Attack of bronchial asthma in children. Non-drug treatments

is a chronic allergic disease of the respiratory tract, accompanied by inflammation and changes in the reactivity of the bronchi, as well as bronchial obstruction that occurs against this background. Bronchial asthma in children occurs with symptoms of expiratory dyspnea, wheezing, paroxysmal cough, episodes of suffocation. The diagnosis of bronchial asthma in children is based on allergic history; spirometry, peak flowmetry, chest radiography, skin allergy tests; determination of IgE, blood gas composition, sputum examination. Treatment of bronchial asthma in children involves the elimination of allergens, the use of aerosol bronchodilators and anti-inflammatory drugs, antihistamines, and specific immunotherapy.

The triggers of bronchial asthma in children can be viruses - the causative agents of parainfluenza, influenza, SARS, as well as a bacterial infection (streptococcus, staphylococcus, pneumococcus, Klebsiella, Neisseria), chlamydia, mycoplasmas and other microorganisms that colonize the bronchial mucosa. In some children with asthma, sensitization may be caused by industrial allergens, taking medicines(antibiotics, sulfonamides, vitamins, etc.).

Factors of exacerbation of bronchial asthma in children, provoking the development of bronchospasm, can be infections, cold air, weather sensitivity, tobacco smoke, exercise, emotional stress.

Pathogenesis

In the pathogenesis of bronchial asthma in children, there are: immunological, immunochemical, pathophysiological and conditioned reflex phases. In the immunological stage, under the influence of the allergen, antibodies of the IgE class are produced, which are fixed on target cells (mainly mast cells bronchial mucosa). In the immunochemical stage, repeated contact with the allergen is accompanied by its binding to IgE on the surface of target cells. This process proceeds with degranulation of mast cells, activation of eosinophils and the release of mediators that have a vasoactive and bronchospastic effect. In the pathophysiological stage of bronchial asthma in children, under the influence of mediators, swelling of the bronchial mucosa, bronchospasm, inflammation and mucus hypersecretion occur. In the future, attacks of bronchial asthma in children occur according to a conditioned reflex mechanism.

Symptoms

The course of bronchial asthma in children is cyclical, in which there are periods of precursors, asthma attacks, post-attack and interictal periods. During the warning period, children with asthma may experience anxiety, sleep disturbance, headache, itchy skin and eyes, nasal congestion, and dry cough. The duration of the precursor period is from several minutes to several days.

Actually, an attack of suffocation is accompanied by a feeling of pressure in the chest and lack of air, shortness of breath of the expiratory type. Breath becomes wheezing, with the participation of auxiliary muscles; wheezing can be heard in the distance. During an attack of bronchial asthma, the child is frightened, takes the position of orthopnea, cannot talk, catches air with his mouth. The skin of the face becomes pale with pronounced cyanosis of the nasolabial triangle and auricles, covered with cold sweat. During an attack of bronchial asthma in children, there is an unproductive cough with thick, viscous sputum that is difficult to separate.

Auscultation determines hard or weakened breathing with a large number of dry wheezing wheezes; percussion - box sound. On the part of the cardiovascular system, tachycardia, increased blood pressure, muffled heart tones are detected. With a duration of an asthma attack of 6 hours or more, they talk about the development of status asthmaticus in children.

An attack of bronchial asthma in children ends with the discharge of thick sputum, which leads to easier breathing. Immediately after the attack, the child feels drowsiness, general weakness; he is slow and lethargic. Tachycardia is replaced by bradycardia, increased blood pressure - arterial hypotension.

During interictal periods, children with asthma may feel almost normal. According to the severity of the clinical course, 3 degrees of bronchial asthma in children are distinguished (based on the frequency of attacks and respiratory function indicators). At mild degree bronchial asthma in children asthma attacks are rare (less than 1 time per month) and are quickly stopped. In the interictal periods, the general state of health is not disturbed, the spirometry indicators correspond to the age norm.

Moderate degree of bronchial asthma in children occurs with a frequency of exacerbations 3-4 times a month; speed indicators of spirometry are 80-60% of the norm. With a severe degree of bronchial asthma, asthma attacks in children occur 3-4 times a month; FVD indicators are less than 60% of the age norm.

Diagnostics

When diagnosing bronchial asthma in children, data from a family and allergic history, physical, instrumental and laboratory examinations are taken into account. Diagnosis of bronchial asthma in children requires the participation of various specialists: a pediatrician, a pediatric pulmonologist, a pediatric allergist-immunologist.

The complex of instrumental examination includes spirometry (for children over 5 years old), tests with bronchodilators and physical activity (veloergometry), peak flowmetry, X-ray of the lungs and chest organs.

Laboratory tests for suspected asthma in children include clinical analysis blood and urine, general sputum analysis, determination of general and specific IgE, blood gas analysis. An important link in the diagnosis of bronchial asthma in children is the production of allergic skin tests.

In the process of diagnosis, the exclusion of other diseases in children with bronchial obstruction is required: foreign bodies of the bronchi, tracheo- and bronchomalacia, cystic fibrosis, bronchiolitis obliterans, obstructive bronchitis, bronchogenic cysts, etc.

Treatment of bronchial asthma in children

The main directions of treatment of bronchial asthma in children include: identification and elimination of allergens, rational drug therapy, aimed at reducing the number of exacerbations and relief of asthma attacks, non-drug rehabilitation therapy.

When detecting bronchial asthma in children, first of all, it is necessary to exclude contact with factors that provoke an exacerbation of the disease. For this purpose, a hypoallergenic diet, the organization of a hypoallergenic life, the abolition of drugs, separation from pets, a change of residence, etc. can be recommended. Long-term prophylactic use of antihistamines is indicated. If it is impossible to get rid of potential allergens, specific immunotherapy is carried out, which involves desensitization of the body by introducing (sublingual, oral or parenteral) gradually increasing doses of a causally significant allergen.

basis drug therapy bronchial asthma in children are inhalations of mast cell membrane stabilizers (nedocromil, cromoglycic acid), glucocorticoids (beclomethasone, fluticasone, flunisolide, budesonide, etc.), bronchodilators (salbutamol, fenoterol), combined drugs. The selection of the treatment regimen, combination of drugs and dosage is carried out by the doctor. An indicator of the effectiveness of the treatment of bronchial asthma in children is long-term remission and no progression of the disease.

With the development of an attack of bronchial asthma in children, repeated inhalations bronchodilators, oxygen therapy, nebulizer therapy, parenteral administration glucocorticoids.

In the interictal period, children with bronchial asthma are prescribed courses of physiotherapy (aeroionotherapy, Code ICD-10

Bronchial asthma in children, the symptoms of which can be easily identified, is increasingly common in childhood or even infancy. At the same time, the course of the disease is chronic accompanied by obstructions or periods of relative calm.

Scheme of the development of pathology

IN human body there are bronchi, which are part of respiratory system. They are branched structures inside the lungs. Outside, they are covered with a layer of smooth muscles, the contraction of which causes a decrease in the lumen of the bronchi, and relaxation causes expansion. Such work of muscle fibers is natural for the human body.. The presence of muscles is necessary to increase the lumen, in cases where it is necessary to inhale more air during physical exertion.

In bronchial asthma, there is a violation of the normal functioning of the muscles.

In the presence of an external irritant, which can be any allergen, excessive physical activity, emotional stress, there is an involuntary spasm of the bronchi, which manifests itself at the wrong time.

Also, due to the occurrence of an allergic reaction and concomitant inflammatory process, swelling of the mucosa occurs, accompanied by the appearance of viscous "vitreous" sputum. This factor worsens the situation many times over.

Left - bronchi healthy person, in the center - the bronchi of a patient with bronchial asthma (BA), on the right - an attack in a patient with asthma

The diagnosis of bronchial asthma can be made after the first manifestations of the symptoms described in this article, but a complete examination is required to clarify the doctor's conclusion.

7 main reasons for the development of bronchial asthma in children

The causes of bronchial asthma in children are mostly associated with an allergic predisposition, or are a consequence of frequent colds.

