Bronchial asthma in children is an allergic disease, although a specific allergy is extremely rare. Usually sick children with certain properties of the body, often hereditary. “Direct” heredity is not often observed; much more often in a family history of allergic, metabolic diseases, endocrinopathies, etc., the presence of these diseases in the mother during pregnancy is of particular importance. The influence of such a burden causes a number of functional disorders, for example, the tendency of capillaries to expand rapidly with slight (inadequate) irritation, and increased permeability of vascular and other barriers. These features, characteristic of exudative diathesis (see), observed in more than half of patients with bronchial asthma, facilitate the possibility of sensitization, which in early childhood can occur through the gastrointestinal tract with food allergens. With an existing food allergy, layering respiratory diseases can be a “resolving factor” and cause an allergic reaction in the form of an attack of bronchial asthma. In the future, seizures can occur already under the influence of other irritants. Thus, a purely allergic form of bronchial asthma most often develops.
Infectious-allergic form of bronchial asthma occurs as a result of repeated inflammatory processes in the respiratory system; bacterial or viral antigens, along with autoallergens formed during inflammation, sensitize the body. In the occurrence of subsequent attacks, the conditioned-reflex mechanism is of great importance.
The pathological anatomy of bronchial asthma in children does not differ from that in adults. A fatal outcome can occur from asphyxia with complete obstruction of the bronchi with viscous sputum during an attack.
The clinical picture and the course of bronchial asthma in children have some differences due to the structural and functional features of the children’s body. The narrowing of the lumen of the bronchi in children is associated mainly with swelling of the mucous membrane of the bronchi and increased secretion of mucus and, to a lesser extent, with spasm of still weakly developed bronchial muscles. For children, a sudden, rapid onset of an attack of bronchial asthma is uncharacteristic; it is usually preceded by catarrh of the upper respiratory tract, often vasomotor rhinitis. The younger the child, the easier oxygen starvation occurs in him, therefore, in young children, the attack occurs with increased breathing and shortness of breath of a mixed type, although with a predominance of expiration.
Dry wheezing in the exhalation phase is pathognomonic for an attack of bronchial asthma, but one can often hear wet rales of various sizes during the inspiration phase, which is observed in young children or with an exacerbation of chronic pneumonia at any age. Many patients from the very beginning of the attack appear dry obsessive cough. With “wet” bronchial asthma, more frequent in children, the duration of the attack increases. When combined with chronic pneumonia, an attack can go into a prolonged asthmatic condition. With viral-bacterial pneumonia in young children, an asthmatic syndrome can occur, which disappears during recovery and is not repeated in the future. Of great importance is the nature, duration and frequency of seizures; the combination of bronchial asthma with chronic pneumonia aggravates the course of the disease. Often, bronchial asthma can end during puberty; It is very important to start early and systematically conduct treatment.
Diagnosis. The recognition of bronchial asthma and its form helps a carefully collected history. A blood test for an allergic form reveals leukopenia and eosinophilia; with an X-ray examination of the chest, only emphysema is noted. It is difficult to get sputum in children, as they usually swallow it. Elements specific to bronchial asthma — Kurshman spirals or Charcot – Leiden crystals — are rarely detected, usually only eosinophils are noted (up to 10% and higher). In the differential diagnosis of bronchial asthma in children, acute small-focal pneumonia, a foreign body in the respiratory tract and tumorous bronchoadenitis should be borne in mind.
Treatment. Relief of an attack is carried out by the same means as in adults (in appropriate doses); but children rarely have to resort to intravenous infusions. In an asthmatic condition, which usually occurs with an exacerbation of chronic pneumonia, corticosteroid drugs (prednisone, less commonly cortisone) are prescribed against antibiotics (not penicillin!), Preferably in a hospital. The most important is a comprehensive systematic treatment of bronchial asthma in the interictal period. In an allergic form, by collecting a thorough medical history, allergens and irritants causing seizures are identified and eliminated. Since in children a specific single allergen is extremely rare, nonspecific desensitization is carried out by the same means as in adults, avoiding the pronounced reactions observed, for example, with neobenzinol and similar agents.
With an infectious-allergic form, the identification of an infectious focus and its rehabilitation is of primary importance. Adeno- and tonsillectomy in children with bronchial asthma should be performed with the use of tranquilizers in order to avoid psychological trauma, which can lead to an attack; in the postoperative period, sedatives and antihistamines are prescribed for several days. After adenotomy, nasal breathing training is mandatory. The infectious focus even in young children can be in the paranasal sinuses. In the presence of chronic pneumonia, the rehabilitation of these foci is of particular importance and is included in the stages of treatment of pneumonia. Such patients are also shown sanatorium treatment, preferably in local sanatoriums, and then in forest schools, where they do not go out of the life of the children’s team, do not lag behind in teaching, become tempered and get used to systematically do physical education. Spa treatment of bronchial asthma in children is less effective; Staying on the Black Sea coast of the Caucasus, where severe attacks usually occur, is absolutely contraindicated. The southern coast of Crimea is allowed , provided that it returns to the middle or northern regions by late autumn.
If long-term administration of corticosteroid hormones is necessary in case of severe bronchial asthma, anabolic hormones (for example, dianabol) should be used simultaneously, which is necessary for a growing body.
A prerequisite for a comprehensive treatment is to improve the environment, not only hygienically. Rational education is equally important; sometimes with the wrong behavior of the parents (emphasizing the painful condition of the child) it is necessary to remove the patient from the home environment to obtain prolonged remission. In the complex treatment of bronchial asthma, exercise therapy is of particular importance , since due to the continued growth and high reparative properties of the child’s body, it contributes to the elimination of not only functional, but also reversible morphological changes in the bronchopulmonary system.
Prevention of bronchial asthma in children consists in reducing the possibility of sensitization of the body and preventing respiratory diseases: proper education, hardening and physical education from early childhood, combating rickets, early detection of exudative diathesis, turning off strong food allergens, etc. The clinic should be taken All “threatened” children are registered. Preventive vaccinations are carried out against the background of the use of antihistamines.