Bronchial asthma is one of the most common childhood diseases. Epidemiological studies of recent years indicate that from 5 to 10% of children suffer from this disease, and this indicator increases every year. Of serious concern is also the increase in mortality from bronchial asthma and the number of hospitalizations in pediatric facilities.
This disease is known since ancient times. The term asthma itself comes from the Greek word for shortness of breath or shortness of breath. The ancient Greeks treated bronchial asthma with respect, considering it a sacred disease caused by the gods. In the first century of our era, the Greek physician Areteus noted that women are more likely to have asthma, and men are more likely to die from it, while children have the best prospects for recovery. In the second century AD, Galen described bronchial asthma as a spastic condition of the respiratory system. He correctly suggested that bronchial asthma is associated with obstruction of the bronchi and suggested diluting the mucus that clogs the bronchi. The famous physician van Helmont, suffering from asthma, linked this disease with smoke and irritating substances. Thomas Sydenham defined bronchial asthma as a disease in which the bronchi are “clogged”, and the American doctor Eberly in 1830 noted the important role of heredity in the occurrence of bronchial asthma. In 1900, bronchial asthma was associated with hay fever. Further studies have shown that this disease is caused by many causes.
Currently, asthma in children is considered as a chronic disease, the basis of which is allergic inflammation of the respiratory tract and bronchial hyperreactivity [1]. It is characterized by periodically occurring attacks of shortness of breath or suffocation due to bronchospasm, hypersecretion of mucus and swelling of the mucous membrane of the bronchi. Based on typical asthma attacks, the doctor determines the diagnosis of bronchial asthma. Sometimes such a diagnosis is made even in cases where the child has a long dry paroxysmal cough, which intensifies at night or on waking.
Bronchial asthma refers to diseases with a hereditary predisposition and, as a rule, develops in children, in a family history of which patients with allergic diseases are noted. Some children with bronchial asthma, with an apparent lack of a family disposition, may have relatives who have had wheezing in their lungs that are incorrectly diagnosed as “chronic bronchitis” or “pulmonary emphysema.” Recent studies indicate that bronchial asthma, which begins in early childhood, is most likely of hereditary origin.
It is now well known that the onset of bronchial asthma in most children is associated with exposure to various allergens, among which house dust is the most common. About 70% of children with bronchial asthma are sensitive to house dust. Household dust is a complex mixture containing fibers of cotton, cellulose, animal hair, mold spores. The main component of house dust is mites that are invisible to the naked eye (see figure). The favorite food of home ticks is flakes that peel off human skin and are collected in mattresses, carpets and upholstered furniture. They can also be found in drapery, bedding, soft toys, under skirting boards.
Fig. House dust mite (200 times increase).
The optimal conditions for their reproduction is a warm, humid climate. At a temperature of 10 ° C and 50% humidity, ticks die. A dead house dust mite does not lose its allergenicity, since its body particles have a pronounced allergenic activity. In patients sensitive to house dust mites, asthma attacks most often occur either at night or early in the morning. The occurrence of symptoms of the disease is possible when making a bed, since the concentration of ticks of house dust in the air increases significantly.
The reasons for the development of bronchial asthma can be wool, dandruff, saliva of various animals (cats, dogs, guinea pigs, hamsters and other rodents). The cat allergen contained in saliva, wool or dandruff is the most powerful of all allergens and has exceptional stability and the ability to penetrate deep into the lungs. It is stored for a long time in the environment, even after the cat is removed from the house. Dog allergens (from wool, saliva and dandruff) are able to maintain a high level for several months, even after the dog is removed from the house. Common causes of asthma attacks are horse dander, dry food for aquarium fish, and insects, especially cockroaches.
A serious reason for the development of bronchial asthma can be mold spores contained in the air, air conditioners, as well as in damp, dark rooms (basements, garages, bathrooms, showers). In winter, when the ground freezes or becomes covered with snow, mold on the street ceases to be a problem for asthmatic children. Mold fungi begin to multiply intensively in the air from the beginning of May, reaching a peak in July or August and can cause symptoms of the disease until the first frost. Molds are present in many foods (seasoned cheeses, beer, pickled vegetables, kefir, champagne, dried fruits, yeast dough products, kvass, unleavened bread).
Pollen of flowering plants in 30-40% of children with asthma can be the cause of asthma attacks. The peak of incidence, as a rule, occurs in April-May and is associated with pollen from trees – birch, alder, hazel, maple, ash, chestnut, willow, poplar, etc. If symptoms of bronchial asthma occur in June-August, then the cause is pollen cereal grasses – timothy, fescue, ryegrass, team hedgehogs, bluegrass. Weed herbs (quinoa, ragweed, wormwood, dandelion, nettle) cause asthma symptoms in the summer-autumn period of the year. The spectrum of pollen allergens and the timing of flowering vary depending on the climatic and geographical area. In many plants, pollen is so light that it spreads through the air and freely enters the respiratory tract. Heavier pollen (for example, in roses and pines) is carried by low-flying insects, i.e. it is less allergenic than pollen in the air.
In some children, asthma attacks can induce medications such as antibiotics, especially the penicillin series and macrolides, sulfonamides, vitamins, and aspirin. Moreover, contact with medicinal substances is possible not only when they are taken, but also when children are in the vicinity of pharmaceutical industries.
The increase in the incidence of bronchial asthma noted in recent years is largely associated with environmental pollution, primarily atmospheric air, with chemical compounds, usually due to industrial (a complex of particles of sulfur dioxide) and photochemical smog (ozone, nitrogen oxides).
Adverse effects on children with bronchial asthma are caused by chemical pollution of the air in living quarters. New construction technologies (more lighting, less natural ventilation, the use of modern finishing materials, heating and humidification technology) have noticeably changed the air quality inside the living quarters and increased its negative impact on the respiratory system.
In addition to the above factors, exacerbation of bronchial asthma in children can cause physical exertion, emotional stress, crying, laughing, changing weather conditions, sharp smells of paints, deodorants, perfumes, as well as tobacco smoke. In asthmatic children whose parents smoke, frequent exacerbations are observed, requiring the use of anti-asthma drugs. It was established that the severity of the child’s disease is directly dependent on the number of cigarettes smoked daily by the parents. Attacks of shortness of breath can develop in a child as early as one month of age if parents or other relatives smoke in the family.
Viral infections are among the most common causes of asthma attacks. Respiratory viruses damage the ciliated epithelium of the mucous membrane of the respiratory tract and increase its permeability to allergens, toxic substances, increasing bronchial hyperreactivity. Many asthmatics are prone to frequent acute respiratory infections. The presence of foci of chronic infection, mainly in the nasopharynx, increases the degree of sensitization of the body.
Thus, bronchial asthma is a multifactorial disease, the development of which is closely related to the influence of genetic and environmental factors. Finding out the causes of bronchial asthma significantly increases the effectiveness of therapeutic measures.