Mikhailova Lyubov Igorevna, allergist, 1st city clinical Hospital, Kirov

My profile is allergies, and this is the reason children and adults are referred to me for asthma. I must say right away that the treatment of bronchial asthma in a child is a long and complicated process. Requires taking various drugs for a long time.

It is necessary to determine the allergen that causes the development of a crisis. It is difficult for a child to explain why he should not eat eggs or honey, because he does not understand what an allergy is. With a certain persistence of parents, it is possible to exclude “harmful” foods from the diet, which helps to cope with asthma with “little blood”.

To understand how to treat bronchial asthma in a child, you should know the causes. It is customary to allocate 7 main causes of this unpleasant disease:

Forms of bronchial asthma and its division into classes

When diagnosing a disease, all pulmonologists should be guided by a document published by WHO. All available varieties of bronchial asthma in this document are divided according to two criteria:

features of the origin of the disease;
the severity of it.

But in the light of recent scientific research, such a large division is clearly not sufficient, since new methods in classifying asthma must take into account a large number of nuances, among which:

the severity of the disease before the start of treatment;
whether there is a response of the body to the treatment and how significant it is;
whether it is possible to control the course of the disease in such a way as to prolong periods of remission and prevent the occurrence of new attacks;
is there a relationship between the cause of the disease and the characteristics of its course;
possible causes of complications during the course of the disease.

A clear definition of the cause of the onset of the disease can lead not only to effective therapy, but will also help in time to stop an attack of bronchial asthma. According to the causes of the appearance, the disease is divided into three large subgroups:

Bronchial asthma - an allergic form

In such a case, the causative agent of the disease is an external irritant in the form of an allergen entering the children's body respiratory route or with food, which is less common. As respiratory allergens are considered:

fungal spores;
plant pollen;
animal hair;
ticks;
tobacco smoke.

The bronchi of an asthmatic child react acutely to cigarette smoke

The initial reaction with this form always develops in the respiratory tract and manifests itself in the form of sinusitis, rhinitis,.

Against the background of the course of these concomitant diseases, atopic bronchial asthma begins to develop in children. Much less often, the cause of the development of seizures can be food. It is accompanied, along with the emergence external manifestations, in the form of a rash, redness, stool disorders, coughing or asthma attacks.

How to distinguish a common cough from an allergic one, see.

Food allergies often cause an asthma attack in children, which can lead to a condition known as anaphylactic shock. IN this case urgent care is required for bronchial asthma in children.

infection-dependent asthma

Such a disease as bronchial asthma in children, Komarovsky also subdivides into an endogenous variety of the disease. In this case, the factors leading to a change in the lumen of the bronchi and causing cough and attacks, microorganisms act.

According to statistics, respiratory diseases and bacterial infections of the upper respiratory tract in childhood can trigger asthma attacks.

Identifying cases of this type of asthma is quite simple.: all symptoms quickly disappear during hormone therapy and in the case of the use of drugs belonging to the group of bronchodilators.

Mixed asthma

The causative agents of this type of disease are both allergens and microorganisms.. Factors that provoke the disease can be:

poor environmental conditions;
stressful situations;
bad habits;
various chemical irritants.

A separate type of bronchial asthma, not included in any category, is the cough form of the disease. Due to the lack of pronounced symptoms, it is difficult to diagnose.

A similar variety appears on the background persistent cough, which may indicate diseases such as bronchial obstruction.

The early identification of the allergen and its complete exclusion from the life of the child will be the key Get well soon. Therefore, do not delay a visit to the allergist.

Symptoms that give the right to suspect the presence of asthma

Cough is a defense mechanism when the body reacts to irritation of the respiratory tract.

Timely diagnosis of any disease is a sure chance to provide competent and right treatment. Asthma is no exception to the general rule. Bronchial asthma in children, the symptoms of which are known, is a disease that can be overcome. The first signs that should be " alarm bell for parents are as follows:

systematically occurring whistling when the child breathes;
frequent for no apparent reason;
coughing or difficulty breathing in direct contact with the source of the allergy;
the occurrence of whistles in the breath after exercise or emotional upheaval;
complete lack of the desired effectiveness from the application.

At the same time, there is a division of asthma according to the severity of its manifestation:

Mild degree is characterized by short-term and rare manifestations of the main symptoms. Attacks are short and well eliminated with the help of appropriate drugs.. After physical activity, there is no deterioration in the child's condition. No cough at night.
The average degree is distinguished by the regularity of the occurrence of seizures, which occur weekly. Symptoms in the form of bouts of nocturnal cough also show a periodic character. Physical exercise is only possible to a limited extent.
The severe degree in which infectious-allergic bronchial asthma proceeds is characterized by very frequent attacks that have a long duration. Night cough can cause an asthma attack in bronchial asthma. Practically completely excluded periods of absence of symptoms. Physical activity is contraindicated.

In cases where the onset of the crisis cannot be eliminated on its own, emergency assistance is required for an attack of bronchial asthma, which ambulance doctors can provide.

Diagnostic measures

Holding diagnostic measures, which is based on the history of the disease (bronchial asthma in a child), includes a whole range of measures aimed at determining the type of disease, its severity, and other related parameters.

The first stage of diagnosis is the study of anamnesis, determination external signs the presence of a disease.

The next step, if asthma is suspected, is the appointment clinical research which include a blood test. During the analysis, the immunological status of the patient is determined, and tests are also carried out to identify a group of allergens that are causally significant.

Also, during the diagnostic period, instrumental parameters are checked. They include checking respiratory function . Also at this stage, research is being carried out on all internal organs, through ECG, Ultrasound.

Bronchial asthma: medical history for therapy is the final stage of diagnosis and is a descriptive part of the anamnesis and genesis of the disease, as well as the data of the obtained research results.

In the future, the pathogenesis of bronchial asthma in children allows not only the treatment of the patient in case of crises, but also the prevention of bronchial asthma in children during periods of remission.

Bronchial asthma in children, symptoms and treatment

After the diagnosis is made and it is determined that the child suffers from this particular disease, basic therapy for bronchial asthma in children is required.

Using a nebulizer will help relieve an attack both on the road and at home.

There are several treatment options, among which are traditional medical methods and folk methods, mainly consisting in carrying out phytotherapy.

Treatment of bronchial asthma in children folk ways and the use of inhalers cannot be considered the only way to defeat the disease, but can provide effective impact only in combination with medication.

If bronchial asthma is observed in children, clinical guidelines can only be given by the attending physician based on a number of factors.

With drug treatment, two groups of therapeutic courses are distinguished:

symptomatic, when treatment is reduced to the removal of emerging seizures;
basic, when drugs are taken for a long time, aimed at eliminating the cause of the disease.

As drugs for symptomatic treatment, medications are used that have a vasodilating effect, allowing you to quickly increase the lumen of the bronchi and make breathing easier.

Do not use the drug during an exacerbation more than once every 20 minutes

These include drugs:

Bitolterol;
Terbutaline;
Theophylline;
Ipratropium bromide, and a number of others.

It is possible to take medications in inhalation form, which simplifies the process of taking the medicine, but the effectiveness decreases, since most of the active substance settles in the pharynx, and only 20% “gets” to the bronchi.

Among the existing methods, to improve the process of entry of the active substance into the bronchi during inhalation treatment, one can note the use of.

This type of inhaler is capable of transferring the drug from a liquid form to a fine aerosol within a short time, which has a positive effect on the absorption of the active substance.

Kiryanov Mikhail Vladislavovich, pulmonologist, clinic modern medicine Unimed, Vladimir

Treatment of bronchial asthma is always a rather difficult process, requiring long-term diagnosis and all kinds of assistance from the parents of the child and the doctor.

For the most part, in my practice, there are cases of asthma caused by various allergens. In our clinic, it is possible to quickly take tests to determine allergens, which helps me, as a doctor, get the results and understand what course of treatment is needed.

One of the recent discoveries for me was the drug Erius, which is most effective among other antihistamines. Its use in most cases helps to prevent the onset of an attack in the event of an allergen entering the body.

The use of drugs for symptomatic treatment is not long positive effect and in most cases habituation is observed. To avoid such an effect, careful adherence to the dosage is required.

