How to treat bronchial asthma in a child: first aid and methods of therapy

Bronchial asthma is an inflammatory disease of the bronchi with a chronic course, which is provoked by various allergens.

Parents who pay sufficient attention to caring for the child, his health, hygiene, nutrition, are perplexed when they hear this diagnosis from a doctor. It sounds like a sentence. What to do and how to treat asthma in a child?

In order for the treatment to be effective, it is necessary to understand the characteristics of the course, the symptoms of the disease and what provoking factors exist.

Features of bronchial asthma in children

Childhood asthma is characterized by the onset of initial symptoms in children under 5 years of age. But recently, cases have been recorded even in infants. Boys are more prone to developing the disease.

The disease can be triggered by the following factors:

• during intrauterine development – smoking of the mother or work in hazardous work;
• lack of breastfeeding;
• the presence of allergic diseases – atopic dermatitis, eczema;
• food allergies to cow’s milk protein, chicken protein, nuts, grains, red berries or fruits;
• household allergens – house dust and mites;
• frequent use of antibiotic therapy;
• bad ecology;
• underdevelopment or anomaly in the structure of the respiratory system;
• an allergic reaction to pet hair, bird fluff;
• more than 7-8 cases of ARVI per year, which may be accompanied by bronchial obstruction;
• the presence of allergic diseases or bronchial asthma in the next of kin.

The development of the disease in children under one year is often promoted by food allergens and concomitant dermatitis, at a later age – hay fever.

Symptoms of bronchial asthma in a child

For the convenience of diagnosis, symptoms are divided into age categories.

1. Manifestations in children under one year old: in the early stages, parents may pay attention to persistent nasal discharge, irritability and poor sleep in the child, cough that occurs in the early morning or at night.
2. Later, more formidable symptoms appear: the child refuses to breast or sucks sluggishly, attacks of suffocation occur, breathing becomes noisy, blue discoloration appears in the area of ​​the nasolabial triangle, and the cough is dry.
3. In children from one to six years of age: the first manifestations in the form of persistent cough during active games, prolonged coughing after treated with acute respiratory infections, fatigue, the onset of cough when inhaling through the mouth or from cool air.
4. Further, more obvious signs appear – the child complains of a loss of strength, pain or a feeling of squeezing in the chest area, refuses outdoor games. With the development of symptoms of bronchial obstruction, wheezing, dry cough with difficult sputum, difficulty exhaling and short inhalation appear, chest muscles become excessively mobile.
5. Symptoms in older children: at any time of the day, there may be a persistent dry cough with a sticky, thick sputum. Cyanosis appears under the eyes due to constant oxygen starvation of tissues. Lagging in physical development is possible. Children are inactive, afraid to provoke an attack. When it occurs, they take a forced posture: they sit down, tilting the body forward and resting their hands on the support.

To determine the severity of the disease, a table is used, which takes into account the frequency and duration of exacerbations, the presence of nocturnal attacks and the indicators of a functional test.

These data are necessary to determine the tactics of treatment and further prognosis.

Is it possible to cure asthma in a child

It is currently impossible to cure bronchial asthma forever with any drugs. Why then do the treatment at all? Objectives: 

1. Reduce the severity of the disease.
2. Reduce the frequency of exacerbations.
3. Start to relieve the attack and prevent its occurrence.
4. Improve the child’s quality of life.

Many practitioners assure that a child’s asthma can resolve on its own with the onset of puberty.

Prevention recommendations should not be disregarded, especially if the child has asthma- like symptoms that indicate bronchial involvement (cough, dry wheezing, shortness of breath or shortness of breath), but the diagnosis has not yet been made. If concomitant allergic manifestations are observed, prophylactic therapy with antihistamines is performed.

When diagnosed with bronchial asthma, prevention is aimed at reducing the frequency of exacerbations and involves the elimination of provoking factors:  

1. Removal of household allergens. Parents will have to take care of the cleanliness in the house twice: daily wet cleaning, change bedding at least 2 times a week, use laminate and linoleum instead of woolen carpets. Winter clothing and underwear must be made of artificial materials, free of fluff, fur and wool. Replace soft toys with rubber, wooden ones, or wash them more often.
2. Environmental factors. Perhaps a change of place of residence will solve the problem of the harmful effects of the environment.
3. ARVI prevention. Vaccinating the child, taking multivitamins and hardening the body will help reduce the harmful effect on the bronchi and reduce the frequency of attacks.
4. Food allergy. If it is detected, completely exclude foods containing a specific allergen from the diet. It is necessary to provide the child with a balanced diet.

With such measures, you can achieve long-term remission (the period of remission of the disease).

Treatment

Includes the methods of drug and non-drug therapy. The process is long, in some cases lifelong, so parents should be patient, not believe in miraculous pills and other treatments that can get rid of the disease at once.

Older asthmatic children need to be explained that this is a necessity, and with strict adherence to all recommendations, they will be able to live a full life.

