Bronchial asthma in a child occurs with the participation of genetic susceptibility and environmental factors. Most children with asthma have burdened heredity for allergic diseases – hay fever, atopic dermatitis, food allergies, etc.
Sensitizing environmental factors may be inhalation and food allergens, bacterial and viral infections, chemicals and drugs. Inhaled allergens that provoke bronchial asthma in children are more likely to be house and book dust, animal dander, household ticks, mold fungi, dry food for animals or fish, pollen of flowering trees and herbs.
Food allergies cause bronchial asthma in children in 4-6% of cases. Most often this contributes to the early transfer to artificial feeding, intolerance to animal protein, plant products, artificial dyes, etc. Food allergies in children often develops on the background of gastrointestinal diseases: gastritis, enterocolitis, pancreatitis, intestinal dysbacteriosis.
Triggers of bronchial asthma in children can be viruses – pathogens of parainfluenza, influenza, acute respiratory viral infections, as well as a bacterial infection (streptococcus, staphylococcus, pneumococcus, klebsiella, neisseria), chlamydia, mycoplasmas and other microorganisms colonizing the bronchial mucosa. In some children with asthma, sensitization may be caused by industrial allergens, medication (antibiotics, sulfonamides, vitamins, etc.).
Inflammation, cold air, meteosensitivity, tobacco smoke, physical exertion, emotional stress can be factors of exacerbation of bronchial asthma in children, provoking the development of bronchospasm.
In the pathogenesis of bronchial asthma in children, there are: immunological, immunochemical, pathophysiological and conditioned reflex phases. In the immunological stage, under the influence of an allergen, antibodies of the IgE class are produced, which are fixed on target cells (mainly mast cells of the bronchial mucosa). In the immunochemical stage, repeated contact with the allergen is accompanied by its binding to IgE on the surface of the target cells.
This process proceeds with mast cell degranulation, activation of eosinophils and release of mediators with vasoactive and bronchospastic effect. In the pathophysiological stage of bronchial asthma in children, under the influence of mediators, edema of the bronchial mucosa, bronchospasm, inflammation and hypersecretion of mucus occurs. In the future, attacks of bronchial asthma in children arise by the conditioned-reflex mechanism.
Symptoms of bronchial asthma in a child
The course of bronchial asthma in children has a cyclical nature, in which there are periods of precursors, asthma attacks, post-criminal and interictal periods. During the precursor period, anxiety, sleep disturbance, headache, itching of the skin and eyes, nasal congestion, and dry cough may occur in children with asthma. The duration of the precursor period is from several minutes to several days.
Actually an attack of suffocation is accompanied by a feeling of constriction in the chest and lack of air, an expiratory dyspnea. Breathing becomes whistling, with the participation of auxiliary muscles; there are wheezing in the distance. During an attack of bronchial asthma, the child is frightened, assumes a position of orthopnea, cannot talk, catches air with his mouth. The skin of the face becomes pale with pronounced cyanosis of the nasolabial triangle and auricles, covered with cold sweat. During an attack of bronchial asthma in children, an unproductive cough with difficult to separate thick, viscous sputum is noted.
During auscultation, hard or weakened breathing is determined with a large number of dry wheezing; with percussion – boxed sound. On the part of the cardiovascular system revealed tachycardia, increased blood pressure, muffled heart sounds. With a duration of an attack of bronchial asthma of 6 hours or more, talk about the development of asthmatic status in children.
An attack of bronchial asthma in children ends with the discharge of thick sputum, which leads to easier breathing. Immediately after the attack, the child feels sleepy, weak; he is slowed down and lethargic. Tachycardia is replaced by bradycardia, increased blood pressure – arterial hypotension.
During interictal periods, children with asthma may feel almost normal. According to the severity of the clinical course, there are 3 degrees of bronchial asthma in children (based on the frequency of seizures and indicators of respiratory function). With a mild degree of asthma in children, asthma attacks are rare (less than 1 time per month) and are quickly stopped. During interictal periods, general state of health is not disturbed, spirometry indicators correspond to the age norm.
The moderate degree of bronchial asthma in children proceeds with a frequency of exacerbations 3-4 times a month; spirometry rates are 80-60% of normal. With severe bronchial asthma, choking attacks in children occur 3-4 times a month; indicators of respiratory function are less than 60% of the age norm.