Epinephrine is a synthetic adrenaline

For basic therapy, several groups of drugs are used at once, including:

designed to reduce allergic manifestations;
antibiotics to get rid of existing infectious pathogens;
preparations of the hormonal spectrum;
contributing to the stabilization of the cell membrane.

As drugs for allergies, the most effective are:

Tavegil;
Suprastin;
Zodak;
Erius.

To stabilize cell membranes are used:

Ketotifen;
Tailed;
Intal.

In some cases, the attending physician may prescribe drugs such as Accolate or Singular, which in themselves are not intended to stop an attack or affect the lumen of the bronchi, but help the body cope with hypersensitivity to allergens.

The most commonly used drugs, their dosage and administration features are shown in the table.

Name	Daily dosage according to age	Release form
Salbutamol	2-6 years - 2 mg 3 times 6-12 years - 2 mg 4 times >12 years - 4 mg 3-4 times	Aerosol
BITOLTEROL	>12 years - 2 inhalations With spasm 3 inhalations every 3 minutes	Aerosol
TERBUTALIN	3-7 years - 1/4 tab. thrice 7-15 years - 1/2 tab. thrice	Pills
THEOPHYLLINE	3-9 years 24 mg/kg body weight 9-12 years old 20 mg/kg body weight 12-16 years old 18 mg/kg body weight >16 years - 900 mg/day	Pills
epinephrine (for relief of an attack)	in childhood 100-500 mcg	Injections
IPRATROPIUM BROMIDE	<6 лет – 0.4 мл раствора 3-4 раза 6-12 years - 1 ml of solution 3-4 times >12 years - 2 ml of solution 3-4 times	Solution for inhalation
TAVEGIL	6-12 years - 1/2 tab. 2 times >12 years - 1 tab. 2 times	Pills
SUPRASTIN	1-12 months - 1/4 tab. 3 times 1-6 years - 1/4 tab. 3 times 6-14 years old - 1/2 tab. 3 times	Pills
ZODAK	6-12 years - 1 tab. >12 years - 1 tab.	Pills
ERIUS	>12 years - 1 tab. 1-5 years - 2.5 ml 6-11 years - 5 ml >12 years - 10 ml	Tablets, syrup
KETOTIFEN	>3 years - 1 mg 2 times	Pills
TILED MINT	>2 years - 2 inhalations 2-4 times	Aerosol
INTAL	>5 years 2 inhalations 6-8 times	Aerosol
AKOLAT	7-11 years - 10 mg twice >12 years - 20 mg twice	Pills
SINGULAIR	6-14 years - 5 mg >15 years - 10 mg	Pills

Nursing process as part of planned treatment

Inhalation from the spacer should be carried out as soon as possible after spraying the aerosol.

Very important point for the treatment of asthma is nursing process with bronchial asthma in children, carried out in the conditions of moving the child to the hospital.

Nursing care for asthma in children is a way to improve general state sick, to treat an attack of bronchial asthma, to prevent complications.

There are three forms of such care:

dependent, when therapy is carried out at the direction of a doctor;
interdependent, when the nurse acts as part of a team;
independent, when care is provided as part of the supervision of physical condition patient and diet.

Nursing care for a child with asthma includes:

initial preparation for research and testing;
monitoring the execution of doctor's instructions;
planning the optimal schedule for patient care;
leisure organization. The treatment of children is a special process and requires nurse advice to parents on the organization of the child's leisure, which includes the transfer of toys or books to the hospital.

Prevention

As a preventive measure, it is most often recommended to follow a few simple rules:

Regular exposure of the child to the fresh air.
Exclusion of the possibility of contact with potential sources of allergies.
Carrying out preventive measures to improve immunity.
Passing physical therapy courses.
Implementation of regular wet cleaning in the premises where the patient lives.
Refusal of others from smoking.
The use of synthetic fillings for pillows and duvets, as well as the reduction of upholstered furniture in the apartment.
Constant fight against rodents and domestic insects.

Frequent exposure to fresh air reduces the risk of disease. Therefore, you should often leave the city, visit the forest or the village.

Compliance with the rules will minimize the risk of bronchial asthma in a child.

Almost five centuries ago, on December 8, 1542, Mary Stuart was born, queen of two states - France and Scotland. Her amazing life, more like an adventurous romance, was filled with love adventures, palace intrigues, betrayals and passions…..

Mary Stuart. Flerova Elena Nikolaevna

664

Ilga

More than a year ago, my husband's mother died. There was a stepfather (according to the documents, the husband was not adopted) and a brother by mother. His parents saved up for a cottage, but did not have time to buy it, all the property first passed to his father, who asked him to write a waiver of the inheritance in order to take over the car and so on. The youngest son lives with his father with a girlfriend, I don’t know if he wrote a renunciation of the inheritance. The bottom line is that the father and the youngest divided the money accumulated for the cottage (not a small amount) into their accounts, but they didn’t tell us anything, they accidentally found out from their brother (he said that they were saving money further for themselves), it turns out that the husband does not receive anything from the mother inheritance in general. Everything will be assigned to the brother. The husband claims that he will earn for everything (this is unrealistic). His father lied to him that all the money "burned out." In general, it was always the case that for all the years my father never called himself, never once asked how he was doing, and so on. Brother is like that too. But the husband consistently calls them himself, worries about their health, and so on. I tell my husband - I wonder if you hadn’t called them yourself, would they have remembered you, called? He says - the father is definitely not, he was brought up like that (or not brought up sooner)! I feel sorry for my husband that he is abandoned by them and does not understand this, that his father does not act honestly, and did not receive any inheritance from his mother at all, nothing.

450

Alena Viktorovna

Hi all. I quarreled with my mother, I managed to do this - hang a lump of guilt on me. She lives in the country, she has about 30 cats and several dogs. Favorite dog shepherd) is aggressive, that I don’t even go into the yard of this dacha, I can’t tie it, I don’t like it. The cats are neutered, but they don't get smaller: kind people constantly throw someone up or she picks them up ... it is very expensive to maintain this zoo. the mother is retired (she never actually worked), the father works and receives a pension, but they barely make ends meet. and then someone advised her to go online. It's so simple - you create a page and that's it, they started sending you money! she does not understand anything about this, there is no computer, a push-button telephone. can open google and make a request. All. what's happened social media appears vaguely. Came to me today. Make, he says, a page and lead it. I am in the city, I have two children, two jobs, the youngest just went to the garden, she is constantly sick. She does not sit with children - she does not want to, she has no time. What is it like to create a page / channel and promote it, how long it takes - she has no idea. I can't stand social media! these groups... I'm not even on Instagram. In general, I freaked out, my mother sobbed that no one wanted to help her, she was asking for such a small thing! I’m trying to explain to her - I need photos, videos, stories about animals ... but I can’t even go there. Like this is not a problem - my father takes pictures, I write.
now I'm sitting, crushed by a sense of my own insignificance (((buy her good phone? tablet? will she figure out how to make and develop her blog or page? I definitely don't want to do this myself. This is an encroachment on the last piece of my personal time (((I don’t have it anyway ... children, work, home, and also I teach at a university, I have to write scientific articles (now I have a manual "hanging", soon to take , and for two weeks I have been suffering with the youngest child - she has the flu (((no one ever told me: "Alena, let's sit with the girls, and you go to the bathhouse!". No. Father still sees with my children, if I I need work urgently, my mother never.

302

Squirrel

In general, do men feel sorry for women? Why is it in their minds that a woman is a horse, and must plow at work and at home. And don't whine or complain. In short, plow and laugh at the same time with happiness.
I don't know about others. But I’ll say it myself, it’s hard to work full time, and weekends don’t look like holidays. How are you?

199

Olga Veselova

I have a friend. She has been involved in charity work for several years. She has no financial means to participate. But she has a talent to unite, inspire, infect people with an idea. They are also involved in helping families in difficult situations, and in shelters, but the main activity is fundraising for medical treatment. There have been many stories over the years. And with children, and a pregnant woman, and even for a man who has an accident. She rarely gives details. But then I decided to ask myself. How then communication develops with the people she helps. After all, in order for the story to shoot, you need to get sick of it. They print flyers, stick them around the city, raise all the media, hold charity fairs and concerts. It turned out that after the end of the gathering, people never make contact again. They do not take part in the training camp (to help with putting up leaflets, for example), they do not congratulate you on your newborn. Some who meet in the city turn away and pretend that they do not know each other. Let me tell you right now, she has no worries about it. She has long passed the stage when she was fascinated by people. Trying not to get too close. Helped to the side. Usually newbies who get on the team. disappointed at first. So all the same, you need to remember the good? Do not carry the burden and duty on your shoulders, do not go half-bent to the one who once helped. And for example, do not forget to congratulate him on social networks, or support him when he finds himself in a difficult situation. Most often, when a friend is asked for help, the first words - we have no one else to turn to.

