Bronchial asthma is a chronic disease that develops on the basis of allergic inflammation in child’s airways. There is an acute bronchospasm and increased mucus discharge. Mucus accumulation in bronchi on the background of their spasm leads to bronchial obstruction (blockage of bronchi). Asthma is quite a dangerous disease; it can develop at any age, even infancy.
There are atopic (allergic) and non-atopic (non-allergic) asthma types. Atopic type prevails, it is observed in 90% of children with this disease. The disease has chronic course with alternating exacerbations and attack-free periods.
- Hereditary predisposition to atopic type of the disease: if one of parents is suffering from asthma – risk of asthma at a child is 25 – 30%, if both parents – up to 75 – 80%.
- Presence of allergic diseases at child or his family members (atopic dermatitis, pollinosis, food or drug allergy) is a signal: asthma may develop. 60% of children with asthma, relatives suffer from allergies. During the first year of life, allergens often enter the body through gastrointestinal tract (food allergy), and at older children pollinosis predominate. Often this disease cause is pathological reaction to house dust, pollen, medicines and food. Allergens from grasses and trees pollen can provideeasonal allergenic effects (from May to September).
The most pronounced ability to induce bronchospasm belongs to microscopic mites that live in house dust, carpets, soft toys and bedclothes. High sensitizing role is also played by feathers and wool in blankets and pillows, mold on walls in damp spaces. Animal hair and saliva (dogs, cats, guinea pigs, hamsters), dry feed for aquarium fish, birds feathers also often contribute to sensitization. Even after removing animals from the house, allergens concentration is reduced gradually, during several years.
- Ecological factor: inhalation of harmful substances from the air (exhaust gases, soot, industrial wastes, household aerosols) – common asthma cause as a result of immune disorders in the body.
An important factor in asthma development is smoking (for young children – passive smoking, or being near smokers). Tobacco smoke is a strong allergen, so if at least one parent smokes, risk of child’s asthma significantly (ten times!) increases.
- Viruses and bacteria that cause respiratory organs lesion (bronchitis, acute respiratory diseases, ARVI) contribute to allergens penetration into bronchial tree walls and bronchial obstruction development. Frequently occurring obstructive bronchitis may be triggering factor for asthma. Individual hypersensitivity to only infectious allergens causes non-atopic asthma development.
- Factors of physical exposure to the body (overheating, hypothermia, exercises, sudden weather changes with atmosphere pressure drops) may provoke attack of breathlessness.
- Asthma can be a consequence of mental and emotional stress (stress, fear, constant quarrels in the family, conflicts at school, etc.).
- Separate disease type is aspirin-induced asthma: asthma attack occurs after taking aspirin (acetylsalicylic acid). The drug itself is not an allergen. At its application biological active substances are produced, and they cause bronchospasm.
Occurrence of attack may be caused by non-steroidal anti-inflammatory agents and other medicines, drugs in colored capsules and products containing food dyes.
- Asthma severity may be exacerbated by digestive tract diseases: gastritis, pancreatitis, disbacteriosis, hepatic diseases, gallbladder dyskinesia. Asthma attack emergence during night may be related to gastric material in esophagus (duodenogastric reflux).
- Asthma during first months of life can be caused by smoking during child-bearing, excessive use of allergenic products (honey, chocolate, fish, citrus fruits, eggs, etc.), infectious diseases during pregnancy and use of drugs.
The disease may begin notelessly, with manifestations of atopic dermatitis, poorly treatable. Asthma develops more often at children under three years, more often at boys.
Parents should be alerted and suggest asthma development in presence of symptoms such as:
- periodically appearing wheezing;
- occurrence of cough, mostly at night;
- occurrence of cough or wheezing after exposure to allergen;
- wheezing cough after emotional or physical stress;
- absence of antitussives and anti-asthma agents efficiency.
Main asthma manifestation is attack of breathlessness. Typically, such attack occurs on the background of ARVI. Initially, difficulties with breathing may occur at high body temperature, cough (especially at night), rhinitis. Then laboured wheezing breath attacks are more likely to occur due to colds, contact with animals or physical exercise, plants with strong smell or weather changes.
At asthma attack there are difficulties with breath. Normally inhalation and exhalation duration is the same, and at asthma exhalation is twice as long as inhalation. Breathing is rapid, wheezing, noisy, audible in distance. Chest during attack is a little swollen, face becomes purple.
