Asthma: tight chest and shortage of breath

In Switzerland, 1 in 10 children and 1 in 14 adults suffer from asthma, experiencing wheezing, an irritating cough, a tight feeling in the chest and shortness of breath. What are the symptoms, causes and, above all, treatment options?

Text: Julie Freudiger; photo: iStock

Asthma is a chronic long-term condition that affects the airways in the lungs. They sometimes get inflamed and narrow, making it hard to breathe in and out. The inflammation triggers several reactions: The mucous membrane in the bronchial tubes becomes hypersensitive and swells, forming thick mucus that can clog the bronchial tubes. The muscles around the bronchi contract, narrowing the airways and bronchi. Typically during an asthma attack, the respiratory muscles spasm, leading to shortness of breath.

Non-allergic and allergic asthma

There are two major groups of asthma, and they differ less in symptoms than in cause: Allergic asthma is triggered by allergies and usually starts in childhood or early adolescence. It usually occurs seasonally, but over the years it can take on a life of its own and cause symptoms even without contact with allergens. Adults are more likely to suffer from non-allergic asthma. The causes of asthma in adulthood are still not clearly understood. Triggers are often inflammations of the bronchial mucosa or a chronic cold that has lasted for years. Hereditary factors also play a role. 

Varied symptoms

The symptoms of asthma vary in frequency, duration and intensity. “Asthma is a heterogeneous disease. It not only has different causes, but is also experienced differently,” explains Angelica Ramseier, chief consultant for pneumology at Kantonsspital Winterthur. Depending on the severity of the asthma, some symptoms, such as shortness of breath, are felt permanently. "In mild forms, however, it’s only noticeable during exertion such as physical activity,” says Ramseier.

According to Angelica Ramseier, typical symptoms of a more severe form are sudden and sometimes severe shortness of breath, tightness in the chest and difficult exhalation with a whistling sound. It can also be accompanied by feelings of suffocation, acceleration of breathing and heart rate, and coughing up viscous mucous. The problem is that exhalation is more difficult. Ramseier explains: “Because the airways are so narrow, you can’t fully exhale and there’s less room for air on the next breath. This can cause shallow breathing, and the feeling of shortness of breath sets in.”

In addition, asthma attacks can last from a few minutes to several hours and can even become life-threatening. In rare cases, they even last for several days. 

“Along with taking medication, avoiding triggers is the most important factor in living with asthma as symptom-free as possible.”
Angelica Ramseier, senior consultant for pneumology at Kantonsspital Winterthur

Causes: what triggers asthma?

Asthma symptoms are triggered by one or more external stimuli, such as allergens. But even non-specific stimuli such as cold or smoky air can irritate the bronchial tubes as they are very sensitive as a result of the asthma. “Along with taking medication, avoiding triggers is the most important factor in living with asthma as symptom-free as possible,” explains Angelica Ramseier. Therefore, to reduce symptoms and attacks, asthma sufferers should be aware of their specific triggers. 

Triggers for allergic asthma

  • Pollen
  • House dust or dust mites
  • Animal air (cats, dogs, hamsters, etc.)
  • Mould spores

Foods that can trigger an allergic reaction

  • Seafood
  • Nuts
  • Peanuts, soy and other legumes
  • Glutamate
  • Stabilisers such as sulphites in wine, fruit juices, dried fruit and canned fish

In most cases, shortness of breath goes hand in hand with symptoms such as an itchy mouth, runny nose, conjunctival irritation or urticaria.

Other triggers

  • Respiratory infections such as colds, flu, chronic rhinitis, sinus infections
  • Stress and psychological factors
  • Medicines such as Aspirin, beta blockers and antirheumatic drugs
  • Physical activity
  • Cold and dry air
  • Dust
  • Odours, chemical and physical irritants
  • Cigarette smoke and passive smoking
  • Ozone and fine dust pollution
  • Wood dust

How is asthma diagnosed?

If the patient’s symptoms and medical history fit the clinical picture of asthma, physical exams and pulmonary tests are conducted to establish whether their airways are constricted. “With other respiratory diseases, the feeling of tightness in the chest is constant, with asthma it comes and goes,” says Angelica Ramseier. Lung function tests provide more information. “We use spirometry to measure various lung values. The FEV1 value is particularly important. For this test you have to exhale forcefully into a measuring device through a mouthpiece. The spirometer measures the volume of air exhaled in one second – if the airways are narrowed, the reading will be lower than if the lungs are functioning normally.”

The peak expiratory flow is another important value that has to be analysed. It’s easy to determine this value at home using a simple device, which can be used for self-monitoring or diagnosis. 