177

And the reason is personal, for example, my thirty-something nephews. Such a grasshopper, skips, chirps to itself. No, not a bum. And the work is not bad, not dusty, and the career is little by little visible, not so “ah!”, But there is where. And so they offered him a place - super, the salary cannot be compared with the current one, and then - grow, try. No, he says, I don't want to. I'm still young - I'm looking for my own and haven't lived enough yet. I am silent, but I do not consider him right. Or right?

158

Update: October 2018

Bronchial asthma is a special condition of the child's bronchi, when they are ready to react with a spasm to the ingress of a certain allergen or their various types. Most often, the pathology is genetically determined, therefore it can manifest itself at different ages, even in children under one year old, but is more often recorded at 2-5 years old.

Bronchial asthma in children occurs with alternating periods of exacerbation and remission, while the duration of each of them will differ depending on individual features living conditions and medications taken. It cannot be transmitted from another person. If a child begins to cough or has wheezing after contact with a person who has had similar symptoms, this indicates bronchial obstruction resulting from the collision of the bronchial wall with the virus.

The diagnosis is made after some instrumental and laboratory studies. Once established, it does not make the child disabled, but in order to maintain a sufficient quality of life, it requires the imposition of many restrictions on the nature of nutrition, the region of residence, physical activity, medication, or the ability to acquire pets.

Unfortunately, at this stage, bronchial asthma is incurable and it is impossible to “outgrow” it. With the help of drugs and regimen, it is only possible to maintain remission of the disease for a long time.

A little about the bronchi

The bronchi are cartilaginous tubes that are a continuation of the trachea. The main bronchi depart from the latter at the level of 5-6 thoracic vertebrae in the amount of 2 pieces - right and left. Then they branch into lobar, of which there are two on the right (since there are only 2 lobes in the right lung), and three on the left. Each of the lobes is divided into segmental, conducting air to the segments (pieces) of the share, and those, in turn, into subsegmental, then - interlobular and intralobular. The final stage is considered to be respiratory bronchioles - tubes that fit directly to those structures where oxygen is received from the air and carried directly into the blood.

The bronchial wall consists of three layers:

Internal, mucous. Under it is a loose submucosal layer, which contains nerve endings, lymphatic tissue, a set of lymphatic capillaries, the end sections of the glands that produce bronchial mucus (if these glands die, the mucosa dries up and becomes inflamed).
Medium, consisting of three types of tissues: fibrous, cartilage and muscle. The smaller the caliber of the bronchus, the less cartilage tissue in it, and vice versa, the larger it is, the denser the cartilage. With a decrease in the diameter of the bronchi, the thickness of the lying obliquely circular muscle fibers increases.
Adventitia, outer shell. It is made up of loose connective tissue.

The mucosa contains many different cells. This:

Type of cells	Function
goblet	They produce mucus, which seizes dust particles and microbes that have entered the bronchi with air. This dust is removed with the help of ciliated cells. Goblet cells are located unevenly: in some areas, the ratio of ciliated and goblet cells is from 4:1 to 7:1, while in others it is 1:1. With the removal from the main bronchi, these cells become less and less
ciliated	They remove mucus, which contains dust and neutralized microbial particles.
Intermediate	These elongated cells that are located between different types cells
Basal	Of these, goblet and ciliated cells of the mucous membrane are formed:
Cells Clara	They produce enzymes that break down surfactant, that is, a substance that prevents the alveoli from collapsing. In doing so, they produce part of the surfactant. In bronchioles they replace goblet cells
M cells	They are taking over microbial cells and report them to immune cells so that they can develop specific antibodies directed only against these microbes
Kulchitsky cells	Produce hormone-like substances that affect the lumen of the bronchi
Immune cells: plasma cells, mast cells, leukocytes and eosinophils	Normally, there are few of them. They form an immunological defense against antigens and microbes that enter with the air.

When a child is born, the bulk of it bronchial tree already formed, but it continues to branch out. The dimensions of the bronchi develop intensively in the first year and during puberty.

In the first year, ciliary and other cells of the mucous membrane only develop, so there is little protective mucus in the bronchi, and it is not well excreted. This leads to easier infection of the lower respiratory tract.

The cartilage of the bronchi in children under one year old is softer and more elastic, which makes it possible for them to move. Bronchial muscles are also underdeveloped, as a result, the cough reflex does not work well, and small bronchi become more easily clogged with mucus during inflammation.

What happens with asthma

In asthma, inflammation of the bronchial wall develops: in its submucosal layer, the number of immune cells increases. Basically, these are cells, the number of which increases with allergies: eosinophils, basophils, mast cells, T-lymphocytes. When allergens hit, they throw out a large amount of biologically active substances. This leads to swelling of the mucous membrane and its production by the glands. a large number mucus. The result is difficulty breathing, coughing, wheezing, heard on exhalation.

Substances released by eosinophils and mast cells, as well as substances synthesized by other immune cells in response to their release, trigger reactions chronic inflammation bronchial wall, which leads to the appearance of scar tissue under the mucous membrane. Because of this, the bronchi become hyperreactive, that is, subsequently they instantly spasm in response to allergens.

Disease classification

There are such forms of bronchial asthma:

Mostly allergic (atopic). It can take the form:
- bronchitis (that is, with cough and sputum production);
- a combination of both asthmatic symptoms and a runny nose with the release of copious amounts of light snot;
- combination of asthma symptoms with sneezing, nasal congestion, separation of light snot;
- exogenous asthma: when symptoms appear in response to contact with allergens (animal dander, plant pollen, food, household chemicals and decorative cosmetics).
Nonallergic asthma. It occurs upon contact with protein-free substances that cannot be allergens. These are substances produced by industrial production, drugs. Non-allergic forms of asthma also occur in response to neuropsychic overload, endocrine diseases, physical activity, or ingestion of any microorganism.
Mixed asthma, when characteristic symptoms can occur in response to some external allergen, as well as to an infectious, endocrine or neuropsychiatric disease.

Asthma can affect a child of any age, but most often it is found in children 2-5 years old.

Reasons for the development of pathology

Increased bronchial reactivity may be due to:

Hereditary predisposition (about 60% of children have relatives suffering from bronchial asthma). The disease may not manifest itself, but if:
- the child was born as a result of a difficult birth or after a difficult pregnancy;
- when he was born prematurely;
- if he lives in an environmentally polluted city, his chances of developing asthma in early childhood are greatly increased.
Environmental factors:
- dust: industrial and domestic;
- animal saliva;
- feathers and down of birds;
- household chemicals;
- allergenic substances contained in food products;
- microbial particles: bacteria, fungi, viruses, which do not necessarily have to start the disease (for example, SARS or sinusitis), but can provoke an attack of bronchial asthma;
- tobacco smoke;
- medications (there is even a diagnosis of "Aspirin Asthma" and "Steroid Asthma");
- perfumes;
- pollutants contained in the air;
- change in environmental conditions: cold, thunderstorms, high humidity.
Most often, asthma is provoked by a combination of several allergens.
Internal factors: endocrine, infectious, neuropsychiatric diseases, heavy weight child.
Some other factors, such as physical activity.

The course of asthma is exacerbated by diseases of the internal organs. The main "fault" falls on the gastrointestinal tract, where they can develop: dysbacteriosis, gastritis, gastroduodenitis, constipation, biliary dyskinesia. The intestines are a great reservoir for toxins. With his illnesses, they can be there long time persist and gradually enter the bloodstream.

