What is Bronchoconstriction?

Sports-playing boy using asthma inhaler
Sports-playing boy using asthma inhaler. Getty Images/Gary Ombler/Dorling Kindersley

Bronchoconstriction is the medical term for the narrowing of the airways that occurs in an asthma attack.

The bronchioles or tubes that air flows into and out of the lungs are surrounded by a type of muscle called smooth muscle. In asthmatics, these muscles often squeeze tighter in reaction to certain triggers and the inflammation associated with worsening asthma. As the bronchioles narrow, blocking airflow and making it harder to breathe, you may develop other symptoms such as shortness of breath, wheezing, cough, chest tightness, and even asthma attacks in some cases.

Why Do I Get Bronchoconstriction?

The narrowing of the airways and subsequent symptoms associated with bronchoconstriction happens inside the tubes that allow air to flow into the lungs when you breathe in and vice versa. Smooth muscles constrict or shorten when you are exposed to triggers. This exposure results in inflammation that further narrows your lung's airways. Asthma treatments are focused on either acutely improving bronchoconstriction or preventing the narrowing altogether.

How to Prevent and Treat Bronchoconstriction

Bronchoconstriction and the symptoms that follow are the most frequent and immediate results after being exposed to an asthma trigger. Understanding what is going on, why the process is occurring, and treatments for bronchoconstriction are among the most important skills for asthmatics to maintain control of their asthma.

The first and best way to treat bronchoconstriction is to avoid it all together.

The most comprehensive and complete way to do this is to h ave an asthma action plan. This plan is your roadmap to asthma control. It outlines your goals and the steps you need to take to achieve them.

The first step is to understand what triggers your asthma and to avoid those triggers. While this sounds easy, it is not always as easy as it sounds.

Many times you need to act like a detective and record your symptoms. When you then look at your symptoms over time the picture about what is causing your symptoms is more clear. For example, I once had a patient that only developed symptoms when they were exposed to freshly cut grass. It was not until her parents looked at her symptoms over time that they were able to see the pattern.

Diet can also impact bronchoconstriction. High intake of sodium has been associated with bronchoconstriction, while high dose of omega-3 fish oils may decrease the risk. As such watching your sodium and supplementing with omega-3s or getting more in your natural diet may limit some symptoms.

Rescue inhalers are the first medication that many patients will use to treat asthma symptoms from bronchoconstriction. By relaxing smooth muscle in the lung, bronchoconstriction decreases, airflow obstruction decreases, and breathing becomes easier. These medications functionally create a bigger tube for air to flow through.

Once rescue inhalers are not sufficient to keep your symptoms under control (generally defined as needing to use a rescue inhaler more than twice per week or needing to get a new prescription refill in less than a month), most doctors will prescribe an inhaled steroid.

Inhaled corticosteroids or ICS  are the most effective and potent anti-inflammatory medications for the prevention of asthma symptoms. ICS is the current standard of care once you need more than a rescue inhaler for the acute relief of asthma symptoms. Inhaled corticosteroids increase asthma control better than and more effectively than any other form of monotherapy.

Activity and Bronchoconstriction

If you participate in sports or just have an active lifestyle, I have several suggestions when trying to avoid or prevent bronchoconstriction. Sports that have short bursts of exercise (or low minute ventilation) versus endurance sports like long distance running may be easier on the lungs.

Such sports include things such as wrestling, sprinting, football. This does not mean that you cannot participate in endurance sports, but you may have more issues and will need to make sure you take appropriate precautions.

Soccer, basketball, and hockey and similar endurance type activities can all be very difficult for asthmatics. It is essential that you, your coaches, and fellow participants know that you have asthma and what to do if you are not able to communicate. Make sure you have an adequate warm up period help prevent exercise induced asthma symptoms.

Cold weather exercise is generally more difficult for those who suffer from asthma. Heat exchange masks (Make sure you talk with your doctor if you think you might want to try out this way to decrease exposure to cold weather), limiting the amount of cold air exposure through things like scarfs, exercising when it is warmest, and using a rescue inhaler before venturing out into the cold  are all things you can do to prevent symptoms.

Source:

MA.Krafczyk. Exercise-Induced Bronchoconstriction: Diagnosis and Management. January 16, 2016.

National Heart, Lung, and Blood Institute. Accessed: January 16, 2016. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma

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