Asthma in children

This effect can lead to narrowing or blocking the child's airway, breathing hardest them, which is called acute episode of asthma (also called attack, exacerbation or crisis). Bronchial asthma attacks may be rare or frequent, mild or severe. Most often the symptoms can be controlled at home, using an action plan (written plan stating that medications are needed and when needed a medical specialist). If the crisis is severe may require emergency treatment. These exacerbations can lead to death, but only in rare cases. Even if the child has fewer episodes of acute airway inflammation and it is in need of treatment. If inflammation is not controlled, asthma can lead to permanent changes in the bronchi, affects the child's lungs and thus increases the risk of complications as Bronchitis and Pneumonia.

Causes of asthma

Causes of asthma are unknown. Doctors believe that genetic factors, environmental and immune inflammatory etiology combine in bronchus (it can evolve from bronchial asthma and acute exacerbations or asthma episodes)

- Asthma can occur in several family members (the disease is inherited), the children in such families are at increased risk compared with other children to develop a long-term inflammation (chronic) in the bronchi;

- In some children, immune system cells release chemicals that cause inflammation in response to other substances, called allergens (substances that produce allergic reactions) has been shown that exposure to allergens such as dust, cockroach, animal dander, has a role in the development of asthma, asthma is more common in children with allergies (atopic children) although not all atopic children develop Asthma

- Environmental factors and lifestyle in which there is a certain level exposure to pathogens may play a role in the development of asthma, some doctors argue that appear increasingly more cases of asthma because of pollution and less because exposure to certain bacteria and other germs, and therefore the child's immune system will develop so that will be more likely to develop allergies and asthma.

Symptoms

Asthma symptoms can be mild or severe. Children may be asymptomatic (have no symptoms), have severe symptoms daily or more frequent symptoms are situated somewhere between these two extremes. Interval at which symptoms may change.

Symptoms of asthma include:

- Wheezing, whistling noise, the intensity range that occurs when the lung airways (the bronchi) narrow

- cough, which can sometimes be the only symptom, is usually dry (without mucus) and is more night

- Tightness (tight) chest

- dyspnoea which manifests as shortness of breath, rapid, shallow

- Sleep disturbances

- The child gets tired quickly during exercise.

If your child has one or two of these symptoms does not necessarily mean he has asthma. How much are a greater number of symptoms, the more likely to be due to their asthma. An episode of acute asthma symptoms occur when the child grows more intensity.

Factors that trigger or worsen acute asthmatic episode are:

- Colds or other respiratory diseases, especially those caused by viruses, such as flu

- Physical exercise (physical exercise-induced asthma), especially if it is cold and dry air space

- Such as exposure to triggers smoke air pollution, dust or animal dander

- Hormonal changes, such as those occurring at the onset menstruation at puberty

- Administration of medicines, as aspirin (asthma induced by aspirin) or Naiads.

Many children show symptoms worsen during the night. Normally, physiological changes in lung function during the day-night cycle. Children with asthma have very obvious this variation, especially at night, so commonly occur during sleep cough and shortness of breath. If children are awakened from sleep because of cough or disposal, it means that your asthma is poorly controlled. It is difficult counted severity of child asthma episode.

Symptoms are used to classify asthma according to severity.

Your doctor may instruct the assessment of symptoms. Symptoms with maximum expiratory flow value are used to define areas green, yellow and red (red area covered severe symptoms in the yellow symptoms have a lower intensity in the green and missing them) of the action plan of the asthmatic child. Other diseases with similar symptoms are asthma sinusitis and vocal cord dysfunction.

Mechanism

Asthma begins in childhood or early years of adolescence and can stretch along the entire life of the child. Asthma increases the risk of complications occurring during the disease bronchitis or Pneumonia. Sometimes the inflammation characteristic of asthma child's airway narrowing and mucus production, which translates into clinical appearance of dyspnoea plan. Airway narrows as overreaction to certain substances.

These substances are known asthma triggers and include:

- The child is allergic substances (allergens like dust or animal dander); allergens cause inflammation in the long term (chronic) and may lead to onset of symptoms

- environmental factors such as smoke or cold air can cause bronchial muscle contraction , causing symptoms.

Triggers of asthma vary from case to case. When the disease is triggered by an allergen, it is called allergic asthma. If symptoms are sudden onset, they are united under the name asthma episode (asthma attack or exacerbation). Acute asthma attacks may be rare or common, mild or severe.

Can be difficult to estimate the severity of acute asthma episode the child's important because this is sometimes severe episodes may need emergency care. However, in most cases symptoms can be tackled home with an action plan, which is a written plan that indicates the child needed medication and when necessary consultation service specialist or urgent intervention.