Symptoms

There are three periods in the course of bronchial asthma:

Remission. At the same time, the child feels absolutely or almost healthy; he has no cough, wheezing, or other symptoms. If asthma manifested itself in early age or has severe course, then due to the constant lack of oxygen by the brain, the child lags behind in neuropsychic development, becomes whiny, emotionally labile.
Remission happens:
- complete: nothing bothers the child;
- incomplete: it is difficult to perform some actions, less often you want to play outdoor games;
- pharmacological: to achieve the retreat of the disease is possible only by the use of drug therapy.
Aggravation. These are the time intervals during which attacks are noted. According to the duration of these intervals and the nature of their manifestation, the severity of bronchial asthma is diagnosed.
Attack of bronchial asthma. This is the name of the condition when the main symptom occurs - difficulty in exhaling and wheezing on exhalation. This status usually occurs at night or in the evening; in children, it is often preceded by special pre-seizure symptoms.

Symptoms by which you can suspect bronchial asthma in children are precisely the manifestations of an attack. It can begin with the appearance of pre-seizure signs, which are observed from several minutes to three days. This:

tearfulness;
increased irritability;
sleep disturbance;
poor appetite;
at first - the release of abundant mucous snot, then - an obsessive dry cough, headache, after a few hours the cough intensifies, becomes a little more humid.

The attack itself begins in the evening or at night, when the following symptoms appear:

dry cough, which may decrease if the child is seated or put on legs;
breathing becomes whistling, hoarse, inhalation is especially difficult;
fright;
the child tosses about in bed;
body temperature is normal, may rise slightly;
the skin is pale, moist, with blue around the mouth;
increased heart rate.

At first, the attack can pass by itself within a few minutes to several days. You should not wait for the situation to resolve itself, because it is dangerous for the lack of oxygen to the brain and other vital organs. In this case, help is needed: optimally - inhalation of bronchodilators (best of all - non-hormonal "Berodual").

After the attack has passed, the cough becomes wet, that is, bronchial mucus is coughed up. In children over 5 years of age, it can be seen that asthma sputum is viscous, glassy.

The course of an attack depending on the variant of asthma

With the development of such a subspecies as asthmatic bronchitis, which usually develops against the background of acute respiratory infections, the following symptoms appear:

moist cough;
dyspnea;
difficult exhalation.

The difference between allergic asthma is the rapid development of an attack. If help in the form of inhaled bronchodilators is started immediately, the attack quickly recedes.

Non-allergic asthma is characterized by the gradual development of an attack. The assistance provided does not lead to an immediate effect.

Classification of seizures according to their severity

Type of attack	mild attack	Moderate attack	severe attack	status asthmaticus - serious condition, which can develop both by itself and as a result of an overdose of bronchial dilating drugs
Breath	Slight difficulty breathing	Noisy, wheezing, wings of the nose, muscles between the ribs are involved in breathing	Breathing is both more frequent than normal and noisy, and requires the inclusion of all muscles in the act of saturating the blood with oxygen	Frequent, noisy
Cough with asthma	Dry, as if in spasms	Attacks, after which thick, viscous sputum is poorly discharged	Might not be	In this case, coughing and vomiting are signs of improvement.
Speech	not violated	Speak in separate phrases or words, with difficulty	Cannot speak, has difficulty pronouncing certain words	Impossible: all the energy of the body is spent on the act of breathing
General state	Worse than in a state of health, but generally not bad	The child is capricious, restless. Pale skin, bluish lips	The child is very restless. The skin is pale bluish; cold sweat on the head, bluish lips	Very severe, may be accompanied by loss of consciousness or inappropriate behavior

Severity depending on the course of asthma exacerbations

The treatment of asthma in a child depends on this classification. The main criteria on which it is based can be assessed by any parent. Some of them are determined by the doctor, and are described in the "Diagnostics" section.

sign	Asthma of the lung, episodic course	mild asthma	Average degree of asthma	severe asthma
How often do choking symptoms occur?	Less than once a week, short-term	1 time/7 days or more, not every day	Daily	Constantly
Exacerbations	Lasts a few hours - a few days. Between exacerbations, the child feels well, breathes normally	Lead to disruption of physical activity and sleep	Disrupt physical activity and sleep	Frequent, significantly limit physical activity
Frequency of nocturnal symptoms	2 times a month or less	More than 2 times a month	More than once a week	Frequent
Peak expiratory flow (PEF) or FEV in 1 second	More than 80% of the norm	More than 80% of the norm	60-80% of the norm	Less than 60% of normal
Peak expiratory flow (PEF) or FEV in 1 second	With daily fluctuations less than 20%	Daily fluctuations: 20-30%		Daily fluctuations - more than 30%

Features of asthma manifestations in children of different ages

Bronchial asthma in different age groups manifests itself in different ways. Parents need to pay attention to the characteristics of the symptoms in order to provide timely assistance to the child, diagnose the disease, and then achieve a complete and stable remission through continuous or course medication.

Features of the course in infants

At the age of 1 year, asthma is most difficult to diagnose, since its manifestations differ from the “usual”, classic ones described above:

must eat prodrome with discharge of liquid mucus from the nose, constant sneezing, dry cough;
the only signs determined by the doctor are edematous tonsils, single dry rales over the lungs;
the child becomes restless, irritable;
sleeps badly;
on the part of the gastrointestinal tract, there may be either constipation or diarrhea;
breathing becomes "sobbing", breaths - frequent and short, exhalation - with a whistle and noise.

Features in children 1-6 years old

Up to 2 years, it can be just an increase and shortness of breath in a dream, during outdoor games, physical education.

In children aged 2-6 years, this is:

restless sleep;
periodic coughing, which can only occur in a dream;
dry cough, and sometimes a feeling of squeezing the chest appear during physical exertion, outdoor games;
if you breathe through your mouth, there is a strong dry cough.

Schoolchildren

Symptoms of asthma in children of this age are:

coughing during sleep;
cough after physical activity;
children try to run and jump less;
during a coughing fit, the child tries to take a sitting position, while bending, leaning forward.

Asthma in teenagers

Asthma is usually diagnosed by this age. The child already knows what can provoke an attack in him and should have an inhaler with him. It often happens that by adolescence, asthma seems to disappear, but in fact, the increased reactivity of the bronchi persists, "waiting in the wings." Often, cases are recorded when a disease that has passed in a teenager returns in old age.

Diagnostics

Parents of children who have:

almost any cold is accompanied by a cough and dry wheezing, giving the doctor the right to diagnose "Broncho-obstructive syndrome";
when bouts of wheezing or a dry, non-productive cough occur:
- a) in the warm season, during the flowering of certain plants;
- b) after physical exertion;
- c) while taking certain medications (especially if they contain acetylsalicylic acid);
- d) during fear, stress, strong emotion.

The main diagnostic method is peak flowmetry. It is performed using a portable peak flowmeter device, resembling a tube into which the child will need to exhale air at maximum speed. This will allow you to estimate the maximum expiratory rate, thanks to which you can judge the patency of the bronchi.

Peak flowmetry is carried out from the age of 5, when it is already possible to cooperate with the child. It is performed 2 times a day: first in a hospital, then at home, fixing in parallel the baby’s daily routine, the medication schedule. So you can analyze what affects the occurrence of an attack, the effectiveness of the drugs taken.

Peakflowmetry is performed while standing, at one selected time, before taking the drugs. If it is necessary to evaluate the effectiveness of inhaled bronchodilators, then measurements are taken before inhalation, and then 20 minutes after taking the medication. The assessment is carried out according to the nomogram, which takes into account not only the obtained indicators, but also the growth of the child.

The peak expiratory flow rate (PSV) is 80-100%, with daily deviations of less than 20%. "Safety" - PSV 60-80%, daily fluctuations 20-30%. In this case, it is necessary to increase the dosage of those drugs that make up the "basic therapy".

If PSV is less than 50%, and daily fluctuations are more than 30%, you need urgent help with bronchial asthma, which must be started at home with subsequent hospitalization.

Therapy of the disease

Treatment of bronchial asthma in children begins with the exclusion from the child's life of those things that can provoke an attack. Firstly, it is a hypoallergenic life, and secondly, a hypoallergenic diet.

