What is bronchospasm?

Causes, diagnosis, and treatment of this respiratory condition.

Bronchospasm happens when the bronchial muscles in the lungs contract erratically. This results in a restriction of the airways and a patient will find it hard to breathe because less air reaches the lungs. The feeling has been described as trying to breathe through an obstructed snorkel when underwater. Bronchospasms are reversible.

 

Many asthmatics suffer from bronchospasms, but it could affect patients with other airway-related conditions. It’s often reported in patients over the age of 65 years and children. Exercise-induced bronchospasms are observed in athletes because strenuous physical activity leads to a temporary contraction of the bronchial muscle.

 

What causes bronchospasm?

Certain underlying medical conditions, medications, allergies and exercise can cause bronchospasms. The most common causes include:

 

Medical conditions

  • Asthma
  • Chronic obstructive pulmonary disorder
  • Chronic bronchitis
  • Emphysema
  • Lung or viral infections

 

Environmental causes

  • Smoking
  • Dust and air pollution
  • Chemical fumes (e.g. cleaning products, paints)
  • Cold air/weather

 

Allergens

  • Mold
  • Dust mites
  • Pet dander
  • Pollen
  • Foods

 

Medications

  • Anaesthetics
  • Antibiotics
  • Blood pressure medications

 

Other causes

  • Exercise

 

The prevalence of exercise-induced bronchospasm is quite high at 5% to 20% of the population and a much higher prevalence in asthmatics. Scientists have found that it is particularly common among children (45%) and could be a predictor for asthma in some kids.

 

When air is inhaled during exercise, the nose tries to warm up the air, but with increasing exercise duration and exertion, the heat is lost which cools down the airways and causes our parasympathetic nervous system to restrict the muscles. That’s also why it is so painful to breathe in cold air.

 

What are the symptoms of bronchospasm?

The most commonly observed symptoms of bronchospasm include:

 

  • Difficulty breathing
  • Wheezing
  • Coughing
  • Tightness in the chest

 

Symptoms may get worse depending on the severity of your airway restriction. Severe cases require urgent medical attention. In severe bronchospasm, patients often don’t make any wheezing or breathing sounds because their airways are so restricted that very little air can pass.

 

How is bronchospasm diagnosed?

Your doctor will usually examine your medical history and ask about asthma and other medical conditions as well as any allergies you may have. There are a variety of breathing tests a healthcare provider can perform to establish if further medical tests are required.

 

  • Lung function and volume tests. Spirometry is a common test to determine lung function. It measures how much air a patient breathes out into a mouthpiece that’s connected to a computer. The test determines how well a patient’s lungs are working.
  • Pulse oximetry. People living with asthma or other lung conditions usually have less oxygen in their blood. The pulse oximeter is a little device that can be clipped onto the finger to measure the oxygen level in blood. It can also check for hypoxemia.
  • Blood gas test. Another way to measure how much oxygen and carbon dioxide are present in a patient’s blood is to draw a small amount of blood and perform an arterial blood gas test.
  • Chest x-ray. A chest x-ray is usually ordered to check whether a patient has an infection or respiratory obstruction.
  • CAT scan. Computerized tomography (CT or CAT) scans usually take multiple x-ray measurements to process into a single image of the lung.

 

What are the treatments for bronchospasm?

Treatment of bronchospasms will depend on the severity and the causes.

 

Patients with exercise-induced bronchospasms without asthma are advised to prevent bronchospasms by reducing their exercise regime or restricting exercise to warmer locations. A good physical warm-up before exercise has also been shown to be beneficial in reducing the severity of bronchospasm.

 

Prevention of bronchospasms is recommended in all cases. Patients should avoid triggers, other people who are sick and reduce lung irritation by breathing through their nose when walking in cold weather.

 

To manage bronchospasms, a healthcare provider can prescribe bronchodilators. The medication is used to relax the smooth muscles and widen the airways. Inhaled bronchodilators are recommended as they act faster than tablets or shots.

 

There are three types of bronchodilators:

  • Beta-2 agonists (including formoterol, salbutamol, salmeterol, and vilanterol)
  • Anticholinergics (including aclidinium, glycopyrronium and tiotropium)
  • Theophylline

 

Short-acting bronchodilators are used for fast relief from bronchospasms. They are taken as soon as an attack occurs to provide immediate relief. Some athletes use short-acting bronchodilators before they exercise to avoid bronchospasm. Their action lasts from 2 to 4 hours.

 

However, if you are using your short-term bronchodilators more than twice a week it may be a sign of asthma. Speak to a doctor.

 

Long-acting bronchodilators can be used every day to manage symptoms long term. They are usually prescribed if you suffer from severe or recurring bronchospasms alongside asthma. Typically, they are used twice a day.

 

Common side effects of all types of bronchodilators include:

  • Nausea
  • Rapid heart rate/palpitations
  • Sleep troubles
  • Shakiness or nervousness
  • Achy muscles

 

If you experience any uncommon side effects or your condition isn’t improving, get urgent medical care.

 

References

  1. Benca, J. (2007). Bronchospasm. Complications in Anesthesia, 189–192. https://doi.org/10.1016/b978-1-4160-2215-2.50051-x
  2. Caggiano, S., Cutrera, R., Di Marco, A., & Turchetta, A. (2017). Exercise-Induced Bronchospasm and Allergy. Frontiers in Pediatrics, 5. https://doi.org/10.3389/fped.2017.00131
  3. Scott, S. (2008). Exercise-Induced Bronchospasm. ACSM’s Health & Fitness Journal, 12(2), 36–38. https://doi.org/10.1249/01.fit.0000312410.55378.58
  4. Rees, L. T. (1963). Bronchospasm during anaesthesia. Anaesthesia, 18(1), 103–104. https://doi.org/10.1111/j.1365-2044.1963.tb13711.x
  5. Aggarwal, B., Mulgirigama, A., & Berend, N. (2018). Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management. NPJ primary care respiratory medicine, 28(1), 31. https://doi.org/10.1038/s41533-018-0098-2
  6. Cazzola, M., Page, C. P., Calzetta, L., & Matera, M. G. (2012). Pharmacology and Therapeutics of Bronchodilators. Pharmacological Reviews, 64(3), 450–504. https://doi.org/10.1124/pr.111.004580

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