Diagnosis of bronchial asthma in a child
When making a diagnosis of bronchial asthma in children take into account the data of family and allergic history, physical, instrumental and laboratory examination. Diagnosis of bronchial asthma in children requires the participation of various specialists: a pediatrician, a pediatric pulmonologist, a children’s allergist-immunologist.
The complex of instrumental examination includes spirometry (children over 5 years old), tests with bronchodilators and exercise (bicycle ergometry), peak flow measurements, and radiography of the lungs and chest organs.
Laboratory tests for suspected bronchial asthma in children include a clinical analysis of blood and urine, a general analysis of sputum, determination of total and specific IgE, a study of blood gas composition. An important part of the diagnosis of bronchial asthma in children is the production of skin allergy tests.
In the process of diagnosis, it is necessary to exclude other diseases in children with bronchial obstruction: foreign bodies of the bronchi, tracheo-and bronchomalacia, cystic fibrosis, bronchiolitis obliterans, obstructive bronchitis, bronchogenic cysts, etc.
Treatment of bronchial asthma in a child
The main directions of treatment of bronchial asthma in children include: identification and elimination of allergens, rational drug therapy aimed at reducing the number of exacerbations and relief of asthma attacks, non-drug restorative therapy.
When identifying bronchial asthma in children, first of all, it is necessary to exclude contact with factors that provoke an exacerbation of the disease. For this purpose, a hypoallergenic diet, organization of a hypoallergenic life, withdrawal of medicines, separation from pets, change of residence, etc. may be recommended. Long-term prophylactic administration of antihistamines is indicated. If it is not possible to get rid of potential allergens, specific immunotherapy is carried out, suggesting desensitization of the body by administering (sublingual, oral or parenteral) gradually increasing doses of cause-significant allergen.
The basis of drug therapy for bronchial asthma in children is inhalation of mast cell membrane stabilizers (nedocromil, cromoglicic acid), glucocorticoids (beclomethasone, fluticasone, flunisolide, budesonide, etc.), bronchodilators (salbutamol, fenoterol), combined drugs. Selection of treatment regimen, combination of drugs and dosage is carried out by a doctor. An indicator of the effectiveness of treatment of bronchial asthma in children is a long-term remission and the absence of disease progression.
With the development of an attack of bronchial asthma in children, repeated inhalations of bronchodilators, oxygen therapy, nebulizer therapy, parenteral administration of glucocorticoids are performed.
In the interictal period, children with bronchial asthma are prescribed physical therapy courses (aeroionotherapy, inductothermia, UHF-therapy, magnetic therapy, electrophoresis, phonophoresis), hydrotherapy, chest massage, acupressure, respiratory gymnastics, speleotherapy, etc. Homeopathic therapy in some cases helps prevent relapses diseases and reduce the dose of hormonal drugs. Selection and prescription of drugs is carried out by a children’s homeopath.
Manifestations of bronchial asthma in children may decrease, disappear or increase after puberty. 60-80% of children have bronchial asthma for life. Severe asthma in children leads to hormonal dependence and disability. The course and prognosis of treatment affect the course and prognosis of asthma.
Prevention of bronchial asthma in children includes the timely identification and elimination of causely significant allergens, specific and nonspecific immunization, treatment of allergies. It is necessary to train parents and children in methods of regular monitoring of the condition of bronchial patency using peak flowmetry
Bronchial asthma in children is a chronic allergic disease of the respiratory tract, accompanied by inflammation and changes in the reactivity of the bronchi, as well as the resulting bronchial obstruction. Bronchial asthma in children occurs with symptoms of expiratory dyspnea, wheezing, paroxysmal cough, choking episodes.
The diagnosis of bronchial asthma in children is established taking into account the allergic history; spirometry, peak flow measurements, chest X-ray, skin allergy tests; determination of IgE, blood gas composition, sputum examination. Treatment of bronchial asthma in children involves the elimination of allergens, the use of aerosol bronchodilators and anti-inflammatory drugs, antihistamines, specific immunotherapy.
Bronchial asthma in children is a chronic allergic (infectious-allergic) inflammatory process in the bronchi, leading to a reversible violation of bronchial permeability. Bronchial asthma occurs in children from different geographic regions in 5-10% of cases.
Bronchial asthma in children often develops at preschool age (80%); Often the first attacks occur in the first year of life. Studying the characteristics of the occurrence, course, diagnosis and treatment of bronchial asthma in children requires an interdisciplinary interaction of pediatrics, pediatric pulmonology and allergology-immunology.