Hypoallergenic life

To ensure that the child gets as few allergens as possible, follow these rules:

keep books in a closed cabinet;
clothes, especially woolen, do not store in the children's room, and even more so do not spray them with moth remedies;
do not buy soft toys for children, clean the donated copies with a vacuum cleaner, after wrapping them with wet gauze;
wash soft toys and bedding with hypoallergenic powders with the addition of acaricides to kill possible house mites;
remove pets from the house;
if there are fish, feed them "wet" and not dry food;
constantly ventilate the room, use air cleaners such as a HEPA filter, which will remove wool, dust, fungal spores;
during cleaning, the child should not be in the room;
the bathroom and toilet should be cleaned with vinegar from mold spores;
the optimal coating for toilets and bathrooms is tile, not linoleum.

Medical treatment

It includes 2 aspects:

basic therapy;
emergency medicines.

So called drug treatment aimed at suppressing allergic inflammation and predisposition to bronchospasm. The intake of basic therapy drugs lasts at least 3 months, in severe cases they have to be used year-round.

Means of basic therapy can be:

hormonal;
non-hormonal;
additional.

Non-hormonal therapy

This includes several groups of drugs. Let's consider them in more detail.

Mast cell membrane stabilizers

As mentioned above, the submucosa of the bronchi contains the so-called mast cells. They contain granules with various substances - mediators of inflammation. When confronted with an allergen, the cell membrane becomes permeable, and substances from the granules come out, triggering bronchospasm, coughing, and mucus secretion.

If you "fix" the membranes of mast cells, then you can avoid swelling of the bronchial mucosa, their spasm. With the help of these drugs, the attack is not stopped, but - more importantly - it is prevented, lengthens the intervals between the symptoms of choking and coughing that occur.

Unfortunately, the action of these drugs does not occur immediately; they have a cumulative effect, so you need to take them for at least 3 months. They begin to "work" in 2-12 weeks, their action continues for some time after the end of the course.

Membrane stabilizers include:

"Tayled" in the form of an inhalation aerosol;
"Kromogen" - an aerosol for inhalation;
"Intal" (sodium cromoglycate) and "Intal plus" - capsules with powder for inhalation;
"Tilemint" - an inhaler with a special device that creates a cloud of fine particles of the drug in front of the mouth, which improves the delivery of the drug to the bronchi of small caliber by 1.5 times;
"Ketotifen" - a drug in tablets.

You need to start applying them 10-14 days from the start of flowering, if the attacks are caused by the pollen of seasonal plants.

"Intal" is prescribed 4 times a day, "Tailed" and "Tailedmint" - twice. If a mild attack occurs during the use of the drug, instead of Intal, you can use Intal Plus, which contains not only a membrane stabilizer, but also a bronchodilator. "Intal +" is used in a short course, at the end of the exacerbation, you need to switch back to "Intal" or "Thailed".

Use inhalers with "Intal", "Kromogen" or "Tailed" as follows:

so that the substance gets to the mast cells of the bronchi, before using these inhalers, it is recommended to inhal the child with bronchodilator drugs;
from one capsule you need to try to take as many breaths as possible;
you need to inhale the medicine with your head thrown back so that it is easier for the medicine to reach its destination;
in some children, "Intal" may cause irritation of the bronchi, so at the beginning of treatment, it may be necessary to use bronchodilator drugs ("Berodual", "Salbutamol");
if, despite the used mast cell stabilizer, the child has frequent seizures, it is necessary to cancel this drug and replace it with another long-acting agent;
when combined with asthma allergic rhinitis or food allergies, eye drops ("Optikrom") or an inhaler in the nose ("Lomuzol") with similar drugs are additionally applied.

Such drugs are not canceled abruptly, they are "removed" gradually, under the control of peak flow measurements.

The benefits of these drugs are:

relief of asthma attacks;
ease of use;
safe;
there is no addiction;
best used in a child with bronchial asthma with viral infection instead of the usual interferons or other means.

Antihistamines

The task of these drugs is to turn off the receptors that bind to the main internal allergenic substance, histamine.

The first generation drugs include: "Suprastin", "Dimedrol", "Diazolin", "Tavegil", taken 2-3 times a day. They cause drowsiness and act for a short time. Now they will be used only during the relief of an attack, in the form of intramuscular injections.

To prevent the state of suffocation, blockers of histamine receptors of the second or third generation are currently prescribed. These are Fexafenadin (Telfast), Erius, Tsetrin, Ebastin. These drugs are also used during exacerbations of asthma. Apply them even after that for a month.

Leukotriene receptor antagonists

Preparations with the active substance zafirlukast (Acolat) or montelukast (Singular) are available in tablets. They are especially effective for exercise-induced asthma and aspirin-induced asthma. Also, these drugs are effective if there is a need to use inhalation hormonal drugs: leukotriene receptor antagonists help to avoid increasing the dose of hormones.

Specific immunotherapy

This is the name of the treatment when those allergens that cause an asthma attack are introduced into the child's body in microdoses, with gradual increase doses.

Apply SIT from 5 years. Start treatment during remission. It is most effective when asthma is combined with allergic rhinitis or when allergic to one substance.

Hormonal basic therapy

It is prescribed for frequent exacerbations of the disease, when without the use of these drugs it is possible to develop asthmatic status. This therapy is more effective than any other in suppressing edema, the release of histamine and other substances contained in mast cells. Thereby:

indicators of peak flowmetry increase;
daytime and even nighttime asthmatic attacks go away;
do not require the use of bronchodilators;
reduce the chance of needing emergency care.

A huge disadvantage of hormone therapy is that it is addictive and often requires an increase in dose. In addition, it can cause the development of fungal stomatitis.

The most commonly prescribed drugs are Bekotid, Seretide, Symbicort.

Alternative therapies

In the treatment of asthma, other types of treatment are also used: physiotherapy, herbal treatment, essential oils, homeopathic medicines.

Phytotherapy

This type of treatment can be used after consultation with the attending physician and only during the non-attack period, under the control of PSV. The following recipes are used:

Take 3 parts of nettle leaves, 2 parts of coltsfoot leaves, 5 parts of rosemary herb, mix. Select 4 tablespoons from the mixture, pour a liter of cold water, leave to brew overnight. In the morning, boil over low heat for 7-10 minutes, cool, strain. Give 1-2 times a day; dosages are listed below.
Mix 10 tsp. coltsfoot leaves, 12 tsp marsh rosemary herbs, 4 tsp each licorice roots and elecampane rhizomes, 6 tsp nettle leaves. Mix all herbs, pour 4 tbsp. in an enamel bowl, pour a liter of water room temperature, insist 8 hours. Next, put the infusion on a small fire, let it boil and boil for 10 minutes. After cooling and straining, you can use 1-2 times a day.
Take equal parts powder of licorice root, knotweed, nettle and calendula, mix. Next, you need 3 tbsp. mixture, which pour 0.5 liters of boiling water, put in a water bath, where it is infusion in boiling water for another 15 minutes, after which it is filtered and cooled.

Dosages:

babies - 1 tbsp. l. appointment;
children 1-3 years old - at the reception 2 tbsp. l.;
from 3 to 10 years old - 3 tablespoons each;
10-12-year-olds - 50 ml each;
over 12 years old, like adults - half a glass.

Homeopathy

As an adjunct therapy, you can use drugs prepared directly by a homeopathic doctor. Some homeopaths recommend to eliminate sensitivity to allergens with new generation preparations from the Italian laboratory Guna. This, for example, Allergy Plex 31 - Fur (ALLERGOPLEX 31 - Animal wool) or Allergy Plex 29 - Pollens and dust (ALLERGOPLEX 29 - Pollen and dust).

These drugs are prescribed after consultation with an allergist and finding out those substances that cause an attack in a child. They are selected together with the doctor of this laboratory.

Physiotherapy

To prevent exacerbations of asthma in children, the following physiotherapy methods are used:

breathing exercises (for example, according to the Buteyko method or);
acupuncture;
treatment with mountain air, including in sanatoriums located in the highlands: in Kislovodsk, on the southern coast of Crimea, in the Elbrus region;
massage - just a manual effect and with the addition essential oils to which the child is not allergic (for example, thyme, lavender, tea tree).