Depending on the symptoms, asthma diagnosis also includes clarification of allergies, which is done by means of skin or blood tests. However, evidence of allergy does not always confirm allergic asthma. 

“With the right treatment, asthma can usually be managed well.”
Angelica Ramseier, senior consultant for pneumology at Kantonsspital Winterthur

Treating asthma

Asthma cannot be fully cured. “However, it can usually be managed well given the right treatment,” says Ramseier. Especially children with allergic asthma have a good chance of living a symptom-free daily life.

However, left untreated, the chronic respiratory disease can impair and damage the functionality of the lungs. This is also true for very mild asthma. “In every case it’s important to inhibit inflammation,” says the expert. “Many patients with mild asthma are worried about taking medication. And that’s understandable. You don’t want to take cortisone lightly. But in this case it’s essential.”

Depending on the severity of the asthma, medication is either taken permanently or only when acutely needed. The treatment of asthma focuses on three areas: expand the bronchial tubes, inhibit inflammation and avoid allergens (in case of allergic asthma). 

Drug therapy:

  • In acute asthma attacks, fast-acting drugs loosen the spasms in the bronchial tubes so that air can circulate freely again. It is important to inhale correctly. Instructions are available from Lungenliga Schweiz.
  • Basic treatment: To counteract inflammation of the bronchial mucosa and prevent permanent damage, a medication containing cortisone is prescribed. This is also inhaled and expands the bronchial tubes in the long term.
  • Biologics: Biologics are the body’s own substances (antibodies) that are replicated in the laboratory and used in very severe cases to reduce inflammation.
  • Treatment of allergies: With allergic asthma, the allergy also needs to be treated. Depending on the case and severity, desensitisation (immunotherapy) is an option. 

Avoiding allergens:

  • Keep yourself informed about the pollen count and plan your activities accordingly. The Meteo Schweiz and Allergiezentrum Schweiz apps, for example, display the pollen count in real time.
  • Stay outdoors as little as possible during pollen season.
  • Don’t let the laundry dry outside.
  • Install pollen screens on the windows and pollen filters in the car.
  • Wash your hair before going to bed.
  • Use mite-proof covers for mattresses, covers and pillows.
  • Remove dust catchers such as stuffed animals.
  • Don’t have carpets in your home.
  • Choose holiday destinations at over 1,200 metres above sea level, because there are no mites above this altitude.
  • Don’t have pets.
  • Avoid foods that cause allergies.
“In my opinion, anything that calms your breathing and helps you understand your own body better makes sense.”
Angelica Ramseier, senior consultant for pneumology at Kantonsspital Winterthur

Breathing exercises, exercise and an asthma diary

Those who suffer from asthma can do a lot to improve their quality of life and promote their health. This includes quitting smoking and avoiding smoky rooms as much as possible. Asthma suffers who are overweight may benefit from losing a few kilograms. Lower body fat may help improve lung function and ease symptoms. Sports and exercise, especially endurance sports, are not only a good balance and reduce stress, they also support asthma treatment. 

Being diagnosed with asthma can be stressful. Angelica Ramseier has seen this in her patients: “Many people are worried by the uncertainty of the diagnosis.” The feeling of not getting enough air during an attack can even trigger panic, which in turn intensifies the breathing difficulties. That’s why it’s important to find out more about asthma and know your disease. An asthma diary can help keep control and an overview. 

Certain breathing exercises help strengthen the lungs, reduce shortness of breath and help with relaxation. The “Breathing and exercise” courses run by Lungenliga teach strengthening and calming breathing exercises. “There are many ways you can get to know your breathing better. In my opinion, anything that calms your breathing and helps you understand your own body better makes sense,” says Angelica Ramseier. 

“Despite having asthma, I live a normal life”

Juliette Buholzer explains how asthma affects her daily life

“I was two years old the first time my parents had to take me to A&E because I couldn’t stop coughing and was struggling to breathe. But I don’t remember anything about it, nor do I remember all the examinations I went through until I was diagnosed with asthma. When I’m not mid-asthma-attack, I don’t really have any noticeable symptoms. But I still have to take my asthma spray every morning so that my lungs can expand properly. Before I used the spray regularly, my bronchial tubes were constantly inflamed, and I couldn’t stop coughing.

Luckily that’s not the case any more. But as soon as I’m sick or suffer from hay fever, I need to take the spray several times a day. When I have an asthma attack, the coughing is particularly bad in the evening. I have difficulty breathing – and it can be scary. But my mum has taught me some breathing exercises from yoga, and these help me to relax. If I’m up all night coughing because of the asthma, I have to stay home the next day. But that doesn’t happen very often. Despite having asthma, I can still live a normal life. I only really notice it during swimming lessons, when I can’t swim very far under water, because my lung volume is small.”