The debut of asthma at a young age requires a special approach, both in therapy and in explaining to the adolescent the need for compliance with certain measures. Unfortunately, the “rebellious spirit” sometimes opposes medical prescriptions, as a result of which the disease becomes more severe, the number of emergency conditions increases. There is a solution – consider the most current options for modern treatment of bronchial asthma.
Adolescent asthma is as elusive as adolescents themselves
According to a prominent pulmonologist, professor of the First MGMU named after IM Sechenov, Ovcharenko Svetlana Ivanovna, the clinical picture of the disease in adolescents does not always fit into the “classics of the genre” due to psychological and behavioral characteristics. Adolescents tend to paradoxical course of asthma, which can be explained by the following factors:
- Dependence on the opinions of others, the state of depression, complexes about the fact of the disease,
- Abuse of short-acting inhalers,
- Smoking,
- Fuzzy following the recommendations of the doctor.
“Fuel to the fire” adds statistics: boys are sick more often than girls, both at an early age and in adolescence, the ratio is estimated as 6% of boys to 3.7% of girls. Partly, the numbers are formed precisely due to the disappointing chain “illness” – “refusal to treat” – “severe course, complications”. Therefore, the boys need to conduct a more visual, but at the same time, a careful explanatory conversation about their disease.
Is there a radical remedy to cure asthma?
One of the important breakthroughs of the 21st century in the treatment of diseases is the use of allergen-specific immunotherapy, the so-called ASIT therapy. The technique has been developed abroad, and everything is taking root more reliably in our country. Let us see what is its beauty and how it works.
The main problem in bronchial asthma becomes inflammation of an allergic nature, as well as increased hyperreactivity of the bronchopulmonary system when confronted with various volatile substances. That is, the pathological response of an allergic nature arises on any (harmless to another person) stimulus – to inhale a fragrant flower, smell of paint, catch a barely noticeable train of French perfumes … And if another person has only positive (or not) emotions, then asthma The asthmatic status can develop when asthma attacks flow into one another and, without the aid of inhalers or resuscitation specialists, in addition to unpleasant sensations, the person receives a real threat to life and health.
Doctors have figured out how to reduce the inadequate response of the immune system. The principle of ASIT therapy is ingenious and simple to impossibility and somewhat similar to vaccination. In the case of the prevailing allergic genesis of bronchial asthma, under the supervision of an allergist-immunologist, the patient is clearly determined by his “weak link”, namely, to which he has a reaction – skin scarification tests are carried out with both specific antigens and nonspecific agents. Together with the results of the examination (x-rays of the chest organs, complete blood count, external respiration function), the doctor makes a decision about the beginning of the systematic introduction of micro-doses of one or another allergen in order to reduce the sensitivity of the organism.
And if at the dawn of using the methodology, it was a systematic injection of the drug, now tablets and drip drugs have appeared on the pharmacological market – which greatly simplifies the treatment of patients younger (from the age of five) and adolescence.
We have something to strive for …
Unfortunately, in the Russian Federation not all the preparations necessary for the course of ASIT therapy are presented. In particular, there are means of helping people suffering from birch seasonal dusting, but those who determine the response to pets will have to wait a bit. Representatives of the pharmaceutical company promise to adjust the supply in the next few years. In the United States of America and European countries such therapy with might and main (with success!) Is used.
When can I start ASIT?
Several large clinical studies have been conducted (Lambert N., Massanari M.), which have proven the safety and efficacy of ASIT therapy in bronchial asthma. At the same time, the important point is the proof of the allergic nature of bronchial asthma, for this, laboratory tests are necessary – the determination of specific immunoglobulins E in serum.
Naturally, it is necessary to achieve absolute control over asthma symptoms before initiating therapy. Allergist-immunologist Ksenia Kuzmina argues that the direct indication for the appointment of ASIT therapy is controlled mild and moderate asthma (not severe!). If asthma is only partially controlled, as shown by Massanari M. research, omalizumab will help control it. The preparation of monoclonal antibodies reduces inflammation by binding to “responsible” cells – class E immunoglobulins. Monoclonal antibodies are approved for use in adults, adolescents and children from six years old (Thomson NC, Chaudhuri R.).
Signs of “controlled” asthma:
- There are no awakenings at night for coughing or choking attacks,
- In the daytime, seizures are recorded no more than twice a week, respectively, ambulance medications — inhalers with a short-acting bronchodilator — are required no more than twice a week,
- According to the results of the main test of asthmatics, respiratory function (external respiration function), the volume of the enhanced exhalation in the first second must be at least 70%.
For the approval of control over the course of bronchial asthma, any means can be used – glucocorticosteroids, anti-leukotriene preparations. During allergen-specific therapy, the use of omalizumab was used in parallel to the studies performed.
Subtleties of treatment of bronchial asthma in adolescents
The puberty period is a crucial age. On the one hand, there are “volatile” states that the child can outgrow and forget forever. On the other hand, if a child has an allergic march — atopic dermatitis was recorded at an early age , pollinosis developed a little later, and the first signs of asthma are already noted — you should not hope in this case that the child will “outgrow”.
At the very early stage, bronchial asthma responds well to drug control, and provided the adolescent perceives the disease adequately, adheres to a hypoallergenic way of life, has regular check-ups with a specialist, and receives ASIT therapy in a timely manner, the child receives a tangible hope of long-term remission.
How long does it take to “cure”?
Like any chronic disease, an allergic background for the manifestation of bronchial asthma is formed over the years – for a long time there are conditions for the breakdown of the adequate functioning of the body. Partly, therefore, a lot of time is required for the treatment of such a neglected process – as allergist immunologists say, it takes several years to achieve a lasting effect, that is, several courses of therapy. In some patients after the first course, there is no significant clinical effect – but this should not be a reason to interrupt therapy! After 3-5 years, at the end of the course, the effect is sure to be. If we consider that this is a real chance to take the disease under complete control and abandon the attachment to the use of inhalers and more serious means – this is a real way out.
The debut of asthma in a teenager: there is a solution!
The most important point is to persuade a teenager for obedient treatment, who may have not yet faced with extreme manifestations of asthma, namely the status when asthma attacks flow into one another or with a debilitating cough for many months, with a coughing form. Igor Sergeevich Gushchin , a professor at the Institute of Immunology at the Ministry of Health of the Russian Federation and an expert on allergen-specific therapy , asserts that “the earlier the treatment is started, the fewer the symptoms the child has, the more pronounced the effect will be”.
It is important joint work of doctors, parents and psychologists. It is necessary to tell the child unobtrusively, but quite definitely, about the mechanisms of his illness, that he has nothing to be ashamed of, and this disease is quite common among the inhabitants of megalopolises, but it is absolutely necessary to fight it, moreover, follow the recommendations of the doctors as carefully as possible. And then he will have a chance for a healthy “cloudless” future. The idea of constant attachment to inhalants and, in contrast, freedom from “slave” dependence on drugs can affect the “rebels”.
Health to you and your loved ones!