In addition to using various therapeutic effects, parents should not neglect visiting asthma schools, where parents and children are carefully taught the rules of behavior during an attack, methods for its timely recognition and prevention, and alternative methods of self-help during an attack. Psychologists work with sick children in asthma schools.

Help with seizure

Emergency care for asthma in a child is as follows:

Give the child a seated position.
Provide fresh air.
Call an ambulance.
Try to calm the child.
Release the child from the squeezing elements of clothing.
Administer inhaled bronchodilators. It is optimal if it is "Berodual" in the form of a solution for inhalation, which will be inhaled using a compressor inhaler (nebulizer) at an age dosage. You can use both "Berodual" in the form of a ready-made inhaler, and "Ventolin" ("Salbutamol") in the form of a solution or inhaler. "Berodual" is preferable, it causes less tachycardia.
If there is no inhaler "at hand", you can give "Eufillin" in tablets so that the dose is 3 mg / kg per dose.

It is very important not to overdose on a bronchodilator, otherwise you can cause asthmatic status - a life-threatening complication that requires mandatory hospitalization. The number of inhalations - no more than 5 times a day. For 1 injection, the head of the inhaler can be pressed 3-4 times. It is more optimal to use a spacer into which 1-2 injections of the drug are injected. If there is no ready-made spacer, it can be made by cutting 2 plastic bottles. Next, throw away their lower parts and apply the upper ones to each other so that the neck is turned outward on each side. In this case, the child takes 1 neck in his mouth, an inhaler is inserted into the second.

From a spacer, homemade or industrially produced, you need to inhale a bronchodilator drug for at least 5 minutes.

For drugs produced in the form of powder inhalers, devices called "turbuhaler", "diskhaler" are used. If asthma attacks are frequent, it is worth buying a system for a child. easy breath". This is a device connected to a spacer, which makes it possible to synchronize the child's breathing and the flow of the drug into the bronchi. So there will be no need to wait until the baby is about to take a breath to inject the drug, and most of the medicine will not remain in the throat, but will enter the bronchial tree.

Complications of asthma

There are 2 types of complications of this pathology: from the lungs (pulmonary) and from other internal organs.

From the side of the lungs, these are:

emphysema of the lungs (they become more “airy”, but those areas in which oxygen is exchanged between air and blood work worse);
atelectasis - shutting off part of the lung from breathing due to blockage of the bronchus;
pneumothorax - air entering the pleural cavity;
Respiratory failure is a condition where there is not enough oxygen in the blood.

On the part of the heart, this is either an increase in blood pressure in its right sections, which “serve” the lungs, or heart failure with the appearance of shortness of breath, tissue edema.

In most cases, asthma is caused by allergies. It manifests itself in the form of inflammation of the airways, in which acute bronchospasm is accompanied by an increase in mucus secretion.

Symptoms of the disease

Every parent should know how asthma can manifest itself. Signs in a child are usually pronounced. The baby begins bronchospasm, which doctors call bronchial obstruction. This is expressed as follows. The child begins paroxysmal dry cough. Over time, viscous sputum begins to stand out.

You can understand that obstruction has begun by breathing. If in a healthy child the duration of inhalation and exhalation is approximately the same, then with the development of an asthmatic attack, shortness of breath appears. It is characterized by a short inhale and a long exhale. In this case, the patient has wheezing, which is heard from afar.

There are also so-called first signs of asthma in children, which are observed even before the onset of an attack. So, the baby starts coughing, nasal congestion and itchy skin are observed.

During an attack, older children may complain of a feeling of lack of air, squeezing in the chest area. Sleep is disturbed in babies, they become whiny, irritable, lethargic.

Provoking factors

To prevent the development of the disease, you need to know what exactly can lead to problems. Experts include air pollution, changes in atmospheric pressure, flowering of allergenic plants, and even an unfavorable psychological atmosphere in the house as provoking factors.

If you have people in your family with hereditary allergic diseases, then you first need to find out how asthma can manifest itself in a child. The symptoms must be known in order not to miss the onset of problems. Also at risk are children with exudative-catarrhal diathesis.

An allergen that leads to bronchospasm can be plant pollen, certain foods, tobacco smoke, drugs, and household dust. The reaction can start from inhaling cold air or from physical exertion.

At the first contact, the body, as it were, gets acquainted with a foreign substance, but at subsequent “meetings” it already begins to react violently. The immune system produces antibodies, which in turn release biologically active substances, which cause asthma in children to develop. Signs and symptoms in the form of shortness of breath, a compulsive cough, and difficulty breathing are hard to miss.

Characteristic features of the disease in infants

In all babies, before an asthma attack, the so-called At this time, deviations from the respiratory organs can be noticed. Liquid mucus begins to stand out from the nose, itching appears and the constant sneezing associated with it, dry cough. The doctor can listen to single dry rales, see swollen tonsils. These are the first signs of asthma in a child under one year old.

The disease also affects the nervous system. The baby becomes restless, irritable, his sleep deteriorates. Violations are also observed from the digestive system - constipation may begin or loose stools may appear.

Asthma develops in children, usually on the background of respiratory diseases. Only in exceptional cases, its appearance can be due to stress. In this case, the symptoms of asthma appear gradually. This is due to the fact that swelling of the bronchial mucosa and hyperemia increase at a slow pace.

The attack itself can last from several minutes to several days. It will be accompanied by wheezing, which is heard even at a considerable distance, expiratory shortness of breath.

It is worth noting that sometimes the first signs of asthma in children under one year old go unnoticed. They may appear sporadically without any regularity, in different time. At the same time, they can pass on their own, without any therapy. And in the period between attacks, parents do not notice any deviations.

Preschool children

It is also not always possible to suspect the development of the disease in older children. Signs of asthma in a child at 2 years old can be blurred. For example, they may experience rapid and irregular breathing during sleep. It also happens during physical activity.

TO characteristic manifestations diseases are also frequent sneezing, periodic coughing, restless sleep. Often children do not even notice that they are coughing in their sleep. This happens reflexively. If the child sleeps separately, then the parents may not even hear the cough. Therefore, it is necessary to observe the child, if the teacher from the kindergarten speaks, then the baby coughs during sleep.

Preschoolers cannot always describe their feelings, so parents should monitor their condition. For example, signs of asthma in a 5-year-old child may appear during active games. It is necessary to consult a doctor if, after a short run, the baby begins to cough. Active movement can cause pain in the chest, a feeling of squeezing.

Symptoms of asthma in schoolchildren

The older the child, the more and more accurately he can describe his condition. Therefore, it is already a little easier to determine the disease in schoolchildren. But this can only be done if you know what signs of asthma in children may be.

As with preschoolers, children school age the disease is evidenced by coughing during sleep and after physical exertion. Patients can talk about the pressing feeling that has appeared in the chest area. In addition, having caught the connection between physical activity and emerging discomfort, children try to run as little as possible, avoiding any active games. Even in the absence of complaints, it is necessary to monitor students who refuse to attend physical education classes, try not to run, and sit quietly during breaks.

If a child has a coughing fit, it is difficult for him to sit upright. He tries to alleviate his condition, bends, humpbacks, leans forward. You may also notice excessive pallor. Preschoolers and children of primary school age may become frightened and even burst into tears during an attack.

Adolescence

As a rule, by the age of 12-14 the diagnosis is already established. At this age, it is important to teach your child to recognize when asthma starts. Signs in a child, as a rule, are always similar. He should always have with him a special inhaler prescribed by a doctor. Parents are obliged to ensure that the medicine does not run out in it, and change the used container in time.

Symptoms of the disease in children of middle and senior school age are not particularly different from those found in babies. But adolescents are already able to control the disease, which means they can prevent an exacerbation.

It is worth noting that despite the fact that many people have attacks during sports, teenagers with asthma need physical activity. Just before the loads, you need to take the medicine prescribed by the doctor and monitor your breathing. It should be even and rhythmic.

Attacks can cause allergens. But teenagers should already know which substances provoke the disease. If possible, they should avoid them. If seasonal plants provoke allergic attacks, then it is necessary to take medications on a regular basis that block their development.

