Bronchial asthma

What is it?

The asthma is a chronic disease It affects the bronchi. It is a chronic inflammation of the innermost part of the bronchi. This inflammation makes them more sensitive to stimuli (bronchial hyperresponsiveness). These cause the bronchi to swell and the bronchial lumen to narrow, making it more difficult for air to pass.

asthma is the chronic disease most common in childhood and in adolescence; affects 12% of children.

Causes

The cause is the bronchial hyperresponsiveness which causes some stimuli: (dust mites, pollen, animal epithelium), viruses, exercise or irritants to easily inflame the bronchus and make it difficult for air to enter, generating the asthmatic crisis.

There are currently several ways to classify the type of asthma: by gravity, by the phenotype, the cause ...

In all of them the child presents periods with symptoms and periods free of symptoms. In function of the severity of asthmatic attacks they will be more or less frequent.

asthma has a genetic basis (There may be several cases in the family).

Symptoms

asthma has four main symptoms:

• .
• Wheezing (wheezing when breathing). It should be borne in mind that not all wheezing in infants is asthma, only part of it. The infant who whistles may be due to bronchial asthma is between 25 and 30%.
• .
• Chest tightness

Not all symptoms have to appear at the same time.

In some children the asthma is allergic, that is, it is produced by an allergen that the child inhales and causes inflammation of the bronchus. In fact, allergy is the leading cause of bronchial hyperresponsiveness in children.

This does not mean that asthma is always allergic, since many asthmatics are not allergic and many allergy sufferers do not have asthma, but rather other manifestations.

The smoke of the tabacco it is the main non-specific irritant for the bronchial tubes of asthmatic children. It is essential not to smoke at home if there is a child with asthma.

Diagnosis

It is a complex issue since in most cases you must wait for the child to grow up to confirm the diagnosis. Also, the younger the child, the less likely it is asthma.

We cannot perform respiratory function tests on children this young, so the asthma diagnosis is done using these parameters:

• Parents' medical history: Above all, it will focus on whether the parents or siblings have asthma or a history of atopy (food allergy, atopic dermatitis, rhinitis, allergic asthma ...).
• Assessment of the child's wheezing episodes: there are some data that support the diagnosis of asthma in infants:
  • Intermittent episodes of wheezing that appear to be related to a trigger.
  • Crises occur only in some season of the year.
• Physical exam of the baby by the Pediatrician during the episode of wheezing that shows a true crisis of bronchospasm.
• Evidence: A chest X-ray can be performed to rule out other diseases, blood tests to assess a possible immunodeficiency, allergy, the sweat test to rule out cystic fibrosis or a cardiac study.
• Response to treatment good.

Treatment

There is no curative asthma treatmentWe only have symptomatic treatments. What is possible is to control the disease, keeping the child without symptoms and promoting a normal life.

In cases of allergic asthma, the main thing is avoid the allergen that causes asthma attacks. In these cases, immunotherapy (allergy shots) may be helpful.

The treatment of the asthmatic attack is based on the inhaler use that dilate the bronchus (bronchodilators) and a background treatment (to space or avoid attacks) with anti-inflammatories. Inhaled drugs have a clear advantage: they are fast and local in effect with minimal side effects. Only in severe crises or with a poor response to inhaled treatments, the Pediatrician will prescribe oral corticosteroids.

It is important to control asthma well and that the child play a sport that you like, asthma and sport are not at odds.