Asthma is classified as: light flashing, easy persistent, moderate persistent and severe persistent.

Children:

- Intermittent asthma easy, easy, and persistent, often mild symptoms usually lasting only shows while in the presence of a trigger

- Easy asthma requires treatment only intermittently during an asthma flare

- Persistent asthma or moderate persistent light should follow a daily treatment to control chronic inflammation of the airways, these children are at high risk for developing severe acute episodes

- Persistent severe asthma symptoms all the time, these children need treatment every day and have an increased risk of developing severe asthma episodes, life-threatening, known as status asthmatics.

Asthma has a great impact on the child's life. Even a mild form can cause changes in the airways (remodeling) and may accelerate and exacerbate the decline in lung function that occurs along with aging. Asthmatic patient’s loss of this function occurs early in childhood.

Sometimes the disease does not respond to asthma treatment because the child takes no medications or takes them correctly, not avoiding triggers, or do not follow daily treatment plan or the action. It is important that parents and others who deal with them take care these children to ensure that they follow the correct treatment and action plan to prevent such disease progression and increased risk of death. If they meet those two plans, the vast majority of children with asthma can live a normal life.

Risk factors

Are incriminated several factors that can increase a child's risk of developing asthma. Some of these factors can be controlled, while others do not.

Risk factors that can not be controlled:

Child-sex: during childhood the disease is more common among boys, until in the early teen when it appears with the same frequency in boys and girls, young adults predominate disease in women

-Race: asthma is more common in black race

-Inherited tendency (genetic predisposition) and respiratory system to react excessively to various stimuli, children who inherit this disease often develop a tendency

-History Allergies (Allergic group): children who have allergies are more prone than the rest to develop bronchial asthma, most children with asthma and allergic shows, atopic dermatitis, or both, studies on large groups showed a 40% 50% of children atopic dermatitis develop asthma; if children have atopic dermatitis are at risk them to develop at the age of adult severe persistent asthma

-Family history of allergies or asthma (many family members have asthma or allergies): children with asthma often have relatives with asthma or allergies different

-Infection at an early age with respiratory syncytial virus in the same age and wheezing this site: respiratory syncytial virus infection produces a lower respiratory infection and is a risk factor for this site wheezing and wheezing children develop asthma more frequently than those who do not have these symptoms.

Risk factors can be controlled:

-Smoking during pregnancy: Women who smoked during pregnancy had an increased risk for wheezing map (a symptom of asthma) to their children, children whose mothers had smoked during pregnancy had a lower lung function than those whose mothers did not smoke

-passive smoking: Children exposed to this factor, especially from the mother are at increased risk for asthma, those who already have asthma and are exposed to smoke will have more severe symptoms

-Obesity: Obesity has been demonstrated association between children and more frequent asthma present to them, but why this association is unclear, it is not known if the disease is a causal factor for the other or if there is a third factor to determine their both, symptoms caused by obesity are sometimes confused with those of asthma

Dust: dust exposure child is associated with an increased risk of asthma

-Bugs: it was shown in one study as those living in houses infested with cockroaches have a four times greater risk of being diagnosed with asthma than other children.

Some of these factors can be modified to reduce the risk of developing asthma or if it is already present, develop more severe symptoms.

The association between the risks of developing asthma is contradictory. In one study has shown that exclusive breastfeeding during the first nine months of the child's life reduces the risk of developing asthma. However other studies have demonstrated a protective effect of breastfeeding, but on the contrary have shown an increased risk of developing disease.

Involvement in triggering pet asthma is controversial. Some studies indicate that the home's existing pet cats or dogs, increases the risk of developing asthma. However, other studies showed that pets in the house early in the child's life may decrease risk of developing this disease child. If your child is already asthmatic and allergic to these animals, these animals present in cassava disease worse.

Risk factors that may worsen the disease or can cause episodes of acute asthma are:

Small-old Child

-History of severe, acute episodes such as worsening fast and frequent nocturnal symptoms or recurrent episodes requiring hospitalization

-Child has difficulty taking his medication or have to use common beta2-agonists with short-acting

-Child has frequent changes of maximum expiratory flow

-Child has symptoms that last a long time

-Child is not fast enough oral corticosteroids used during a crisis

-Child is not physically supported by family or friends.

Triggers which may worsen the disease and can lead to acute asthma episodes in childhood are:

-Upper respiratory tract infections and severe flu

-Allergens like dust or mold.

