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Asthma

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Definition:
Asthma ist eine chronisch entzündliche Atemwegserkrankung mit bronchialer Hyperreagibilität und reversibler Atemwegsobstruktion, die zu episodenartigen respiratorischen Symptomen führt.
Häufigkeit:
Eine der häufigsten chronischen Erkrankungen mit einer Lebenszeitprävalenz von 10 % in Deutschland.
Symptome:
Variable, episodenartig und oft nachts auftretende Symptome: Atemnot, Husten, Engegefühl in der Brust, pfeifende Atemgeräusche (Giemen). Anfallsartige Beschwerden oft im Zusammenhang mit Auslösern (z. B. Allergene, Atemwegsinfekte, körperliche Belastung).
Befunde:
Im beschwerdefreien Intervall möglicherweise unauffällig. Zeichen der Atemwegsobstruktion: verlängertes Exspirium, trockene Nebengeräusche (Giemen, Pfeifen, Brummen), Tachypnoe, Einsatz der Atemhilfsmuskulatur. Bei schwerer Obstruktion: Erschöpfung, Zyanose, fehlendes Atemgeräusch („stille Lunge“).
Diagnostik:
Anamnese und klinische Untersuchung. Lungenfunktionsdiagnostik Nachweis einer (partiell) reversiblen Atemwegsobstruktion (Spirometrie mit Reversibilitäts- und ggfs. Provokationstest).
Therapie:
Medikamentöse Stufentherapie abhängig von der Asthmakontrolle. Kombination aus Bedarfsmedikamenten („Reliever“) und Langzeittherapeutika („Controller“). Weitere nichtmedikamentöse Maßnahmen umfassen u. a. Patientenschulung, Allergenkarenz und (Atem-)Physiotherapie.
  • Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin. Klimabewusste Verordnung von inhalativen Arzneimitteln. S1, AWMF-Nr. 053-059. Stand 2022. www.degam.de 
  • Ärztliches Zentrum für Qualität in der Medizin (ÄZQ). Nationale Versorgungsleitline Asthma. 4. Auflage, Stand 2020. www.leitlinien.de 
  • Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP). Diagnostik und Therapie von Patienten mit Asthma. AWMF-Leitlinie Nr. 020-009. S2k, Stand 2017. www.awmf.org 
  • Global Initiative for Asthma. Pocket Guide for Asthma Management and Prevention. Stand 2020. www.ginasthma.com 
  • Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP). Spirometrie. AWMF-Leitlinie Nr. 020-017. S2k, Stand 2015. www.awmf.org 
  • Deutsche Gesellschaft für Allergologie und klinische Immunologie. Allergieprävention. AWMF-Leitlinie Nr. 061-016. S3, Stand 2014 (in Überarbeitung). www.awmf.org 
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  • Lino Witte, Dr. med., Arzt in Weiterbildung, Innere Medizin, Frankfurt
  • Marlies Karsch-Völk, Dr. med., Fachärztin für Allgemeinmedizin, München
  • Monika Lenz, Fachärztin für Allgemeinmedizin, Neustadt am Rübenberge
  • Jonas Klaus, Arzt, Freiburg im Breisgau