Credit: © Stock

Around 330 million people worldwide currently suffer from asthma, according to the Global Asthma Report 2014 of the Global Asthma Network Steering Group. This makes asthma one of the most common diseases in the world. Especially children in industrialized countries, are affected by this chronic disease. Worldwide, the rate of childhood asthma is 14 percent. In 70 percent of the cases, the first symptoms appear before the age of five.

Proportion of asthmatics in the world population

What is Asthma?

Asthma is a long-lasting and seizure-related inflammatory disease of the respiratory tract, which is associated with increased sensitivity of the bronchi to various stimuli. Typical symptoms include chest tightness, difficulty breathing, coughing and wheezing. So far, there are no therapies worldwide that completely cure adult asthma. However, it is now possible in Germany, through an appropriate treatment, to extend the seizure-free periods and relieve the discomfort, so that a normal life is possible. Things are different with children. About half of the children with early diagnosed asthma, have a chance of being cured at the latest in adulthood, with an appropriate treatment.

Two main forms of the disease

1. Allergic asthma
Allergic asthma is caused by an allergic reaction. The triggers vary from patient to patient. Pollen from plants, dust mites or animal hair can trigger the asthmatic attacks. Allergic asthma is often inherited and often begins in childhood.
2. Non-allergic asthma
Non-allergic asthma has several causes. It may be due to an infection that causes airway inflammation. The bronchial spasms, mucous congestion, coughing and shortness of breath. After the cold, the asthma disappears initially, but returns and becomes chronic over the years. Also due to intolerance to certain medicine or in response to chemical or toxic substances, non-allergic asthma may occur.

Prof. Dr. Hamelmann: How is asthma diagnosed

The examination in Germany always starts with a detailed conversation with the doctor. It is not just about the symptoms of the disease. The physician also asks about illnesses in the family and existing allergies to get a comprehensive picture. Depending on the assumption, the doctor has a large number of examination options available after the initial consultation. Prof. Dr. Eckart Hamelmann is a Senior Consultant at the Evangelical Bethel Clinic in Bielefeld, where most asthmatic patients in Germany are treated. In an interview, he names the most important methods for the diagnosis of bronchial asthma:

Bodyplethysmograph; ©Stan3000

Pulmonary function test
To test lung performance, pulmonary function testing is a top priority if asthma is suspected. The patient sits down in a closed glass cabin (in the body plethysmographs) and the doctor instructs him to breathe variously into the mouthpiece of a device. Depending on the breathing, the doctor can determine the tidal volume. Most important here is the measurement of so-called second air (FEV1). The more the bronchi are narrowed, the less air you can exhale per second.

Allergy-Lab test
Because asthma is often caused by allergy, skin tests and blood tests are performed to detect hypersensitivity to certain substances. In the skin prick test, various test substances are applied to the skin in the form of droplets. Then the skin is scratched with a lancet. If small swellings appear after a few minutes, this indicates an allergy to the substance. However, as the respective allergy is not necessarily responsible for the development of asthma attacks, further tests may be necessary.


Sweat test
In order to exclude more serious metabolic diseases such as cystic fibrosis, the so-called sweat test is performed in patients with severe asthma. The sweat glands are stimulated with the medicine pilocarpine. Then a mullet is placed on the forearm to collect the sweat for 30 minutes. This procedure is safe and painless and can also be used on very young infants from the 3rd day of life. In the collected sweat, the content of chloride can be measured. If the chloride concentration is high, cystic fibrosis is suspected.
Lungs X-Ray

An X-ray of the ribcage may also be necessary to treat other diseases, e.g. to exclude pneumonia. After completing all the necessary examinations and controls, the doctor will design a treatment plan that will specify medications and other measures.

Construction of therapy

At the beginning of the therapy there is a detailed asthma training, in which one learns everything about the handling of the illness in the own, particular life situation. The physicians show and practice inhalation methods with the patient, discuss effective measures to prevent asthma attacks and determine the medication plan. It is particularly important in this phase of the therapy that the patient understands all explanations of the physician. Therefore, a professional medical interpreter is essential, especially for asthma patients.