Consult specialist

If the child has been diagnosed with asthma and has an action plan (which specifies the medication to be administered during an acute episode)

- Have called emergency services if it shows severe symptoms of asthma (the red plane) and the plan has been met but:

- Child is still difficulty in breathing;

- Your child is unwell and maximum expiratory flow and is still below 50% of normal at 20 to 30 minutes after administration Emergency medication;

- Emergency should be consulted to your doctor if your child:

- Has severe symptoms get worse;

- Has an acute asthma episode, which is located in the red zone at 6:00 and plan to

administration of medication is still needed inhaled medications administered every 1-3 hours and maximum expiratory flow is below 70% of its normal value;

- Has an episode found in the yellow zone plan and maximum expiratory flow is

further to 70% of normal despite treatment at home as planned;

- Has a first asthma episode and symptoms include wheezing, chest tightness and mild dyspnea;

- Coughing and spit mucus yellow or dark brown with blood.

Specialist advice should be made if the child:

- Have asthma symptoms, there is a plan of action and symptoms are mild (chest constriction, coughing and mild dyspnea or fatigue during exercise occurs quickly);

- Located in the yellow symptoms of the action plan, daily but controlled drug;

- Maximum expiratory flow and asthma is worsened in the last 2-3 days.

If your child has been diagnosed with asthma but shows symptoms requires a medical specialist. Many children and teens with frequent wheezing have asthma but have not been diagnosed. Among them, those who are less likely to be diagnosed are:

- Girls, especially girls;

- smokers or those exposed to cigarette smoke at home;

- Those with poor socioeconomic status;

- Those with allergies.

Watchful waiting

This is a time when the family doctor and parents see child's symptoms and his condition, but without using drugs. If his condition does not change although it’s already established treatment for 1-3 months, it is necessary to refer to your doctor.

Watchful waiting period if they meet the recommended daily treatment plan and action plan and the child is found in its green zone. Symptoms should be monitored and avoid triggers.

Medical specialists recommend

Specialists doctors who can diagnose and treat asthma are:

- Pediatrician;

-GP;

-Physician.

Needed a physician consultation or allergist if pneumologist:

-Child or unusual symptoms is unclear whether or not asthma;

-Child has other associated diseases treatment difficult;

-Child fails to comply with action plan and the daily treatment;

-Treatment goals are not achieved at 3-6 months after its start;

-There are episodes of acute life-threatening asthma;

-Child has persistent moderate or severe persistent asthma;

-Child is bound to take continuous oral corticosteroids or inhaled corticosteroids high-dose corticosteroids or taken orally more than twice a year;

-Is needed Skin tests for allergy;

Try is beginning treatment with anti-allergic vaccines (immunotherapy).

Investigations

Asthma diagnosis based on medical history, physical examination and simple pulmonary function tests, as spirometry. Diagnosis in infants and toddlers is often very difficult. Symptoms are similar to those of other diseases such as respiratory syncytial virus infection, Inflammation of the lungs, sinuses (sinusitis) or small airways (bronchiolitis).

At this age spirometry is untenable, making the diagnosis to be made based on symptoms only. Repeated episodes of wheezing are the key symptoms in asthmatic children. However, asthma is the most common condition that can cause these episodes, but if your child has frequent wheezing, it should be investigated, especially if they are present and coughing and dyspnea.

Because your doctor can diagnose a child with asthma, it must verify the existence of factors associated with disease such as:

-More than three episodes of wheezing per year, with a duration longer than a day and affecting sleep

-Parents with a history of asthma and atopic dermatitis or two of these three symptoms: wheezing which is not associated with colds, hay (allergic rhinitis), Number of eosinophils (Type of white blood cells present in great numbers in allergic diseases).

In a child older than, lung function tests can diagnose the disease can cause asthma and its severity and complications existence.

These tests are:

-Spirometry: is the most common test used to diagnose asthma in children is measured by how fast it is inspired and expired air in and out of the lungs and that the amount of air inspired (inserted) and out (eliminated) in and the lungs, this test is to aid them medical specialist to determine if the air flow in and mobilized from the lungs is decreased due to bronchial inflammation and airway inflammation if the diameter can return to normal after administration of specific drugs, is recommended to undertake this exploration at intervals of at least 1-2 years after starting treatment of asthma

-Testing changes during the day with peak expiratory volume (maximum) is done once every one or two weeks, the test is necessary when symptoms are present frequently, but the results are normal spirometry

-bronchoscope: Uses a flexible tube called a bronchoscope to examine the airway, sometimes of respiratory diseases, as tumors or foreign corpus can cause symptoms similar to those found in asthma, it is recommended to examine whether wheezing is heard in the unequal two lungs, or if there is a good response to asthma therapy, this technique allows a biopsy (a very small harvested from bronchial wall) to reveal changes characteristic of asthma.