Often at this age, the process of remission begins. All signs of asthma disappear, and parents decide that their child has simply "outgrown" the disease. But in fact, bronchial hyperreactivity persists. If a teenager encounters several provoking factors, then the disease may return. Sometimes it happens in adulthood. Quite often there are situations in which asthma disappears in adolescence and reappears in the elderly.

Diagnostics

To accurately determine whether a child has asthma, it is not enough to know the first signs and main symptoms of this disease. Shortness of breath, rapid and difficult breathing, obsessive cough can also appear with obstructive bronchitis. Therefore, without consulting doctors can not do. First of all, you need to visit a pediatrician. He will already give a direction for all the necessary tests and refer you to an allergist. If necessary, you may also need to consult a pulmonologist.

Apart from general research blood and urine, can also be taken on Asthma, it contains an increased content of eosinophils, Kurschmann spirals (mucus from the respiratory tract), Charcot-Leiden crystals (lysophospholipase released from eosinophils), Creole bodies (accumulation of epithelial cells).

To establish a diagnosis, the doctor must deal with the details of the baby's life. He needs to know how and when the seizures start. Even according to such a description, sometimes it becomes clear to a specialist what exactly is an allergen for a baby. It is also important for the doctor to know how the child reacts to bronchodilators. Asthma will be indicated by a temporary improvement in the background of their use.

Diagnosis consists in conducting special tests. One of the most common are skin allergy tests. For these purposes, potential allergens are applied to slightly scratched areas of the forearm. After 20 minutes, the doctor evaluates the results. Look at which particular areas of the skin turned red the most.

This allows you to identify the allergen, but does not make it possible to understand whether the respiratory system is disrupted. Parents themselves can determine this, knowing the signs of bronchial asthma. The cough form in children requires a more thorough diagnosis. To determine the working volume of the lungs, a special examination is carried out - spirometry. With its help, the degree of impaired functioning of the respiratory system is assessed.

To do this, measure the volume of exhalation-inhalation made with an effort and the total capacity of the lungs. For the first time, these measurements are taken without any drugs. Then the examination is repeated after taking bronchodilator medications. If the lung volume increases by more than 12%, then the sample is considered positive.

Bronchial hyperreactivity after exercise is also assessed. If the forced expiratory volume decreases by 20%, this indicates that the little patient asthma. Signs in a child, however, can be so pronounced that such a detailed examination is not always prescribed.

Clinical manifestations

It should be understood that in children it is often impossible to make a diagnosis due to the fact that an obstructive syndrome occurs with bronchitis. In a few days, they develop a cough, symptoms appear that indicate respiratory disorders, and wheezing wheezes are heard. As a rule, treatment consists not only in taking brocholytics, but also antibiotics, antihistamines. With subsequent SARS, symptoms of pulmonary obstruction may appear.

The signs of asthma in infants are quite vague, so special attention is paid to the history, asking parents about the onset of the disease, and physical examination.

The course of the disease itself can be divided into 3 conditional stages:

Attack immediately. Acute suffocation develops due to difficult entry. It is preceded by a pre-attack stage, which can last from several minutes to 3 days.
Exacerbation period. It is characterized by shortness of breath, the appearance of periodic whistles, an obsessive cough and difficulty in expectorating sputum. At this time, acute attacks may periodically recur.
Remission. The period is different in that the child can lead a normal life, he does not have any complaints. Remission can be complete, incomplete (determined by indicators of external respiration) or pharmacological (preserved when taking certain medications).

It is important to be able to recognize the first signs of asthma in children in order to prevent the development of an acute attack. If it was not possible to prevent it, then the parents and the immediate environment of the child should know what needs to be done. It is also important to understand that attacks are distinguished by the severity of bronchospasm.

The safest is the mild degree. With such an attack, a spasmodic cough begins, breathing is slightly difficult. At the same time, the general well-being of the child remains good, speech is not disturbed.

With a moderate attack, the symptoms are more pronounced. The child's health worsens, he becomes capricious and restless. The cough is paroxysmal in nature, thick viscous sputum is difficult to pass. Breathing is noisy and wheezing, shortness of breath is present. The skin at the same time turns pale, the lips become bluish. Children can only speak in single words or short phrases.

A severe attack is characterized by the appearance of shortness of breath, which is heard at a distance. The heartbeat in babies quickens, cold sweat appears on the forehead, general cyanosis is observed skin, lips are blue. Symptoms of asthma in children 6 years of age and older are characterized by the fact that the patient cannot speak, he is able to pronounce only certain short words. Babies, as a rule, cannot explain their condition, they only cry and express anxiety in all available ways.

Most severe cases are called status asthmaticus. This is a condition in which a severe attack of the disease cannot be stopped for 6 or more hours. The child develops resistance to prescribed medications.

Features of the course of the disease

It is important to know how asthma can manifest itself before an attack begins. Signs in a child can be as follows: capriciousness, irritability, tearfulness, headache, obsessive dry cough.

In most cases, attacks begin in the evening or at night. Initially, there is a cough, noisy breathing, shortness of breath. Children are often frightened, start crying, tossing about in bed. Initial manifestations asthma in babies is often expressed in the form of broncho-obstructive syndrome with acute respiratory infections. Also, against the background of colds, an attack of asthmatic bronchitis can begin. It is characterized by shortness of breath, in which breathing is difficult, and a wet cough.

Atopic bronchial asthma is characterized by the rapid development of an attack. Timely use of bronchospasmolytics allows it to stop. But with an infectious-allergic form, attacks develop slowly, symptoms increase gradually. It is far from immediately possible to stop an attack by taking bronchospasmolytics.

After normalization of the condition, sputum begins to be coughed up, shortness of breath disappears. In some cases, the condition improves only after vomiting.

Actions of parents

Regardless of the age of a child who has been diagnosed with asthma, his relatives should be careful to prevent the development of attacks and reduce their frequency. To do this, you must strictly follow all the recommendations of doctors, drink prescribed drugs and avoid potential allergens.

IN kindergarten all educators, nurse, music worker should be aware of the situation. It is also important to give them a list of allergens that are the reason that asthma begins in a child. It is also advisable to report the symptoms of the onset of an attack to them. In this case, they will be able to send the child to health worker or call your parents.

If caregivers know what the child is allergic to, they can help avoid contact with these substances. For example, you can replace flowers in a nursery preschool if any of them provoke the onset of an attack. Also, educators are able to monitor the nutrition of the baby. Of course, even two-year-old crumbs need to be explained that they should not eat. But not always children can control it themselves.

At school, teachers should also be aware of the child's problems. First of all, it is necessary class teacher tell the child has asthma. In children, signs and symptoms may appear gradually. For example, if there was contact with an allergen at school, then the child may sleep restlessly at night, cough during rest, his breathing may become confused. In this case, it is necessary to ask the baby in detail about what he did during the day, what he ate and in what rooms he was.

Physical education teachers should also be warned. But if the doctor sees the need, he will send the child to the commission, where he can be given partial or complete exemption from physical activity at school.

But keep in mind: the child must be gradually accustomed to active image life. Asthma is not a hindrance to most sports. Even some Olympic champions suffered from this disease in childhood. It is important to simply teach your child to monitor their condition and be able to recognize the first signs of bronchial asthma. Children should have a good defense mechanism. You just need to explain to the child that it is important, even with a slight discomfort, to stop and restore breathing.

Treatment tactics

It is impossible to figure out on your own what to do if the first signs of asthma appear. Treatment should be prescribed by an allergist, sometimes complex work and the involvement of a pulmonologist are required. Also important is correct behavior parents. There is no need to panic, but there is no need to be inactive either. It is necessary to have a conversation with the baby, discuss the possible causes of the development of the disease, tell what can and cannot be done.

How to deal with a condition such as bronchial (Komarovsky, by the way, claims that it is simply necessary) is to use medication to prevent the development of an attack and put the patient into a state of remission.

You can stop the condition with the help of glucocorticosteroids. First you need to use fast inhalants. Therapy should be supportive. If it is not possible to achieve the desired effect with the help of Nedocromil or cromoglycic acid, then inhalations are made with glucocorticosteroids.

Therapy should be aimed at:

Elimination of clinical manifestations;

Improving the function of breathing;

Reduced need for bronchodilators;

Development Prevention life threatening states.