Drug treatment

The goal of treatment is to relieve the onset of an attack in children and basic therapy in order to mitigate the course of the pathology. The drugs are taken orally, by injection, and by inhalation .

Symptomatic therapy is aimed at quickly relieving spasm in the bronchi, which caused the attack. Medicines are used to help dilate the bronchi ( bronchodilators ). The most preferred are:

• adrenergic agonists ( salbutamol , fenoterol);
• anticholinergics ( ipratropium bromide);
• methylxanthines , theophylline products;
• combined drugs – adrenergic agonist + anticholinergic ;
• hormonal drugs in inhalation form.

The group of the drug is determined by the doctor, taking into account the severity of the course, age, frequency of attacks, indicators of instrumental examination, the effectiveness of previously prescribed drugs.

The method of administration of drugs is preferably inhalation. The agent goes directly to the respiratory system and acts faster. There are special devices for delivering aerosol to the bronchi – this is a nebulizer. Thanks to the device, the substance does not settle on the back of the pharynx, but passes further along the airways. Asthmatics need such a device in the house.

Another device that makes it easier to administer asthma medications is a spacer . It allows you to use a smaller dose of the drug, but increases the efficiency of its penetration into the lungs by 2 times.

These medicines have only a temporary effect and are used in emergency cases. Uncontrolled use can lead to the emergence of resistance (resistance) with the next attack. Therefore, it is necessary to monitor older children who may abuse drugs for fear of an attack.

Basic therapy consists of drugs with anti-inflammatory and bronchodilatory effects. These include:

• long-acting bronchodilators ;
• systemic and inhalation hormonal agents;
• antileukotriene drugs;
• cromones ;
• anticytokine drugs.

The basic treatment is also selected by the doctor, taking into account the individual characteristics of the child. Parents should never cancel it or change the dosage. This is especially true for the systemic use of glucocorticosteroids . A number of serious side effects can occur when they are canceled.

Non-drug treatment

There have been no official clinical studies on the topic of non-drug methods, and there is no evidence base for these methods. But doctors note that children who managed to achieve a high effect in treatment, long-term remission and lasting results received additional therapy. It includes:

• physiotherapy procedures. Ultraviolet irradiation activates metabolism, improves tissue respiration. Acupuncture helps to produce hormones that help stop an attack in the future;
• physiotherapy exercises, including running, swimming, active games. Such exercises increase resistance to stress, promote the development of the respiratory system, restore blood circulation and improve tissue oxygenation;
• good results are obtained by conducting breathing exercises. She trains the muscles, the child learns to control breathing, the bronchi are drained (cleansed) from viscous sputum;
• use of natural factors – mud clinics, mineral waters, climate change, salt caves, alpine therapy in resorts. This helps to restore the function of external respiration, small bronchi clogged with mucus are cleared;
• massage, vibration massage helps to improve the exchange of oxygen and carbon dioxide in the lungs, obstruction decreases, the bronchi are cleared.

Herbal medicine, aromatherapy, which some parents love so much, are not recommended for children with asthma. The reason is that they can cause an allergic reaction and trigger another attack.

Any of the non-drug methods can be used only after consulting a doctor. He will assess the risks and give recommendations that contribute to a good result. 

First aid for an attack

A seizure is an acute condition of suffocation, wheezing, heard from a distance, and a spastic cough.

Algorithm of actions when providing first aid:

1. Count the number of breaths. Give the child a drug that expands the bronchi through an inhalation can, a spacer or a nebulizer. Sit down so that he can lean on (chair, bed) and use the accessory muscles for breathing. Monitor the status change for 20 minutes. The respiratory rate should decrease, the intercostal muscles should not sink, and the cough should become less frequent.
2. If after 20 minutes there is no effect, repeat the administration of the drug at the same dosage or change to a combined drug. Assess the condition.
3. If there is no improvement, give an inhaled corticosteroid.
4. If the attack cannot be stopped within one hour, the child should be immediately taken to the hospital.

When diagnosing asthma in a child, parents should be trained in first aid. This can be done in health schools organized in polyclinics.  

Evaluation of treatment results

Treating asthma successfully means gaining control over it. The following signs are evaluated:

1. Reducing the frequency of attacks to less than 2 times a week.
2. The attacks and awakenings at night stop.
3. The child’s physical activity is restored.
4. The need for drugs is reduced.
5. The results of functional tests ( peak flowmetry , spirometry) are improved .

Based on these indicators, the allergist reduces the dosage of basic therapy drugs, and can cancel systemic drugs. Asthma in children requires a constant planned visit to the doctor in order to correct therapy, conduct instrumental examinations and assess changes.

Finally

Bronchial asthma is not so bad. Of course, a parent, once seeing a child in a state of seizure, is frightened and tries to find all sorts of methods to alleviate the symptoms and get rid of the disease. But any doctor will confirm: the