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.
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
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:
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.
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.
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.
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.