There is a new test is used to track an asthmatic patient. It is called a systemic nitric oxide test. It measures the amount of nitric oxide in exhaled air and a decrease of this value suggests that treatment reduces inflammation characteristic of the disease.

Tests to identify triggers of the crisis of bronchial asthma

If the child has persistent asthma and are under daily treatment, it is important that your doctor knows if there is an exposure to allergens that can cause an allergic reaction.

Allergy tests include:

Skin-tests: skin on the back or hands it stings and introduced one or more small doses of allergens, it measures the degree of swelling and the red skin   to determine which allergens to cause allergic reactions, skin tests is quick, easy and relatively safe, they are necessary when considered necessary to administer anti-allergic vaccines (immunotherapy)

RAST-test in which a sample of venous blood and tested for  antibodies which are produced in response to a specific type of allergy, RAST can be performed with or in place of allergic skin test, to measure levels of IgE and ELISA can be used.

It can perform other types of tests to distinguish between asthma and other diseases such as sinusitis, Nasal polyps, Gastro esophageal reflux disease.

Differential Diagnosis

Differential diagnosis is a diagnostic phase in which the disease is great because other diseases that have symptoms of common characteristics. Asthma is often difficult to diagnose because symptoms vary from child to child and changes over time in the same baby. The same symptoms can also occur in other diseases such as colds, flu or other respiratory viral infections.

In order to tell if asthma or other diseases are due to child symptoms, the doctor uses these tests:

-Ray chest, because that determines whether such a foreign body is found in the airway;

Sweat-test, measuring the amount of salt in sweat, is used to determine if symptoms are produced by a disease called Cystic Fibrosis.

Treatment

Despite the child's asthma can not be cured, symptoms can be controlled using medications, especially corticosteroids and beta2-agonists with inhaled administration. Your doctor will work with the patient and family to develop an action plan and to determine the type of treatment required.

With this plan is trying to accomplish goals asthma treatment:

-To reduce airway inflammation so as to prevent their long-term changes;

-To decrease the severity, frequency and duration of bronchial asthma by avoiding exposure to stimuli;

-To treat acute episodes when they occur;

-To ensure a normal life (the child can participate in daily activities such as school, recreation and physical exercise) in reducing symptoms.

Infants and young children need early treatment of symptoms, respiratory problems to prevent such problems. Severity of symptoms in this age group is higher than in adults because the airways they have a smaller diameter. Although it seems that a treatment administered only when needed, only when symptoms appear, it is enough to demonstrate that a third of fatal episodes of asthma occur in children with persistent asthma easily. Even if the child's symptoms do not appear to be serious practitioner will prepare an action plan to control them. Some specialists recommend treatment of asthma in young children, therapy module called "rule of two."

This means that young patients will receive long-term medication if:

Have symptoms of at least two times per week;

The night is awake because of asthma at least two times per month;

-Use more than two containers per year fast-acting drugs.

The program for  Asthma Education and Prevention recommends treatment with long-acting medicines for infants and small children:

-Require constant treatment for their symptoms at least two times per week;

Severe acute episodes were more often than once every six weeks and they require more frequent administration of inhaled bronchodilator 4 hours in 24 hours;

Acute episodes often have 3 times per year and it lasts longer than one day, affecting sleep;

Have a family history atomic dermatitis or two of these three symptoms:

Wheezing episodes, not associated with colds;

-allergic rhinitis;

An increased eosinophils (eosinophils are a type of white blood cells that are present in allergic reactions).

Emergency Treatment

If a patient has severe asthma episode (red area on the asthma action plan) is given drugs given in the action plan and emergency physician should be contacted to determine further action. This action is important if the peak expiratory flow does not return the child to remain in the green or yellow zone after taking drugs. The child must be brought to the emergency room in this case. In the hospital, he will receive inhaled corticosteroids and beta2-agonists and may be administered oxygen to improve breathing. Doctors will monitor respiratory function and the child's condition. Depending on the lung function response to this treatment, the doctors will decide if the baby will remain hospitalized specialists or will change the plan of action and treatment.

Regular medical consultations

Patient is required to make regular medical consultations to monitor its evolution, to change if deemed necessary daily treatment and action plan. The frequency of consultations depends on the child's asthma.

Thus:

-Consultation is carried out at 6 or 12 months if the child has asthma or slightly persistent flashing light that is well controlled for at least three months;

-Consultation is carried out in three or four months in children with moderate persistent asthma;

-Consultation is carried out at 1 or 2 months for those with severe persistent asthma or uncontrolled asthma.

