Bronchial asthma is a chronic inflammatory disease of the lower respiratory tract, one of the most common among children. Thus, according to epidemiological studies, 5–10% of the child population suffers from bronchial asthma (BA). one
In 50-80% of cases, asthma begins at an early age: the first symptoms of the disease appear in children under 5 years of age. Over time, they may pass, but often the disease becomes chronic 2 .
Specialists are concerned that in recent years there has been a tendency towards an increase in the incidence of bronchial asthma in children and its more severe course 3 . According to the results of the study, in Russia, 33% of children with asthma experience sudden severe attacks every week; in addition, 36% of patients seek emergency care during the year, 27% go to the doctor because of the worsening of the disease 4 . Severe asthma is accompanied by a dysfunction not only of the respiratory organs, but also of other body systems 3 . As a result, children “drop out” of social life, miss kindergarten or school 4 and cannot fully develop.
Signs of bronchial asthma. Broncho -obstructive syndrome
Bronchial asthma can be suspected by characteristic symptoms that appear
mainly at night or early in the morning: coughing fits, wheezing and shortness
of breath, or a feeling of tightness in the chest. In children under 2 years of
age, there may also be noisy breathing, a change in its frequency, vomiting
associated with coughing, chest retraction, difficulties during feeding
(groaning sounds, sluggish sucking) 5 . The combination of these
symptoms is called broncho- obstructive syndrome.
Symptoms do not occur on their own, but as a reaction to irritating factors (so-called triggers). These include:
- tobacco smoke;
- contact with animals;
- exercise stress;
- stressful situations;
- respiratory infections.
Under the influence of triggers, the mucous membrane of the bronchi
becomes inflamed, swells, an excess of mucus is formed, which accumulates in
their lumen and thickens. Large and small bronchi narrow and become impassable.
This condition can develop over a short period of time (acute form) or
constantly slowly progress (chronic form). Broncho-obstruction is dangerous
because, in severe exacerbation of BA, it can lead to the development of acute
respiratory failure and increase the risk of patient mortality 6 .
Children with a high risk of developing bronchial asthma should be examined and consult a specialist . If a child has an allergy, or someone in the family suffers from asthma and other allergic diseases, then the diagnosis of bronchial asthma is usually confirmed 7 .
Treatment: anti-inflammatory therapy with ICS
Inflammation of the respiratory tract, characteristic of asthma, appears
already in the early stages of the development of the disease, therefore,
treatment should be prescribed as early as possible and be long 4 .
The earlier the diagnosis is made and anti-inflammatory therapy initiated, the
better the prognosis of the disease 6,7 . Children with well-controlled
asthma can attend kindergarten and school, and even play sports.
The task of therapy is to reduce shortness of breath and suffocation and relieve spasms in the airways (special preparations are used for this – short-acting bronchodilators ), but the main thing is to eliminate allergic inflammation of the bronchial mucosa and improve their functions 3 with the help of glucocorticosteroids (GCS). Currently, inhaled glucocorticosteroids (IGCS) are considered the most studied and effective drugs. They act locally and have a pronounced anti-inflammatory activity, they are able to suppress both acute and chronic local inflammation 8 . When inhaled, the drug quickly reaches the respiratory tract, so the effect occurs within a few minutes and does not depend on the age of the child 3 .
There are three types of drug delivery vehicles: pressurized metered dose inhalers (PMAs), breath-activated metered dose inhalers (DPIs), and nebulizers 5 . The choice depends on the age and ability of the child to follow the instructions associated with the inhalation technique. The nebulizer is considered the most optimal, which does not require special inhalation techniques, therefore it can be used even in newborns. For inhalation through a nebulizer, only dosage forms specially designed for this purpose should be used: solutions and suspensions.
As a result of treatment with inhaled glucocorticosteroids , already on the 5th–7th day from the start of therapy, the majority of patients with an insufficient level of BA control show the disappearance of broncho -obstructive syndrome. By the 3rd week of treatment, normalization or a significant improvement in the function of external respiration and the condition of the bronchi 1 are observed . However, in order to achieve stable control of the symptoms of the disease and minimize the risk of developing an exacerbation of asthma, it is necessary to continue maintenance therapy for at least 3 months 7 .
Inhaled corticosteroids relieve inflammation in the bronchi and effectively control the symptoms of bronchial asthma, but do not cure the disease, since bronchial asthma is a chronic inflammatory disease 7 . After stopping treatment, his symptoms may recur. At the same time, any exacerbation of asthma is a dangerous condition that carries a risk to the life of the child. It is important to understand that only an integrated approach will help control the disease. So, parents need to know exactly what risk factors cause broncho- obstructive syndrome in a baby, and, if possible, eliminate them. It is necessary to strictly follow the doctor’s instructions, as well as learn how to promptly provide first aid during attacks. Finally, it is important to constantly monitor the condition of the child. With the help of these three components – adequate therapy, correct inhalation technique and self-control – it is possible to achieve all the goals of treatment and significantly improve the quality of life of the child and his family.