Asthma is caused by an overreaction of the immune system. It is often allergic in nature. Among the main allergens: pollens, molds, dust mites, the hair of domestic animals (cat, dog, etc.). But pollution, physical exertion, climate change can also promote asthma.
In the case of allergic asthma, the allergen (eg pollen) is inhaled. It goes into the bronchi and causes an overreaction of the immune system. This results in a enlarged bronchial muscles and an overproduction of mucus which reduce the passage of air. It’s the asthma attack. How to treat it effectively? How to limit recurrence?
Cortisone, the first disease-modifying treatment against asthma
One daily intake by inhaler
Inhaled cortisone is still the medicine most asthmatics need to take 2 times per day. It lines the walls of the bronchi, limits their swelling and reduces the inflammation that causes coughing and shortness of breath. The drug acts in a progressive and lasting way. The prescribed dose depends on the severity of the asthma.
“We decide on the treatment following a clinical examination, the measurement of the breath and the dosage of the exhaled nitric oxide, which gives the level of inflammation of the bronchi”, explains Dr Anne Prud’homme, pneumoallergologist.
It can be reassessed, or adapted from time to time, depending on the symptoms. The dose is set at the minimum necessary. “This is a benefit / risk assessment between the need to control asthma and the need to limit the side effects of treatments”, underlines Dr Jean-Philippe Santoni, pulmonologist.
Inhaled cortisone has far fewer side effects than cortisone taken by mouth. In high doses and long-term, however, it can cause growth disorders in children, increasing the risk of respiratory infections, candidiasis and adrenal problems in adults.
She may be combined with other drugs in the same bronchodilator, such as long-acting beta-2 mimetics, which induce relaxation of the walls of the bronchi. When asthma is mild, it may not be necessary to take DMARD all year round. It can be taken for a few weeks or a few months, for example to get through a difficult time like the pollen season.
Orally, it is reserved for exceptional situations
Cortisone in the form of tablets or injections is reserved for more serious forms, or periods of exacerbations, when the person is the victim of seizures despite their usual treatment. This may be the case, for example, following a high exposure to an allergen.
In this situation, it is taken as short as possible.
A bronchodilator to soothe asthma attacks
The emergency inhaler, which asthmatics should keep with them, can respond immediately to the onset of symptoms. It contains a substance that attaches to the walls of the bronchi. It causes a quick release and an reopening that allows air to circulate again.
These can be different classes of drugs, such as fast-acting beta-2-mimetics, or anticholinergics. 1 to 2 puffs are usually sufficient, to be renewed every 5 to 10 minutes if necessary. Emergency calls should be made if symptoms do not improve after 20 minutes.
Allergic asthma: a biotherapy in the event of a severe crisis
Pulmonologists use it in cases of severe asthma that is not controlled by a disease-modifying treatment taken at the maximum dose. “We are considering this option as soon as 2 or 3 exacerbations under treatment”, says Dr Prud’homme.
Not all biologic medicines are suitable for all forms of asthma. For severe asthma with a significant allergic component, specialists can usually prescribeomalizumab, a monoclonal antibody that helps normalize the level of immunoglobulin E (IgE) responsible for the asthma attack. The drug is given by injection every 2 to 4 weeks.
“The coronavirus can exacerbate asthma” – Dr Anne Prud’homme
“Viruses are an important destabilizing factor in asthma, which includes the coronavirus. But taking a daily treatment limits these risks of exacerbation in case of infection. The basic treatment protects the mucous membranes, and asthmatics who take it are no more at risk of catching the coronavirus, maybe even less. Despite their respiratory fragility, people with asthma are indeed under-represented among Covid-19 patients.
On the other hand, this is not the case for those whose asthma is poorly controlled. It is very important for asthmatics to continue their cortisone treatment. There is no contraindication for them in relation to the coronavirus, cortisone is on the contrary a protection “.
Natural solutions for asthma
THE’acupuncture is “to be encouraged, provided that it does not replace the basic treatment if it is necessary”, considers Professor Antoine Magnan, pulmonologist. The High Authority for Health places it “as an adjunct to a treated and educated patient,” he says. The evidence remains insufficient to recommend it as a first-line treatment (Inserm evolution, U 669, 2014).
In herbal medicine, we can use plantain or fumitory in herbal tea, in reasonable doses. On the other hand, it is better to be very careful with inhalations and essential oils (tarragon, mandarin).
Does Fasting Cure Asthma?
Rare studies observe that symptoms improve or even disappear after fasting for a few days. But it’s hard to really conclude, as fasting protocols differ, relaxation and the practice of a physical activity They are included, the studies do not allow statistical calculations, and their results are based on questionnaires and not on the assessment of physicians. For Professor Magnan, in any case, it’s no!
Secure your environment to prevent allergic asthma
- Reduce your exposure against dust mites, molds, animal hair and pollen by ventilating its accommodation outside the peaks of pollution, morning and evening, for at least 10 minutes.
- Vacuum and mop as often as possible, it gets rid of dust and animal hair.
- Protect yourself against dust mites by placing a full cover on his mattress, by washing the sheets every week at 60 ° C, and by reducing the upholstery.
- In the pollen season, rinse your hair after each outing limits the presence of pollens.
Tobacco, essential oil blends, interior perfume … also avoid irritating and aggravating factors.
Protect yourself from air pollutants
- Cleaning products can release irritating substances, such as formaldehyde. Ventilate during use, and favor NF-environment or Ecolabel products. Please note, bleach is not recommended, as it is irritating to asthmatics!
- Avoid all smoke inside: cigarette smoke reinforces inflammation of the bronchi, increases the risk of an asthma attack and potentiates allergens. Chimney fires are also harmful because of the nitrogen dioxide they give off.
- Better to limit exits during peaks of pollution, because of ozone and fine particles that penetrate deep into the bronchi.