During these checks practitioner will check if treatment goals were achieved. During this consultation your doctor will inquire if the symptoms and expiratory volume peak (maximum) stayed constant, have improved or got worse and if asthma attacks occurred during physical exertion, night, During episodes of laughing or crying loud. This information should be kept by the patient and his family in a so-called "asthma diary." It is recommended that the patient was present in peak-flow meters site (which is measured by unit volume peak expiratory) for the physician to see if it is used correctly. According to the information category that asthma is framed child may change and with it a type and quantity of medications.

Initial treatment

There are many ways in which asthma treatment can be addressed. Because the pathogenesis (development) asthma is many factors involved that interact (genetic, environmental factors and immune response), one type of treatment will be effective for all children, and treatment must be individualized for each patient. After being diagnosed with asthma, your doctor will discuss with parents some important issues about treatment.

They concern:

-Oral or injectable corticosteroids (systemic glucocorticoids) such drugs can be used to control symptoms before starting therapy daily, in the future will be administered when severe symptoms occur suddenly, such as breathing difficulties (episodes acute asthma), oral corticosteroids are more often used than those administered injection, systemic corticotherapy include prednisone and dexamethasone

-Administered inhaled corticosteroids: These medications are preferred in long-term treatment of asthma, they reduce airway inflammation in children when administered daily is achieved disease control and prevent acute episodes, this type of corticosteroids include: dipropionatul of beclomethasone, Triamcinolone, fluticasone propionate, budesonide and flunisolidul;

Beta2-agonists, with shorter duration of action: they are used to treat acute episodes of asthma, airway relax and so the child will breathe easier, these agents include albuterolul and pirbuterolul;

-Continuous education about asthma: the more family and child to know more about the disease so it is easier to control the disease, they must bear in mind that the vast majority of symptoms can be controlled and that patients whose symptoms can not be controlled are few;

-How should be correct inhaler device introducing drugs directly into the lungs, if used correctly symptoms can be controlled successfully, many experts recommend the use of the inhaler once spacer-Of (part of the inhaler which is inserted in the mouth when breathing).

Short-term goal of treatment is to control symptoms, long-term goal is to prevent the appearance of these symptoms so that children have a normal life.

About asthma treatment must be specified as:

-There is a form of asthma that is caused by exercise which can lead to episodes of acute in this case we recommend taking drugs just before exercise;

-Management of asthma before surgery: to remember that patients with moderate or severe asthma have a higher risk of complications during and after surgery.

Note!

Once diagnosed asthma, it is important to initiate treatment. The child may feel good most of the time, so that parents find it hard to believe he has a chronic disease, asthma, even the light can produce airway changes that hasten or worsen the physiological decline in lung function that occurs with age.

Ongoing treatment

After initiating treatment, it is important that family and child to learn more about the disease and develop a plan together with the general practitioner disease management. To achieve this requires a good collaboration between parents, children and doctors. Because asthma disease takes birth from a complex interaction between genetic, environmental and of the immune system, can not apply the same plan for all children.

Asthma management consists of:

A daily treatment plan: it specifies in writing how to treat inflammation of the lungs child, plan or slowly help prevent development of long-term effects of asthma and required daily medication says, daily treatment plan includes an "asthma diary ' they are registered respiratory peak flow (maximum), symptoms, triggers and medications used in episodes of acute emergency, the plan and family physician valuable help in their effort to control the disease, treatment plan often combines daily plan action;

Action-plan: contains tips designed to help family and patient in control asthma flares at home and is helpful in identifying triggers which can then be avoided or modified, helping the patient to realize her symptoms and help the doctor to take rapid decisions about treatment;

Respiratory peak-flow monitoring: is easily underestimated the severity of child symptoms, they can be overlooked until the child's lungs function at about 50% of best peak respiratory flow specific individual in question, measuring the respiratory flow peak is an effective way to track lung function at home and may be helpful to parents and children, as can be seen through or when damage occurs in lung function before it drops to a dangerous level, it is measured with a device called a peak flow meter;

A plan that aims triggers or factors that worsen the disease: this triggers the symptoms are magnified, so the child is important to avoid exposure to irritants (smoke, polluted air) Or substances which may be allergic to (the hair of animals);

A plan to treat other health problems: if the patient has other associated diseases such as sinus infection (sinusitis) Or Gastro esophageal reflux disease it is appropriate to their treatment;

-Correct use of medicines indicated: physician may adjust drug doses according to the control that you made on asthma