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Asthma affects more than 4 million people in France. If it often begins in childhood, it can also appear only in adulthood. These cases are more and more numerous. The explanations of an allergist.

Asthma is a chronic inflammatory disease bronchi. This inflammation leads to edema, contraction of the bronchi and hypersecretion of mucus which cause bronchial obstruction.

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Like any chronic disease, asthma appears on a predisposed ground, most often during childhood. But if these predispositions are less important, the disease can declare itself in adulthood, and until very late in life, especially in women. These cases are more and more frequent.

What will trigger asthma?

On a genetic predisposition, certain environmental factors will trigger inflammation: allergens (pollen, dust mites, moulds, etc.), irritating chemicals, tobacco, air pollution.

Added to this are contributing factors such as obesity or menopause. During this period, in fact, hormonal changes lead to an imbalance of the mucous membranes, which are more prone to inflammation.

How does asthma manifest itself?

The big symptom is dyspnea, i.e. difficulty in breathing. It is often accompanied by a feeling of tightness in the chest and wheezing. This is the “triad” of asthma.

Sometimes coughing is the only symptom. More rarely, pain in the lungs, headaches on exertion or sleep disturbances may appear. These symptoms occur during asthma attacks, which are more or less frequent and severe depending on the patient. Indeed, asthma is a protean disease, both in terms of symptoms and the inflammatory mechanisms involved. In reality, it would be more accurate to speak of “asthma”.

How is the diagnosis made?

Diagnosis is based on clinical examination and pulmonary function testing (EFR). The patient blows into a small device called peak flow, which will measure the peak expiratory flow (PEF), that is to say the maximum speed of the breath on expiration. This examination is carried out at different times of the day, and after taking Ventoline®.

What are the treatments for asthma?

Before any treatment, there is therapeutic education. It consists in particular in avoiding the triggering factors, by taking certain environmental measures.

The treatment will be different depending on the severity of the disease. If the symptoms are mild with infrequent attacks, only an attack treatment will be prescribed. These are fast-acting bronchodilators, such as Ventoline®, to be taken at the first signs of an attack.

In case of more frequent attacks (3 to 4 per month), a basic treatment will be associated to limit the attacks. It is based on long-acting bronchodilators. These inhaled corticosteroids have really changed the lives of asthmatics. In the event of severe asthma (approximately 5% of cases), new treatments aim to attack the biological cause of the disease, namely the inflammatory mechanisms. These are biotherapies.

Biotherapies: the treatment of tomorrow for asthmatics?

Biotherapies use antibodies that will target molecules involved in inflammatory mechanisms. These can be different in different patients depending on the characteristics of the disease, environmental factors (we speak of the asthma phenotype). It is therefore a personalized medicine, complex… and expensive. Moreover, there is a lack of perspective on these treatments.

But they are unquestionably a real hope for patients with severe asthma.

Our expert: Dr Maxime Hosotte, allergist at the Nancy-Lorraine private hospital (ELSAN group)

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