Non-drug measures:
In asthma, the life situation of the patient also plays a major role, therefore, the drug therapy is only one component of the healing success. During the treatment, for example, doctors ask whether, as a patient, you are often in stressful situations and how often you do sports. Because physical training and the wrong handling of stressful or anxious states can promote asthma. The life situation also plays a role. Thus, asthmatic seizures can be quite simply related to an animal hair allergy, which requires the separation from a pet. Also some habits, such as smoking, are very harmful especially in asthmatics. The doctor discusses ways in which such asthma-promoting habits can be reduced or discarded.
Drug measures:
The intake of medication is part of the therapy for bronchial asthma. Basically, one differentiates between two groups of asthma medications.
1. Controllers have a long-term effect
Controllers reduce the inflammation of the bronchi and weaken existing inflammation of the airways. For controllers to work, they must be taken regularly and over a longer period of time. According to the German pneumologists, glucocorticoids are the most effective controllers. Glucocorticoids, also known as cortisone, have a similar anti-inflammatory effect as synthetic derivatives of the endogenous hormone cortisol. They are inhaled, in severe asthma, the drug is also administered as a tablet.
2. Relievers help immediately

While controllers do not necessarily have to be carried along, an asthmatic always has a reliever in his pocket. Relievers, within a few minutes relax the cramped bronchi in an asthma attack and dilate the airways. Most of the relievers are beta-2 sympathomimetics for inhalation, e.g. Fenoterol, salbutamol or terbutaline. Relievers relieve acute asthma very effectively, but they do not fight the underlying inflammation (like the controllers). In addition to these two groups of medicines, there are a number of other medicines in asthma therapy, such as leukotriene antagonists, chromones and aminophyllines, which are prescribed for more specific forms of asthma. In patients with severe allergic asthma, the antibody omalizum has recently been released for children. It is injected under the skin and binds the immunoglobulin E, which is involved in the allergic reaction of the patient. Omalizumab is therefore not aimed at combating inflammatory messengers, but at another antibody. Accordingly, it is only approved for allergy sufferers who are affected year round.

Treatment costs in Germany

Basically, one must differentiate in the cost of asthma whether it is the treatment of an allergic shock, which must be treated immediately in the hospital or whether it is about the long-term asthma treatment with a general practitioner. It is also possible to stay in a rehab clinic for asthma patients. Depending on where the treatment takes place, different billing catalogs apply. A doctor in Germany, calculates according to the scale of fees for doctors and in the hospital, it depends on whether the patient is hospitalized, then paid according to the case flat rate catalog. In the case of outpatient care in the hospital, the AOP catalog is consulted on invoicing. The calculation of the exact costs when visiting a doctor in the practice or a rehab clinic is very difficult, because many measures are set individually and therefore the billed costs are very different. To get an impression of standard examinations by a general practitioner, here are the costs of the four of Prof. Dr. med. Hamelmanns diagnostic measures, when performed at a doctor’s office.

Cost of various diagnostic methods in asthma (private specialist)

In addition, the doctor also fees for advice and additional tests. Depending on which therapy has been agreed to, costs of drugs and specialized therapies, such as art therapy, music therapy, occupational therapy or physiotherapy are added.

In hospitals, an average price of € 2,322 is the most common for asthma patients. This includes the emergency care of an asthma patient at home and the subsequent care of the patient. On average, for this treatment price, the patient stays in the hospital for 6 days. Individual services according to needs have additional costs, therefore, the price shown above can also be regarded only as a rough guide.

Distribution of costs in the clinical treatment of asthma *

In international comparison, treatment costs in Germany are overall low, considering its high technical standards and excellent training of the doctors. In the U.S.A., for example, a comparable treatment costs twice as much or more.