New aspects in the approach to diagnosing bronchial asthma

Bronchial asthma is a significant condition of both childhood and adulthood. Chronic bronchial inflammation causes bronchial hyperresponsiveness

that results in repeated episodes of wheezing on respiration, dyspnoea, chest tightness, and cough, predominantly at

night and very early in the morning. This is accompanied by variable bronchial obstruction that is often reversible, either spontaneously

or following treatment. The course of the disease is variable and, in terms of treatment response, it is crucial to determine the asthma

phenotype. Phenotype changes caused by epigenetic mechanisms are characterized by high dynamism and reversibility. An increasing

group of obese asthmatics and elderly asthmatics is becoming evident in the population; these aspects are dealt with in one part of the

paper. The asthma phenotype associated with obesity is manifested by altered respiratory mechanics, a proinflammatory state of the

metabolic syndrome, and reduced response to glucocorticoids. Obese asthmatic patients exhibit obstructive sleep apnoea, habitual

snoring, hypoventilation, and gastro-oesophageal reflux. Weight reduction as part of tertiary prevention improves lung function and

asthma symptoms. Senile characteristics modify the presentation of bronchial asthma in old age, with reduced sensitivity to symptoms

and nonspecific presentation of the disease being typical. An originally allergic asthma appears in old age as nonallergic asthma sensitive

to nonspecific and infectious stimuli. Reduced respiratory muscle strength, increased chest wall rigidity, and reduced lung elasticity all

have a negative impact. The diagnosis is complemented by complicating comorbidities. When diagnosing bronchial asthma, you will find

that it is not a definitive text, but a description of a condition that is evolving and subject to review throughout the life of an asthmatic.

Keywords: bronchial asthma, asthma phenotype, epigenetics, obesity, old age