Asthma

Asthma at a glance

Bronchial asthma is a heterogeneous and chronic inflammatory disease of the airways, in which those affected suffer from breathlessness due to a narrowing of the airways.1 The inflammatory process leads to increased sensitivity of the airways (bronchial hyperreactivity) to various external stimuli.1 Asthma affects both children and adults and is the most common chronic disease in children.2

In 2019, an estimated 262 million people worldwide were affected by asthma and 455,000 people died from asthma.3 Asthma is also widespread in Switzerland: Every 10th child and every 14th adult suffers from asthma.4 From 2018-2022, an average of 78 people in Switzerland died from asthma every year.5

The underlying causes of asthma are not yet fully understood. Risk factors for asthma in childhood and adulthood include:6,7

  • Genetic disposition
  • Smoking/exposure to cigarette smoke
  • Exposure to allergens indoors/occupational exposure
  • Allergies (e.g. allergic rhinitis)
  • Air pollution
  • Viral infections of the respiratory tract
  • Excess weight
  • Stress

Many clinical phenotypes of asthma have been identified, with the most common form being allergic asthma, which is often associated with eosinophilic inflammation of the airways.8 Up to 84% of patients with severe asthma are likely to have an eosinophilic phenotype.9

Prevalence

The prevalence of asthma has increased worldwide in recent decades6

Switzerland

Approximately 10% of children and 7% of adults in Switzerland suffer from asthma4

Mortality

One person dies of asthma in Switzerland about every 5 days5

Symptoms

Asthma is characterised by the following symptoms:8

  • Wheezing
  • Shortness of breath
  • Tightness in the chest
  • Cough

The symptoms vary in their intensity and over time. They are accompanied by variable restriction to the expiratory airflow.8

Symptoms sometimes worsen suddenly and significantly, which is called an asthma attack or exacerbation.2,8 Symptoms are often worse at night or during exercise.2

Diagnosis

Asthma is diagnosed on the basis of typical respiratory symptoms, together with physiological signs of variable restriction to the expiratory airflow.8

Spirometry can be used to assess both restriction to airflow and the response to bronchodilators.10 Bronchial provocation tests allow a non-invasive assessment of airway hyperresponsiveness.10 Analysing blood and sputum for eosinophilia and measuring fractional exhaled nitric oxide (FeNO) can help detect airway inflammation that is characteristic of some asthma phenotypes.10

Treatment

Asthma is considered incurable but highly treatable.1 The long-term goals of asthma treatment are to achieve good symptom control and to minimise the future risk of asthma-related mortality, exacerbations and persistent restrictions to airflow.8

The following inhaled medications are usually used in the treatment of asthma:2

  • Bronchodilators that open up the airways and alleviate symptoms.
  • Steroids that reduce inflammation in the airways, which improves asthma symptoms and reduces the risk of severe exacerbations and death.

In patients with severe asthma who have poor symptom control and/or exacerbations despite treatment with inhaled corticosteroids and long-acting beta2 agonists, phenotypic assessment and consideration of add-on therapy with long-acting muscarinic antagonists (LAMA), antibiotics, bronchial thermoplasty, biologics or as last resort oral corticosteroids is recommended.8

References:
  1. FOPH, Chronic respiratory diseases. Last revised on: 20/11/2020. Available online at: https://www.bag.admin.ch/bag/de/home/krankheiten/krankheiten-im-ueberblick/chronische-atemwegserkrankungen.html. Last accessed on: 08/05/2024. 
  2. WHO Factsheet WHO, Fact sheet Asthma. Last revised on: 06 May 2024. Available online at: https://www.who.int/news-room/fact-sheets/detail/asthma. Last accessed on: 08/05/2024. 
  3. Global burden of 369 diseases and injuries i11 204 countries and territories, 1990-2019: a systematic analysis for the Global Burde11 of Disease Study 2019. Lancet. 2020;396(10258):1204-22. 
  4. Swiss Lung League, diseases and therapies, asthma. Available online at: https://www.lungenliga.ch/krankheiten-therapien/asthma. Last accessed on: 08/05/2024. 
  5. Federal Statistical Office: Deaths and death rates from major causes of death, by age, women/men. Published on 11/12/2023. Covers period from 1990-2022. Tables available at: https://www.bfs.admin.ch/bfs/en/home/statistics/health/state-health/mortality-causes-death/specific.html. Last accessed on: 17/05/2024.
  6. Kuruvilla ME, et al. Epidemiology and risk factors for asthma. Respir Med. 2019 Mar;149:16-22. 
  7. American Lung Association. Asthma Causes and Risk factors. Available online at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/learn-about-asthma/what-causes-asthma. Last accessed on: 17/05/2024. 
  8. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2024. Updated May 2024. Available online at: www.ginasthma.org, Last accessed on: 08/05/2024. 
  9. Heaney LG et al. Eosinophilic and Noneosinophilic Asthma: An Expert Consensus Framework to Characterize Phenotypes in a Global Real-Life Severe Asthma Cohort. Chest 2021;160(3):814-830. 
  10. Aaron SD, et al. Underdiagnosis and Overdiagnosis of Asthma. Am J Respir Crit Care Med. 2018 Oct 15;198(8):1012-1020.

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CH-12797 Revision date 05/2026

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