Bronchial asthma in children is a respiratory tract disease associated with inflammatory processes occurring there. Under the influence of an external stimulus, most often an allergen, a spasm occurs, causing suffocation.
In pediatrics, the diagnosis of “bronchial asthma” in most cases is made to patients over the age of 2 years. The disease is most often associated with a genetic predisposition.
If this pathology has already been encountered in relatives, it means that it is highly likely that the child will have the same diagnosis.
Bronchial asthma in a child
Bronchial asthma in children occurs with alternating states of exacerbation and remission. Moreover, the frequency and duration of each of the periods is associated with the individual characteristics of the child’s body.
Asthma is not contagious. If a child develops a cough and wheezing after contact with a patient with similar symptoms, this is not asthma. Most likely, this is bronchial obstruction caused by an infectious disease of the bronchi.
In order for a child to be diagnosed with bronchial asthma, it is necessary to conduct a series of tests and examinations. Despite the fact that this disease does not make a child disabled, it requires compliance with a number of restrictions.
They are related to food, lifestyle and living conditions. The main task of parents is to provide the child with such conditions under which asthma attacks will occur as rarely as possible.
Classification of the disease
There are several classifications of bronchial asthma in children.
In the first case, asthma is classified based on the underlying cause of the disease. In this case, the following forms of the disease are distinguished:
- Allergic BA. It is associated with allergic reactions to a particular irritant. It manifests itself as a cough, sometimes accompanied by a runny nose. In this case, the discharge from the nose is transparent. The patient may sneeze and complain of nasal congestion. Most often it appears due to allergens such as animal hair, dust, pollen, and other types of exogenous irritants.
- AD not associated with allergies. It occurs due to contact with non-protein substances. Most often these are drugs, chemicals. This type of BA also includes pathologies associated with psychoemotional shocks caused by physical exertion, resulting from disruption of the endocrine system and from damage by pathogens.
- Mixed type BA. In this case, asthmatic symptoms can be both a reaction to an allergen and other factors.
Usually, when diagnosing bronchial asthma in children, the severity of the disease is determined. In this case, there are:
- Easy degree. At this stage, bouts of the disease are rare. They are quickly and easily docked. At night, the disease almost never bothers the child. Physical activity is allowed and easily tolerated. When a state of remission occurs, there are no signs of the disease at all.
- Moderate degree. In this case, the manifestations of bronchial asthma in a child are more pronounced. Attacks are disturbing about once every seven days. To stop them, bronchodilators are required. Night attacks are more frequent. Physical activity is limited. Without drug therapy, even in the stage of remission, respiratory dysfunctions are observed.
- Severe disease. Asthma flares are very frequent. The attacks are repeated several times a week and can be severe and prolonged. Requires daily corticosteroid medication. Asthmatic manifestations are observed every night. Sleep is disturbed. Physical activity is difficult to bear. There are no periods of remission.
If an asthma attack cannot be stopped for several hours, the condition is called status asthmaticus. In this case, immediate hospitalization is required.
Causes of pathology and risk factors
The etiology of bronchial asthma in children is well understood. The main causes and risk factors are highlighted.
Bronchial asthma in a child can occur due to a genetic predisposition, as well as under the influence of external factors. It has been established that the majority of children diagnosed with bronchial asthma have relatives with such diseases as:
- hay fever;
- atypical dermatitis;
- food allergy;
- other types of pathologies associated with allergies.
The disease does not manifest itself in all children with a burdened heredity. However, there are certain factors that increase the likelihood of developing AD. These include:
- severe pregnancy;
- protracted and complicated labor;
- premature birth, when the baby is born prematurely;
- bad ecology.
In addition, another important cause of bronchial asthma in children is the effect of various irritants.
- saliva, wool, fluff, excretions of animals and birds;
- household chemicals;
- food allergens;
- causative agents of infectious diseases;
- perfumery, etc.
In the first years of a child’s life, allergens enter the body mainly with food. In older children, other stimuli are added. For example, you may be allergic to dust or pollen.
A micro mite that lives in house dust can also provoke a spasm of the bronchi. You should also beware of reactions to bird feathers and various mold. However, even if all sources of allergens are removed from the apartment, they will remain in the apartment for a long time.
Smoking is a very serious factor that can cause bronchial asthma in a child. Tobacco smoke is a strong allergen. Children of parents who smoke have a tenfold increase in the risk of the disease.
Also, the risk of developing the disease is increased by respiratory diseases of various nature. Obstructive bronchitis, which recurs over and over again, can provoke asthma.
