BRONCHIAL ASTHMA IN CHILDREN

BRONCHIAL ASTHMA IN CHILDREN

Department of pediatricsDefinition

Asthma is a chronic disease involving the respiratory system in which the airways occasionally constrict, become inflammated, and are lined with excessive amounts of mucus often in response to one or more triggers.

Epidemiology

Bronchial asthma (BA) is one from the most frequent chronic diseases in children and its incidence continues to increase in the last years. Conformable to ISAAC data (International Study of Asthma and Allergy in Children), BA affects 5-20% of children on the earth globe, this index varying in different countries (in USA - 5-10%, in Canada, UK - 25-30%, in Greece, China 3-6%).

Risk factors for BA development in children

Familial antecedents of BA and other allergic diseases.Contact with home dust containing dust mite: Dermatophagoides pteronyssinus.Contact with fur-bearing animals (cat, dog, etc.).Contact with mould (species of fungi Alternaria, Aspergillus, Candida, Penicillium).Contact with the pollen of different plants.Smoke of cigarettes, after woods burning.Presence of cockroaches.

Risk factors for BA development in children

Alimentary (fish, egg, cows milk etc.) and drug allergensMeteorological factors (cold air, fog). Physical activityEnvironmental pollutionPresence of gastroesophageal reflux.Drugs and vaccines (antibiotics penicillin, cephasoline, tetracycline etc., sulfonamides, NSAID, colorants, etc.)Viral infectionsStress factors

Clinical classification of bronchial asthma

Atopic (allergic) asthmaNonatopic (nonallergic) asthmaStatus asthmaticus

Particular forms of bronchial asthma

BA provoked by physical effortCough variant of BAAspirinic BA

Classification of BA in function of severity

Type of BAExacerbations of BANocturnal accessesPEF and PEF variabilityIntermittent< 1 time per weekAsymptomatic, normal PEF between accesses 2 times per month >80%1 time per week, but 2 times per month >80% 20 30% Moderate persistentDaily. Exacerbations affect the activity >1 time per week 60-80%>30% Severe persistentPermanently. Limited physical activity Frequent 30% Clinical picture of BAAnamnesis

Which questions must be given in the case of BA suspicion:Had the patient episodes of wheezing, inclusively repeated?Has the patient nocturnal cough?Has the patient cough and wheezing after physical effort?Had the patient episodes of wheezing and cough after the contact with aeroallergens and pollutants? Had the patient episodes of wheezing after supported respiratory infection?Is decreasing the degree of symptoms expression after antiasthmatic drugs receiving?

Recommendations for personal and hereditary antecedents assessment:

Presence of dyspnea, wheezing, cough and thorax oppression episodes, with evaluation of duration and conditions of improving.Familial antecedents of bronchial asthma.Risk factorsAsthmatic symptoms are manifesting concomitantly (the thoracic oppression is less constant) and have common: - Variability in time (are episodic); - Preferentially nocturnal appearance; - Appearance due to trigger factor (physical effort, exposition to allergens, strong laugh, etc.). - Personal, familial and environmental factors.

Characteristics of asthmatic attacks:

Quick appearance with expiratory dyspnea, prolonged expiration and wheezing, pronounced sensation of thoracic oppression, lack of air (sensation of suffocation). Duration from 20 30 min until a few hours.Spontaneous disappearance or at administration of 2-adrenomymetics with short action.They appear more frequently in night.The attacks appear suddenly and end also suddenly with tormenting cough with elimination of mucous, viscous, pearl sputum in small quantity.

Suggestive symptoms for bronchial asthma diagnosis in children:

Frequent episodes of wheezing (more than 1 episode per month);Cough wheezing induced by physical activity;Nocturnal cough out of viral infection periods; Lack of wheezing seasonal variations.

There are 3 categories of wheezing:

Precocious transitory wheezing; is associated with presence of such risk factors as prematurity, smoking parents, dyspnea until 3 years;Persistent wheezing with precocious onset (until 3 years); recurrent episodes of wheezing associated with acute viral infections (predominantly with respiratory syncitial virus, in children under 2 years, and other viruses, in older children), without atopic manifestations or familial antecedents of atopy; the symptoms persist until the school age and can be present in 12 years old children in significant proportion;Wheezing (asthma with tardy onset, after 3 years age); in this group asthma evolves in childhood period and even in adults; children present signs of atopy (most frequent atopic dermatitis) and air pathways pathology characteristic for asthma.

Predictive signs for childhood asthma (preschool, school age):

Wheezing until 3 years;Presence of major risk factor (familial antecedents of asthma);Two from three minor risk factors (eosinophilia, wheezing without cough, allergic rhinitis).

Physical examination:Basic principles:

The signs of respiratory system affection can be absent.Inspection: - Sitting position (orthopnea) with accessory respiratory muscles involvement; - Tachypnea.At percussion: - Diffuse increased sonority and down placed diaphragm.Auscultatively: - Diminished vesicular murmur; - Dry coarse, polyphonic, disseminated crackles, predominantly at expiration, that can be heard at distance (wheezing); - Moist and subcrepitant crackles in more advanced bronchial hypersecretion.

Causes of bronchial asthma exacerbations:

Insufficient bronchodilator treatment.Long-term defect of the basic treatment.Viral respiratory infections.Changes of weatherStress Long time exposure to triggers.

Appreciation of bronchial asthma exacerbations severity

SymptomMildModerateSevereImminence of respiratory stopping Dyspnea -appears during gait;The child can stay in bed -in older children it appears at speaking, in small children the crying becomes more short and slow; feeding difficulties.- the child prefers to sit down. - appears in rest;- refusal to eat;- forced position (sit down, inclined forward) Appreciation of bronchial asthma exacerbations severity

SymptomMildModerateSevere Imminence of respiratory stopping Speaking -propositions -expressions -words State of alertness -can be agitated -as a rule, agitated -as a rule, agitated -inhibited or in confusion state Frequency of respiration -increased -increased -sometimes> 30/min. Participation of accessory respiratory muscles with supraclavicular retraction -as a rule, absent -as a rule, absent -as a rule, present Paradoxical thoraco- abdominal movement Appreciation of bronchial asthma exacerbations severity

SymptomMildModerateSevereImminence of respiratory stoppingMoist crackles Moderately expressed, often, only at expiration SonorousSonorousAbsentFrequency of cardiac contractions < 100 100 120 > 120 Bradycardia Paradoxical pulse Absent Can be present Often is present Absent Appreciation of bronchial asthma exacerbations severity

SymptomsMildModerateSevereImminence of respiratory stoppingPEF in % from predicted after bronchodilator using >80% 60 80% 60mm Hg

60mm Hg

95% 91-95%