Asthma and Allergy Clinic

Asthma affects all age groups. It is important to consider the age at which it begins: before or after 30 years. Early-onset asthma is often allergic, more common in boys, and usually (but not always) less severe. It may disappear in adulthood. Asthma that develops after 30 is usually non-allergic (though it can be), more common in women, and often more unpredictable. Contrary to common belief, asthma can also develop at an advanced age.

The severity of asthma requires several months of observation to be defined and may change over time. Allergic asthma is often associated with allergic rhinitis, which should be properly treated to improve asthma control. The connection between lower airways (asthma) and upper airways (rhinitis, sinusitis, nasal polyps) is so important that joint consultations are offered every two weeks.

From a pathophysiological perspective, the airways of asthma patients are affected by inflammation and bronchospasm, varying in intensity over time and usually reversible with treatment or sometimes spontaneously.

Airway obstruction and inflammation cause asthma symptoms, which are non-specific and include shortness of breath, cough, sputum production, wheezing, and chest pain. These symptoms occur more often at night and may appear as attacks or become chronic.

Management begins with a detailed history to identify triggering circumstances, especially possible allergic causes (dust, animals, seasonal factors such as pollen), and to assess lifestyle factors (smoking, sports, occupation).

In addition to clinical examination, tests are performed to confirm the diagnosis, assess inflammation and allergic status, and characterize the asthma type. The main test is a pulmonary function test to demonstrate airway obstruction and its reversibility with bronchodilators. Outside of attacks, results may be normal, requiring a bronchial provocation test.

Because asthma is also an inflammatory disease, airway inflammation is assessed by measuring nitric oxide (NO) in exhaled air. This is a simple and harmless test. Inflammation can also be evaluated through blood tests or, less commonly, induced sputum analysis.

The allergic nature of asthma is confirmed through specific tests. Skin prick testing is the preferred method: allergen extracts are introduced into the skin, and results are read after 20 minutes. A positive reaction causes redness, slight swelling, and itching. This method is quick, painless, and suitable even for young children. Blood tests can also provide this information.

Highly effective inhaled treatments have been available for about twenty years. These combine an anti-inflammatory drug (inhaled corticosteroid) and a bronchodilator. Proper inhaler use is essential and must be taught by qualified staff. The clinic provides an “Asthma School” for this purpose.

When allergic rhinitis is present, antihistamines or nasal corticosteroids improve symptoms and asthma control. Allergen immunotherapy (desensitization) may be proposed, involving gradually increasing doses of the allergen to build tolerance.

Significant progress has been made in treating severe asthma over the past 15 years. Biological therapies (injections) target specific mechanisms and are tailored to different asthma types. They are costly and subject to strict reimbursement criteria.

The clinic also manages other allergies, including food, drug, and insect venom allergies. About one in two people will experience an allergic reaction during their lifetime. Diagnosis may involve skin tests, blood tests, and oral provocation tests under medical supervision, as well as controlled desensitization procedures in hospital settings.