Asthma is the most common chronic respiratory failure in childhood, affecting 15-20% of children. Around the world, a significant increase in the frequency of asthma has been shown in the last 30 years, although it has stabilized. The highest incidence is noted in developed countries.
In most children, asthma symptoms are easy to stop, but this is an important reason for missing school, limited activity and anxiety for the child and family. In the UK, about 20 deaths of children due to asthma are still recorded every year.
Asthma is a heterogeneous disorder of various clinical phenotypes with the main clinical manifestation in the form of wheezing. Three phenotypes of wheezing have been established in children with asthma. • Transient wheezing in the initial stage. • Non-atopic wheezing in preschool children. • IgE-mediated wheezing (atopic asthma).
Wheezing is very common in infancy and accounts for approximately half the cases of wheezing in children in other periods. Most infants with wheezing are diagnosed with transient wheezing in the initial stage associated with a viral infection (also known as wheezing).
It is believed that transient wheezing of an early age is the result of a small size of the airways, which are more likely to undergo obstruction due to secondary inflammation in a viral infection. In children with transient wheezing, lung function is reduced from birth due to a small airway clearance. The main risk factors are smoking the mother during and / or after pregnancy and prematurity.
Family history of asthma or allergies is not considered a risk factor. Transient wheezing of an early age is more common among boys than among girls. It usually resolves by 5 years of age, probably due to an increase in airway clearance.
With non-atopic wheezing , on the contrary, normal lung function is noted at an early age, but diseases of the lower respiratory tract of a viral nature (usually RSV) lead to increased wheezing in the first 10 years of life. This phenotype apparently causes less severe persistent wheezing, and improvement occurs in adolescence.
Causes of recurrent wheezing in infancy :
• Transient wheezing of an early age.
• Non-atopic wheezing in preschool children.
• lgE-mediated wheezing (atopic asthma).
• Recurrent aspiration of food. . MB.
• Intolerance to cow’s milk protein.
• Foreign body in the airways.
• Congenital malformations of the lungs, respiratory tract or heart.
• Idiopathic causes.
Bronchiolitis :
• Age 1-9 months
• Poor appetite, apnea, dry cough
• Difficulty breathing – retraction of the compliant areas of the chest, over-bloating of the chest, small bubbling rales at the end of the breath, wheezing, liver displaced downward
• Apnea, cyanosis, respiratory failure
• More severe bronchopulmonary dysplasia in premature babies or congenital heart defects
Pneumonia :
• Fever, poor appetite, cough, lethargy, cyanosis
• Tachypnosis, bloating of the nose wings, retraction of the compliant areas of the chest, wheezing, coarse bubbling wheezing at the end of the inhalation over the affected area
• Oxygen saturation may be reduced,
chest X-ray, parapneumonic effusion or empyema
Transient wheezing in the initial stage – an increased risk of viral infectious diseases in premature babies and when the mother smokes. Non-atopic wheezing – follows a viral infection of the lower respiratory tract
Atopic asthma – recurrent wheezing, eczema, positive family allergological / atopic history of heart failure – respiratory failure, heart murmur, hepatomegaly
Foreign body in the airways – blockage with peanuts or a toy, etc. Aspiration of food – especially with neuromuscular disorders .