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 crc@convex.bg
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!
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.
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:
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.
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:
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.
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.
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).
From an etiological perspective, bronchial asthma is a heterogeneous condition (a disease caused by multiple factors) and can be divided into two broad groups:
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.
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:
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.
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).
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.
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.
Bronchospasm
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.
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.
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:
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:
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.
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:
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):
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:
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.
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:
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:
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:
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.
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:
• 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:
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:
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:
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:
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.
