Coughing frequently and a tight chest may be signs of bronchial hyperreactivity. Prof. Dr Rainald Fischer in conversation about the phenomenon, its diagnosis and treatment options.
Prof. Dr Fischer: In lay terms, bronchial hyperreactivity is when the bronchial tubes are hypersensitive. When we breathe in, it is not only oxygen that enters the bronchial tubes, but also a host of irritants like pollen, dust, smoke, chemicals or cold air. In people with bronchial hyperreactivity, this can cause the airways to overreact, which can lead to symptoms like a cough, shortness of breath or a tight chest.
Prof. Dr Fischer: Bronchial hyperreactivity is measured with instruments based on a provocation test with histamine or methacholine, in which a lung function test is carried out and then a low dose of methacholine is administered, typically increased in two to three concentration levels.
Further lung function tests are used to check at which concentration the bronchial tubes start to constrict. If the FEV1 value (forced expiratory volume in one second) drops after a specific concentration, this is then deemed to be bronchial hyperreactivity.
Prof. Dr Fischer: Bronchial hyperreactivity should not be confused with asthma. While asthmatics tend to have hypersensitive bronchial tubes, this does not mean that everyone with hypersensitive bronchial tubes has asthma. There are people who have bronchial hyperreactivity, for example because of an infection, but who do not usually have any symptoms. But then the bronchial hyperreactivity is triggered if their lungs are exposed to, for example, irritants such as cold air, strong smells, steam or cigarette smoke.
Prof. Dr Fischer: As long as there are no symptoms and the bronchial hyperreactivity was only proven in the provocation test, no treatment is required. In day-to-day life you should avoid the irritants that cause your bronchial tubes to react sensitively. If this is not possible or if you get symptoms, inhalative steroids can be used to calm the hypersensitivity.
It is advisable that children, novices or the elderly use a spray with a spacer for the inhalation. A holding chamber ensures that the medication does not stay in the mouth and throat but reaches the bronchial tubes. If inhaled steroids help or if the symptoms persist, this is an indication of asthma and should be medically investigated.
Prof. Dr Fischer:Inhalation therapy with isotonic saline solution can mitigate a cough caused by bronchial hyperreactivity and reduce its frequency. I advise against hypertonic saline solution in this case, because this may cause you to cough more.
Prof. Dr Rainald Fischer is a specialist for internal medicine in private practice, with a subspecialty in lung and bronchial medicine, specialty of emergency medicine, sleep medicine and allergy medicine in Munich-Pasing. Before that he worked as an internist and lung specialist, most recently as a senior physician at the Munich university hospital. Prof Dr Rainald Fischer is a founding member and president of the Deutschen Gesellschaft für Berg- und Expeditionsmedizin (German Society for Mountain and Expedition Medicine), and also a member of the Cystic Fibrosis Medical Association.
Note: The information in this blog post is not a treatment recommendation. The needs of patients vary greatly from person to person. The treatment approaches presented should be viewed only as examples. PARI recommends that patients always consult with their physician or physiotherapist first.
An article written by the PARI BLOG editorial team.
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