A child takes forced posture: sitting, slightly leaning forward, leaning on hands, head retracted, shoulders raised (the so-called «driver posture»). Breathing is short, not providing sufficient amount of oxygen. At prolonged attack there may appear pain in lower chest, caused by increased load on diaphragm. Attack can last from several minutes to several hours. Cough initially is dry, painful, and then thick, viscous mucus may be discharged.
Sometimes atypical asthma type develops – cough-variant asthma: classic asthma attack doesn’t appear, signs of asthma of this type is painful cough with thick, viscous mucus that occurs mostly at night.
Older children complain air insufficiency and infants are crying, showing concern. Attack usually develops very quickly, immediately after contact with allergen. But at some children it may be preceded by «precursors»: nasal congestion, complaints on itching in throat, cough, skin rash and itching, as well as irritability, drowsiness or anxiety.
Tissues oxygen starvation (including brain) contributes to intellectual, physical, and sexual development retardation at a child suffering from bronchial asthma. Such children are emotionally labile, they may acquire neuroses.
According to asthma at children classification there distinguish between mild, moderate and severe disease course, depending on frequency of attacks, their severity and need for anti-asthmatic drugs.
- symptoms occur periodically;
- asthma attacks are brief, arise spontaneously and relieved by receiving bronchodilators;
- night disease manifestations are absent or rare;
- physical exercise is tolerated normally or with minimal impairments;
- during remission external respiratory function is not impaired, there are no disease manifestations.
- attacks occur once a week;
- attacks are moderate, often require use of bronchodilators;
- nocturnal symptoms are regular;
- limited physical exercise tolerance;
- without basic treatment remission is partial.
- attacks are observed several times a week (can occur on a daily basis);
- attacks are severe, prolonged, daily use of corticosteroids is required;
- nocturnal symptoms appear every night, even several times during the night, sleep is disturbed;
- sharply reduced exercise tolerance;
- no periods of remission.
If attack is impossible to relieve for a few hours – it’s status asthmaticus, requiring immediate hospitalization.
The first step is to determine allergen (provoking factor) and completely avoid any contact with it:
- regularly carry out wet cleaning (with antimites means if necessary);
- when cleaning use vacuum cleaner with water filter;
- use air purifiers to filter the air;
- buy pillows and blankets with hypoallergenic synthetic fillers;
- exclude games with stuffed toys;
- put books in glass cases;
- remove soft furniture and cover it with lint-free cloth;
- in case of significant air pollution change place of residence;
- during plants flowering, provoking asthma attacks, minimize child’s exposure to fresh air – only in the evening, after dew-fall or rain;
- put special net on the windows;
- in case of exercise-induced asthma significantly reduce physical loads, including jumping and running;
- in case of aspirin-induced asthma exclude application of provoking attack medicines.
Medicational asthma treatment is divided into two groups: symptomatic treatment (relieving asthma attacks) and basic therapy.
Child’s asthma treatment is quite a complicated process: drug treatment can be chosen only by doctor. You must not engage in self-medication, as improper drugs use may aggravate disease and lead to longer and more frequent asthma attacks, respiratory insufficiency development.
Symptomatic treatment includes drugs that have bronchodilatory action: Ventolin Inhaler, Salbutamol Inhaler from Asthma Inhalers Online. In case of severe course, corticosteroids are also used. Not only the choice of drug is important, but also method of its introduction.
The most commonly used method is inhalation (the drug penetrates lungs as aerosol). But it is difficult for young children to use asthma inhalers: a child can’t understand instructions and properly inhale the drug. Moreover, at this method of introduction most of the drug remains on the throat back (not more than 20% of the drug reaches bronchial tubes).
Currently, there is a number of devices that improve medication delivery to the lungs. For treatment these devices are optimal: they allow using drugs at lower dosage, which reduces side effects risk.
Spacer is a special chamber, intermediate reservoir for aerosol. The drug enters chamber from container and is inhaled therefrom. This allows a number of inhales, 30% of the drug enter lungs in the form of aerosol. Spacer is not used for drug administration in the form of powder.
Together with spacer «light breathing» system is used: asthma inhaler is activated automatically (no need to click valve on inhaler during inhalation). Aerosol cloud is released at a slower rate and the drug does not accumulate in the throat, twice as many medication enters lungs.
Diskhaler, Symbicort are the same as spacer device, only for powder introduction.
Nebulizer (inhaler) is a device that allows transferring medication into an aerosol. There are the compressor (stream and pneumatic) and ultrasonic nebulizers. They allow drug inhalation for a long time.
Unfortunately, drugs symptomatic treatment have a temporary effect. Frequent, uncontrolled bronchodilator drugs use may trigger status asthmaticus development, when bronchi are no longer responsive to the drug. Therefore, for older children, who can independently use an asthma inhaler, medication dosage should be controlled accurately – children out of fear of attack may overdose bronchodilatory drug.