Overheating and hypothermia also have a detrimental effect on the state of the body.
A strong emotional shock in a child – fear, stress, scandals in the family – is a risk factor for the development of bronchial asthma.
It is also important to mention aspirin asthma. Taking acetylsalicylic acid (although the medication itself is not an allergen) can cause a choking attack in a child.
A variety of diseases of the gastrointestinal tract can worsen the course of asthma. For example, gastroesophageal reflux causes nocturnal seizures.
Symptoms of bronchial asthma in children of different ages
Based on the general symptoms, there are three main periods during bronchial asthma:
Symptoms of bronchial asthma in this period in children are either completely absent or mild. However, if asthma starts at a very early age or is very severe, developmental delays may occur due to lack of oxygen during attacks during exacerbations.
In this case, the child can be very tearful and emotionally unstable, even when nothing bothers him. Remission is complete, incomplete, and pharmacological.
With complete remission, the symptoms are completely absent, the child feels healthy. Incomplete is characterized by limited physical activity and minor manifestations.
Pharmacological occurs with constant drug treatment.
It is characterized by repeated attacks of bronchial asthma in a child of varying severity and duration. It is during this period that diagnostics are carried out and the severity of the disease is established.
In this state, such symptoms of bronchial asthma in children as cough, a state of suffocation, difficulty in inhaling and exhaling are manifested. An attack in children most often begins at night or in the evening, and is preceded by specific manifestations.
The main symptom by which one can assume bronchial asthma in a child is the onset of an attack.
In the early stages, children experience the so-called pre-attack symptoms of bronchial asthma, lasting up to three days. These include:
- appetite disorders;
- sleep problems;
- slight clear discharge from the nose;
- dry cough that gets wet over time;
All this is followed by the attack itself. It is characterized by:
- dry cough, ameliorated by standing upright;
- wheezing difficulty;
- increased heart rate;
- pallor of the skin, cyanosis.
At the beginning of the disease, the attack stops itself after a while. However, you should not wait for this, it is necessary to give the child bronchodilators. Lack of oxygen is detrimental to the child’s body. After the end of the attack, the cough becomes wet, the child begins to cough up.
It should be borne in mind that there are characteristic features of the course of bronchial asthma in children of early and older age:
- In infants. At this age, asthma is difficult to diagnose, as it proceeds differently than in children of other age groups. The child develops clear nasal discharge. On examination, the doctor may notice swelling of the tonsils and wheezing in the area above the lungs. The child’s sleep is disturbed, he becomes more irritable. Stool disturbance is possible. Inhales become frequent and short. When exhaling, a whistle is heard.
- Child’s age from one to 6 years. The first signs of asthma development in children at this age become more pronounced and easily diagnosed. These include: sleep disturbance, intermittent cough, often appearing in sleep. After physical exertion, the child may complain of heaviness in the chest.
- School age. Most often, you can observe a cough at night or after exercise. The child tries to avoid active games. When coughing, a characteristic posture is observed: an emphasis on the hands in a sitting position.
- In adolescents. Most often, by this age, the disease has already manifested itself, and the diagnosis has been established. Very often during this period a long remission occurs, and it seems that the disease has passed. However, it is not. The increased sensitivity of the bronchi persists, and the disease is waiting in the wings. It often happens that forgotten symptoms return already in adulthood.
Potential consequences and complications
Attacks of bronchial asthma, constantly recurring in children, can cause a variety of complications.
They are classified into 2 types:
- Complications associated with disruption of the respiratory system. Most often it is pulmonary emphysema, atelectasis, pneumothorax, or respiratory failure.
- Complications associated with impaired heart function. In this case, an increase in blood pressure in its right parts (associated with the supply of blood to the lungs), as well as heart failure or tissue edema, is possible.
Diagnosis of bronchial asthma is carried out in children, taking into account both hereditary factors and allergic history. A pulmonologist should be consulted if at least one sign of bronchial asthma is detected .
A doctor’s consultation is necessary if children have:
- Every cold is accompanied by a dry cough and wheezing. In this case, a diagnosis of “broncho-obstructive syndrome” is made.
- Dry cough and wheezing are seasonal and appear during the period of active flowering of plants.
- When the body responds to physical activity, taking medications and the manifestation of strong emotions by coughing and shortness of breath.
The main type of examination that is carried out to diagnose bronchial asthma in a child is peak flowmetry. With its help, the maximum expiratory flow rate is estimated to determine the state of the bronchi.
This examination is prescribed when the child is at least 5 years old. It used to be difficult for a child to explain what is required of him. Measurements are carried out in the hospital and at home.
