It is a condition where there is constriction of the bronchi and bronchioles.
Causes and pathophysiology of bronchospasm
There are three common causes of this condition:
- Inflammation of the respiratory tract.
- Spasm of the smooth muscles present in the bronchioles and bronchi.
- Increased mucus (sputum) production due to an allergic reaction or irritation from mechanical air friction, supercooling, or dry airways, as seen during exercise-induced asthma.
Patients suffering from bronchospasm have low levels of CO2 in their lungs; this leads to low levels of alveolar CO2 and low levels of oxygen in the body due to alveolar hypocapnia.
It can destroy the lungs resulting in arterial hypoxemia and arterial hypercapnia or hypocapnia.
Likewise, oxygen transport decreases, which acts as an additional factor during bronchospasm; due to this, there is also a decrease in oxygen levels in the tissues that increases the susceptibility to chronic inflammation.
For this reason, people suffering from lung diseases like bronchitis, asthma, bronchiolitis, tuberculosis, etc., experience chronic bronchospasm in the smooth muscles of the airways that occurs as a result of chronic alveolar hypocapnia.
Many chemicals can induce bronchospasm; these chemicals can cause bronchodilation or bronchospasm.
However, CO2 plays a significant role in this condition due to two factors which are the vasodilator potency it has and the additional adverse effects due to alveolar hypocapnia.
Chronic hyperventilation, a condition in which a person breathes more air than is required, leads to cellular hypoxia and immunosuppression.
This results in alveolar hyperventilation with other effects such as increased sputum/mucus production, frequent respiratory infections along with chronic inflammation.
Allergic triggers, such as pollen, dust, etc., can also cause additional problems.
All these factors lead to the narrowing of the airways with a worsening conductivity that produces bronchospasm.
- Having a family or personal history of asthma or irritants, such as mold, pollen, dust, animal dander, latex, food additives, etc., increases the risk of bronchospasm.
- Upper respiratory infections, such as a cold chest, increase the risk of bronchospasm.
- The sudden increase in activity or exercise also increases the risk of bronchospasm.
- Air irritants such as strong odors, smoke, air pollution, cold or dry air, or excessive air from a fan also increase the risk of bronchospasm.
- Certain medications increase the risk of bronchospasms, such as antihypertensives, antibiotics, aspirin, or NSAIDs.
Symptoms of bronchospasm
- The patient suffering from bronchospasm has symptoms of shortness of breath.
- The patient also experiences symptoms of wheezing.
- There is a cough with shortness of breath.
- The feeling of pressure and tightness in the chest can also be a symptom of bronchospasm.
- There is an increase in respiratory ventilation that significantly increases the effects of bronchospasm.
Severe bronchospasm symptoms that require immediate medical attention
- Persistent and relentless cough.
- There is a worsening of wheezing.
- There is a fever present.
- There is blood when coughing.
- Bluish discoloration ( cyanosis ) of the fingernails or toenails.
- Severe shortness of breath
- Persistent chest pain
- Fast or uneven heartbeat.
The medical history and physical examination are performed when the physician examines the patient and asks if they have a history of asthma, allergies, and other illnesses.
The doctor will also listen to the patient’s breathing before reaching a diagnosis.
A chest X-ray, which takes pictures of the lungs, helps detect signs of infection, such as pneumonia or any upper respiratory infection.
CT scan uses an x-ray machine with a computer to take pictures of the lungs to look for problems such as blood clots. Before performing this test, a dye may be administered to visualize the images better.
If the patient has had an allergic reaction to the contrast medium, he should inform the doctor about this.
Pulmonary function tests help evaluate the function of the lungs; they also help measure the force of the breath when exhaling.
Treatment of bronchospasm
Bronchospasm can be successfully treated with medication and by adopting some lifestyle changes. Treatment for bronchospasm consists of:
Bronchodilators: Beta-2 agonists and theophylline may be given, which help expand the airways to make breathing easier. Bronchodilators also help prevent future episodes of bronchospasm.
Theophylline is commonly taken in capsule or tablet form; there is a different version known as aminophylline, which can be given directly intravenously if symptoms are severe.
The exact mechanism of theophylline is unclear. However, it is understood to help reduce swelling and inflammation in the airways and relax the muscles that line the airways.
The effect of theophylline is somewhat weak compared to corticosteroids and other bronchodilators; it also has more side effects because it is commonly used in conjunction with medications that are not as effective.
Anticholinergics: They are a group of bronchodilators, which are different from beta-2 agonists and help relax and open the airways.
Anticholinergics include medications such as tiotropium, ipratropium, glycopyrronium, and aclidinium.
These medications are taken with the help of an inhaler; they can also be administered using a nebulizer for more severe and abrupt symptoms.
Anticholinergics work by blocking cholinergic nerves, which lead to dilation of the airways.
Chemicals released from these nerves cause the muscles that line the airways to tighten.
Inhaled steroids: can be administered to help reduce swelling in the airways and facilitate the breathing process for the patient. Inhaled steroids are commonly used for long-term control.
In addition to medications, the treatment of bronchospasm also consists of physical exercises with nasal breathing that help to retrain breathing.
Exercising slowly increases oxygen stores in the body, and nose breathing during exercise helps prevent bronchospasm and asthma-induced asthma.
Symptoms of bronchospasm can also be alleviated by breathing exercises that involve breathing devices, which trap the exhaled CO2 (Frolov breathing device, DIY excellent breathing device, Samozdrav).
These devices help increase oxygen levels, thus reducing bronchospasm in a few minutes.
Treatment of bronchospasm also includes lifestyle changes, such as avoiding supine sleeping, avoiding mouth breathing, etc.
The Buteyko technique is one of the best lifestyle programs around.
Prevention of bronchospasm
- Triggers like dust, pollen, and other mechanical factors should be avoided as much as possible to prevent bronchospasm.
- Warming up before any exercise helps prevent exercise-induced bronchospasm.
- Contact should be avoided with people who are sick.
- The patient should always be up-to-date on vaccination against pneumonia or flu.
- Nose breathing should always be practiced, especially during cold, dry weather. Breathing through the nose helps reduce lung irritation by heating the air before it reaches the lungs.