodic oxygen therapy may be required for specific forms of the disease to prevent certain complications associated with the disease process.
  • Oral corticosteroids: In rare cases (under the influence of some autoimmune, allergic, and other factors), additional oral corticosteroid administration may be required. This is done according to a specific schedule and is discontinued upon stabilization to minimize the risk of systemic adverse effects.
  • Others: Specific immunotherapy with a suitable combination of biologic agents, specific allergen-directed therapy to target the triggering allergen of the symptoms, anti-inflammatory drug therapy, and, if necessary, some minimally invasive procedures may be required for limited patient groups, mainly with additional underlying conditions, difficult disease control, and frequent exacerbations.


The best treatment for any disease involves taking timely measures for its prevention. For the prevention and control of asthma in individuals, the main measures are directed in three directions: limiting triggers, enhancing individual immune resistance and resilience, and using specific preventive measures (e.g., vaccines). A comprehensive approach is usually recommended, and these measures are applied in parallel with appropriate medication treatment for the disease. The primary goal is to achieve symptom control and reduce asthma attacks by using a minimal number of medications at the lowest effective doses.

Limiting Triggers: Regardless of the high effectiveness of the prescribed medication therapy, if the patient continues to be exposed to triggering actions of various allergens and pathogens, the disease will inevitably progress and lead to complications. For this reason, identifying the triggers of the disease and taking appropriate measures to reduce their harmful impact is one of the first steps taken when diagnosing asthma.

Depending on the identified trigger, different measures are taken:

  • Limiting exposure to allergens: Wherever possible, it is necessary to avoid exposure to tobacco smoke, pollens, dust, industrial pollutants, industrial toxins, certain insects, and others. In-home conditions, using air purifiers and humidifiers and regular wet cleaning of surfaces and floors have a good effect. Outdoors, using appropriate personal protective gear is recommended.
  • Protecting against respiratory infections: The use of personal protective gear, avoiding crowded indoor places, and avoiding contact with visibly ill individuals reduce the risk of contracting common seasonal respiratory infections.
  • Being mindful during physical exertion and exposure to cold: Intense physical exertion can trigger an asthma attack; hence, a gradual increase in physical activity, prolonged warm-up, and having a companion who can respond to the affected individual are recommended. Increased risk is associated with training in cold weather and intense outdoor activities during cold months of the year. In such cases, wearing suitable scarves, hats, masks, or other gear to protect the upper respiratory tract from icy air is advised.
  • Paying attention to medication use: Avoiding self-administration of medication and self-prescribing drugs, including over-the-counter medications, is of utmost importance since some seemingly innocuous drugs can provoke exacerbations or lead to undesirable drug interactions with asthma medications.
  • Providing emotional and mental stability: Emotional extremes can trigger an asthma attack, so maintaining a stable mood and mental resilience is recommended. On the other hand, poorly controlled asthma can lead to episodes of depression and mood changes.
  • Treating and controlling other underlying conditions: In some cases, the lack of treatment and exacerbation of various underlying conditions (especially gastroesophageal reflux disease, conditions associated with significant dyspepsia, heart impairments) may indirectly trigger worsening of asthma and necessitate changes in the medications used and their dosages.

Enhancing Individual Resistance: Fully limiting the harmful effects of triggers in asthma is challenging. Therefore, measures aimed at increasing the body’s resilience play a significant role in controlling and preventing disease exacerbations. These measures are usually complex and may include:

  • A balanced diet: Balanced and proper nutrition significantly contributes to enhancing immunity. Increased intake of fresh fruits and vegetables, adequate fluid intake, obtaining quality clean proteins, limiting the consumption of canned, packaged, processed foods, caffeine-containing foods and beverages, legumes, and avoiding food allergens (honey, chocolate, eggs, strawberries, and others) are recommended.
  • Maintaining optimal weight: Overweight and obesity are global problems and predispose individuals to numerous diseases, affect the efficacy of prescribed medication therapy, and reduce immune defences. Weight reduction and maintaining age-appropriate and condition-appropriate weight have an overall beneficial effect.
  • Limiting harmful habits: Quitting smoking and avoiding alcohol consumption are recommended.
  • Appropriate physical activity: Regular physical activity tailored to the patient’s condition aids in improving respiratory muscles and breathing and overall body toning. It is also known to increase the body’s resilience to harmful effects.
  • Stress control: Stress and emotional extremes create conditions for exacerbation of asthma and, through complex mechanisms, lead to weakened immune protection. Numerous techniques and methods for coping with and controlling stress exist, allowing for an individual approach for each patient.
  • Additional intake of supplements: As assessed by the treating physician, additional intake of vitamins (especially vitamin C, vitamin D), minerals (zinc, selenium, magnesium), some herbs and medicinal plants may be prescribed. Extra attention should be given to possible side effects and undesirable interactions between supplements and medications taken by the patient.

Specific Prevention:

In asthma patients belonging to high-risk groups (such as those with multiple health conditions, elderly individuals, patients with other underlying respiratory diseases, immunocompromised individuals), based on the assessment of the treating physician, specific prevention with vaccines and/or immune preparations may be necessary:

  • Vaccines: Children should receive the vaccines included in the mandatory immunization schedule, and if necessary, consideration should be given to administering vaccines against influenza, pneumococcal infections, coronavirus, and other common respiratory diseases. These vaccinations reduce the risks of infection with some frequently encountered respiratory illnesses that, in turn, can trigger asthma exacerbations and even necessitate hospitalization.
  • Immunotherapy: A limited percentage of affected individuals may achieve good results in terms of controlling disease symptoms with specific immunotherapy or specific anti-allergic treatment. The choice of treatment, the methods of administration, and the specifics of therapy should be discussed with the treating physician.

The incidence of asthma continues to rise, and it is expected that by 2023, more than 400 million patients worldwide will be affected by bronchial asthma. Asthma can be a life-threatening condition if not treated properly. In Bulgaria, over 400,000 people suffer from bronchial asthma. It is also the most common chronic condition in childhood, with asthma attacks in childhood being a leading cause of hospitalizations and emergency department visits, as reported by the Association of Bulgarians with Asthma, Allergies, and COPD.

For World Asthma Day in Bulgaria, the Association of Bulgarians with Asthma, Allergies, and COPD, the Bulgarian Society of Respiratory Diseases, and the Bulgarian Society of Allergology unite their efforts year after year.

Asthma patients should continue to use their daily controller inhaler therapy. Discontinuing inhaled corticosteroids is often a cause of potential serious complications of asthma.

Specialists emphasize that access to innovative medications improves asthma control by reducing the need for hospitalization, limiting the loss of productivity, and premature death of patients.

World Asthma Day has been observed every year since 1998 on the first Tuesday of May, falling on May 5th this year. The Global Initiative for Asthma (GINA) organizes it, with medical and patient organizations worldwide becoming partners annually. The goal is to improve awareness and care for asthma patients, focus public attention on early disease diagnosis, and encourage individuals with asthma symptoms to seek medical help, while ensuring that patients diagnosed with asthma strictly follow treatment recommendations.