What is Bronchospasm?
Bronchospasm is a condition where there is constriction of bronchi and bronchioles. There are 3 common causes for this condition:
- Inflammation of the airways.
- Spasm of the smooth muscles present in the bronchioles and bronchi.
- Increased production of mucus (sputum) because of allergic reaction or irritation due to mechanical friction of air, overcooling or dryness in the airways, such as seen during exercise induced asthma.
Causes & Pathophysiology of Bronchospasm
As mentioned previously, there are 3 main factors which cause Bronchospasm which include inflammation in the airways, spasm of the smooth muscles and excessive production of mucus. Patients suffering from bronchospasm have low levels of CO2 in their lungs. This leads to low alveolar CO2 and low oxygen levels in the body because of alveolar hypocapnia, which can either destroy the lungs resulting in arterial hypoxemia and hypercapnia or arterial hypocapnia with decrease in the transportation of oxygen, which acts as an additional factor during bronchospasm. Due to the decrease in the oxygen transport from bronchospasm, there is also decrease in the levels of the oxygen in tissues which increases the susceptibility to chronic inflammation. Due to this, individuals suffering with lung conditions, such as bronchitis, asthma, bronchiolitis, bronchiectasis, tuberculosis, cystic fibrosis, sarcoidosis etc. experience chronic bronchospasm in the smooth muscles of their airways which occurs as a result of chronic alveolar hypocapnia.
There are many chemicals, which can induce bronchospasm. These chemicals can either cause bronchodilation or bronchospasm. However, CO2 plays a prime role in this condition due to two factors which are the vasodilatory potency which it has and the added negative effects due to alveolar hypocapnia. Chronic hyperventilation which is a condition where a person breathes in more air than required, leads to cell hypoxia and immunosuppression. This results in alveolar hyperventilation with other effects, such as increased production of sputum/mucus, frequent respiratory infections along with chronic inflammation. Allergic triggers, such as pollen, dust etc. can also cause additional problems. All these factors lead to narrowing of the airways with worsening in their conductivity resulting in bronchospasm.
Risk Factors of 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 chest cold, increase the risk of bronchospasm.
- 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 ventilator also increases the risk for having a bronchospasm.
- Certain medications increase the risk of bronchospasm, such as antihypertensives, antibiotics, aspirin or NSAIDs.
Symptoms of Bronchospasm
- Patient suffering from Bronchospasm has symptoms of difficulty in breathing.
- Patient also experiences symptoms of wheezing.
- There is coughing with shortness of breath.
- Sensation of pressure and tightness in the chest can also be a symptoms of Bronchospasm.
- There is increase in respiratory ventilation which greatly increases the effects of bronchospasm.
Serious Symptoms of Bronchospasm which require Immediate Medical Care
- Persistent and unrelenting cough.
- If there is worsening of the wheezing.
- If there is fever present.
- If there is blood upon coughing.
- Bluish discoloration (cyanosis) of fingernails or toenails.
- Severe shortness of breath.
- Persistent chest pain.
- Rapid or uneven heartbeat
Diagnosis of Bronchospasm
- Medical history and physical examination is done where the doctor will examine the patient and ask for any history of asthma, allergies and other illnesses. The doctor also listens to the patient's breathing before arriving at any diagnosis.
- X-ray of the chest, which takes pictures of the lungs, helps in detecting signs of infection, such as pneumonia or any upper respiratory infection.
- CT scan uses an x-ray machine with computer to take pictures of the lungs to look for problems, such as blood clots. A dye may be given before this test is performed in order to visualize the images better. If the patient has had an allergic reaction to contrast dye then he/she should inform the doctor about this.
- Pulmonary function tests help in assessing the function of the lungs. They also help in measuring the strength of the breath upon exhaling.
Treatment of Bronchospasm
Bronchospasm can be successfully treated with medications and adopting some lifestyle changes. Treatment for bronchospasm comprises of:
Medications to Treat Bronchospasm:
- Bronchodilators, such as beta-2 agonists and theophylline can be given, which help in expanding the airways for easier breathing. Bronchodilators also help in preventing future episodes of bronchospasm. Theophylline is commonly taken in a capsule or tablet form. There is a different version of it known as aminophylline, which can be directly given intravenously if the symptoms are severe. The exact mechanism of theophylline is not clear. However, it is understood that it helps in reducing swelling and inflammation in the airways along with relaxing the muscles lining the airways. The effect of theophylline is somewhat weak when compared to corticosteroids and other bronchodilators. Theophylline also has more side effects because of which it is commonly used in conjunction with medicines which are not that effective.
- Anticholinergics are a group of bronchodilators, which are different from beta-2 agonists and help in relaxing and opening 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 act by blocking the cholinergic nerves, which lead to dilatation of the airways. The chemicals which are released from these nerves cause tightening of the muscles which line the airways.
- Inhaled steroids can be given to help reduce the swelling present in the airways and ease the breathing process of the patient. Inhaled steroids are commonly used for long-term control.
- Other than medications, treatment for bronchospasm also comprises of physical exercises with nose breathing which help in re-training of the breathing which slowly increases the stores of the oxygen in the body. Nose breathing done during exercise helps in preventing exercise-induced bronchospasm and asthma.
- The symptoms of bronchospasm can also be relieved using breathing exercises which involve breathing devices, which trap the exhaled CO2 (Frolov breathing device, Amazing DIY breathing device, Samozdrav). These devices help in increasing the oxygen levels in the body thus reducing bronchospasm in few minutes.
- Treatment of bronchospasm also comprises of lifestyle changes, such as avoiding sleeping in the supine position, avoiding mouth breathing etc. The Buteyko technique is one of the best lifestyle programs present.
Prevention of Bronchospasm
- Triggers such as dust, pollen and other mechanical factors should be avoided as much as possible for preventing bronchospasm.
- Warming up before any exercise helps in preventing exercise induced bronchospasm.
- Contact should be avoided with people who are sick.
- Patient should always be updated on vaccination for pneumonia or flu.
- Nose breathing should always be practiced, especially during cold and dry air weather. Nose breathing helps in reducing lung irritation by warming the air before it reaches the lungs.