At the same time, it is important to keep a schedule of the daily routine, as well as to record all medications and food taken. This will reveal the factors influencing the development of the attack.
In addition, the examination is carried out:
- tests with bronchodilators and exercise (veloergometry);
- X-ray of the lungs;
- X-rays of other organs of the chest.
Laboratory tests are also of great diagnostic value:
- clinical blood test;
- clinical analysis of urine;
- general sputum analysis;
- determination of IgE;
- study of the gas composition of blood.
Skin tests for allergens are equally important in diagnosing asthma.
The examination allows to exclude other diseases associated with bronchial obstruction.
Many parents are wondering how to properly treat bronchial asthma in children.
For this, drug therapy is used to reduce the number of seizures, and non-drug methods are used to reduce the manifestations of the disease and prolong the period of remission.
First of all, it is important to understand that it is impossible to completely cure bronchial asthma. There are a number of steps you can take to manage symptoms and prevent flare-ups.
To choose the optimal approach, you should consult a doctor who will tell you in detail how to treat the pathology and how to properly organize the child’s life in order to achieve a state of remission.
Emergency help for an attack of bronchial asthma
Parents should be clear about how the child shows the first signs of an attack. When diagnosed with bronchial asthma in children, it is required to understand that first aid is vital.
First of all, you need to carefully examine the child, you should also analyze his breathing:
- normally, the respiratory rate does not exceed 20 breaths per minute;
- shoulder muscles should not be involved in the breathing process;
- before the attack, the expansion of the nostrils can be noted;
- you should be alert if your breathing is hoarse;
- during an attack of bronchial asthma, a dry cough begins;
- if the skin turns pale, and around the lips has acquired a bluish tint, the child has an attack.
To alleviate the condition of the child, it is required to sit him on a chair. It is important to provide fresh air. Even if the attack is mild, it is still recommended to call an ambulance.
While waiting for a doctor, the child should be reassured.
If there are medications nearby, the attack helps to stop the inhaler with bronchodilators – salbutamol, ipratropium bromide.
When stopping an attack of bronchial asthma in children, a strict dosage of a bronchodilator is important. Overdose can lead to status asthmaticus. And this is dangerous for the child’s life.
Treatment of bronchial asthma in children and adolescents includes several areas:
- hormone therapy;
- non-hormonal therapy;
- additional medicines.
Non-hormonal therapy includes the following types of drugs:
- Mast cell membrane stabilizers. Their action is aimed at reducing mucosal edema. However, the effect is cumulative. Sometimes it is necessary to take medication for at least several months. The drugs of this group cannot stop the attack, but they are effective for maintaining the state of remission.
- Antihistamines. They prevent the development of an allergic reaction. The course of treatment lasts at least one month.
- Leukotriene receptor antagonists. They include the active ingredient zafirlukast or montelukast. Most effective for aspirin asthma or an exercise-induced attack.
Hormonal basic therapy for bronchial asthma is prescribed for frequently recurring attacks, when children may develop status asthma, despite the prescribed non-hormonal treatment.
They are effective anti-inflammatory drugs, but addictive with prolonged use. After some time, an increase in dosage may be required. Development of fungal stomatitis is also possible.
Non-drug treatments for bronchial asthma
In addition to taking medications, other methods are used to treat bronchial asthma in a child. Good results are obtained:
- breathing exercises;
Also, pediatricians note the high efficiency of allergen-specific immunotherapy. But she has an age limit.
The child must be at least 5 years old. The essence of the method is that an asthmatic child is injected with a microdose of an allergen that provokes an asthma attack. By gradually increasing the dose, the body is “accustomed” to the allergen. The course lasts at least three months.
Also, a child with asthma must be provided with a diet. It is required to reduce the intake of carbohydrates and eliminate allergenic foods from the diet.
Predictions for bronchial asthma in children are given by a doctor. According to statistics, in 30% of cases it passes after the onset of puberty.
In other cases, the patient is sick all his life. Someone needs lifelong drug therapy, someone does with prophylactic means. But there is always a risk that the remission stage will stop, and a period of exacerbation will begin.
In severe BA, the child develops hormonal dependence, which can lead to disability. However, with timely treatment started, the prognosis is favorable.
Prevention of bronchial asthma in children
Preventive measures are very important to maintain a satisfactory condition in a child suffering from bronchial asthma. It is important to increase immunity, preventing the development of infectious diseases.
All objects that can cause an allergic reaction should be removed from the house where the sick child lives. It is important to try to maintain a calm atmosphere in the family, protecting the child from unnecessary stress.