As basic therapy, several groups of drugs are applied: antihistamines (Tavegil, Suprastin, Claritin, Loratadine and others); drugs that stabilize cell membrane (Ketotifen, Tilade, Intal and others); antibiotics (for chronic infection centers sanitation). Hormonal preparations can also be assigned for bronchial inflammation treatment and asthma exacerbations prevention. Basic therapy is also chosen by doctor individually, taking into account peculiarities of the child’s organism and asthma severity.
There are also used leukotrienes inhibitors and cromones. They have no effect on the bronchial lumen and do not relieve attack. These drugs reduce individual child’s sensitivity to allergens.
Parents should not stop assigned maintenance or basic therapy independently. They also should not change drugs dosage, especially corticosteroids. Dosage reduction is carried out when there were no attacks within six months. If remission is observed within two years, doctor cancels drug therapy completely. If there is an attack after treatment cessation – treatment is renewed.
It is important to timely treat chronic centers of infection (tonsillitis, caries, adenoids, sinusitis), digestive tract diseases.
Among drug-free treatment methods there should be pointed out physiotherapy, exercise therapy, massage, acupuncture, various breathing techniques, cold water treatment, salt caves and mountains special microclimate. During remission spa treatment is applied (season and type of spa treatment in agreed with doctor).
There is another kind of struggling with asthma: allergen-specific immunotherapy (ASIT). It can be applied to children over the age of five years. The essence of this method: very small dose of allergen that causes asthma is introduced into the body. Gradually allergen dose increase, as if « habituating» body to this allergen. Treatment course lasts for 3 months or more. As a result of treatment, asthma attacks disappear.
Herbal therapy complements and increases conventional treatment with medicines effectiveness, it contributes to a longer period of remission. Nettle and foalfoot leaves, wild rosemary, licorice and elecampane roots are used. Fresh decoctions should be prepared daily. They are taken for a long time, application and dosage should be agreed with doctor. Parents must not test alternative therapies on their own!
At obstructive bronchitis exacerbations and bronchial asthma attacks decoctions and infusions of plants with expectorative action can be used (plantain, horsepine, chamomile, dandelion, knotweed, marigold, nettle, yarrow, St. John’s wort, licorice root, foalfoot). During rehabilitation period there can be used liquorice root infusion, Glycyram, Pertussin during a month.
For aromatherapy aroma lamp can be recommended 10 minutes a day. Essential oils (lavender, tea olive, thyme) are used very carefully in microdoses. For example, 5 drops of essential oil is added to 10 ml of massage oil and rubbed into baby’s chest.
Homeopathic treatment is also used in bronchial asthma treatment. An experienced homeopath chooses individual treatment regimen for a child. Parents are not allowed to independently give medications purchased in homeopathic pharmacy!
There are special asthma-schools, where children and their parents are taught correct assistance during attack, explained rehabilitation essence, massage and physical therapy techniques and non-traditional methods of treatment. Children are taught how to use asthma inhalers. In asthma-schools psychologists work with children.
A child suffering from asthma is necessary to keep to food diet:
- vegetable and cereal soups should be prepared on the second beef broth;
- rabbit meat, lean beef are allowed boiled (or steamed);
- fats: sunflower, olive oil and butter;
- cereals: rice, buckwheat, oat;
- boiled potatoes;
- fresh fruits and green vegetables;
- one-day dairy products;
- white bread.
It is necessary to limit carbohydrates consumption (pastry, sugar, sweets). It is recommended to exclude from diet allergens (honey, citrus fruits, strawberries, chocolate, raspberries, eggs, fish, canned food, seafood). Also, it is better not to use gums.
Parents can keep a food diary, which records all eaten by baby food during the day. Comparing received food and emergence of attacks, you can identify food allergens.
Asthma, which arose in childhood, even in severe form with frequent attacks, may disappear in adolescence. This occurs, unfortunately, only in 30 – 50% of cases.
Timely diagnosed asthma, accurate implementation of all curative and asthma prevention is a key to success.
Which Doctor to Consult
When a child has difficulties with breathing it is necessary to contact pediatrician. He will send a baby to allergist or pulmonologist. In addition, advice of nutritionist, physical therapist, immunologist, ENT doctor, dentist (to eliminate chronic infection centers) will be useful. At prolonged administration of glucocorticoids, even in the form of inhalation, it is necessary periodically to consult endocrinologist, not to miss child’s adrenal function oppression.