Bronchial asthma in children: symptoms, treatment
Bronchial asthma is a chronic disease that develops on the basis of an allergic inflammatory process in the airways of a child. There is an acute spasm of the bronchi and an increase in mucus secretion. The accumulation of mucus in the bronchi on the background of their spasm leads to bronchial obstruction (obstruction of the bronchi).
Bronchial asthma is a rather dangerous disease; it can develop in any, even infant, age.
There are atopic (allergic) and non-atopic (non-allergic) forms of bronchial asthma. Atopic form prevails, it is noted in 90% of children with this disease. The disease has a chronic course with alternating exacerbations and interictal periods.
Causes of bronchial asthma
- Hereditary predisposition to atopic form of the disease: if one of the parents suffers from bronchial asthma, the probability of occurrence of asthma in a child is 25-30%, if both parents - up to 75-80%.
- The presence of an allergic disease in a child or family members (atopic dermatitis, pollinosis, food or drug allergy) is a signal: bronchial asthma can develop. In 60% of children with bronchial asthma, relatives suffer from allergic diseases.
In the first year of life, allergens are more likely to enter the body through the gastrointestinal tract (food allergy), and in older children pollinosis predominates. Often the cause of this disease is a pathological reaction to house dust, pollen, medicines and food. Allergens from pollen of grasses and trees can have a seasonal allergic effect (from May to September).
The most pronounced ability to provoke bronchial spasms is possessed by microscopic ticks that live in house dust, carpets, soft toys and bedding. A high sensitizing role is also played by fluff and feather of birds in blankets and pillows, mold on the walls of damp premises. Wool and saliva of domestic animals (dogs, cats, guinea pigs, hamsters), dry food for aquarium fish, fluff and feathers of poultry also often contribute to child allergization. Even after removal of the animal from the premises, the concentration of allergens in the apartment decreases gradually over several years.
- Environmental factor: inhalation of harmful substances (exhaust, soot, industrial emissions, household aerosols) with air is a common cause of asthma development due to immune disorders in the body.
An important risk factor for developing asthma is smoking (for small children - passive smoking, or finding a person near the smoker). Tobacco smoke is a strong allergen, so if at least one of the parents smokes, the risk of a child developing asthma significantly (in dozens of times!) Increases.
- Viruses and bacteria causing damage to the respiratory organs (bronchitis, acute respiratory infections, acute respiratory infections) promote the penetration of allergens into the walls of the bronchial tree and the development of bronchial obstruction. Often repeated obstructive bronchitis can become a trigger mechanism for bronchial asthma. Individual hypersensitivity only to infectious allergens causes the development of non-atopic bronchial asthma.
- Factors of physical impact on the body (overheating, hypothermia, physical activity, sudden changes in weather with changes in atmospheric pressure) can trigger an attack of suffocation.
- Asthma can be a consequence of the psychoemotional stress of the child (stress, fright, constant scandals in the family, conflicts in school, etc.).
- A separate form of the disease is "aspirin" asthma: an attack of suffocation occurs after the use of aspirin (acetylsalicylic acid). The drug itself is not an allergen. When it is used, active biological substances are released, they cause spasm of the bronchi.
The occurrence of seizures may contribute to the use of non-steroidal anti-inflammatory drugs and a number of other drugs, medicines in colored capsules. as well as products containing food colorings.
- To aggravate the severity of bronchial asthma may diseases of the digestive tract: gastritis, pancreatitis, dysbiosis, liver disease, dyskinesia of the gallbladder. The onset of an asthma attack at night can be due to the casting of gastric contents into the esophagus (duodenal-gastric reflux).
- The cause of asthma in the first months of a baby's life can be smoking a woman when carrying a child, excessive use of allergic products (honey, chocolate, fish, citrus, eggs, etc.), infectious diseases during pregnancy and the use of medicines.
Symptoms of bronchial asthma
The disease can begin to go unnoticed, with manifestations of atopic dermatitis, poorly treatable. Asthma develops more often in children up to the age of three, boys are more often sick.
To warn parents and force to suggest the development of bronchial asthma in a child should be such manifestations:
- periodically arising wheezing;
- the appearance of cough, mainly at night;
- the appearance of a cough or wheezing after exposure to an allergen;
- cough with wheezing after emotional or physical exertion;
- no effect of antitussive drugs and the effectiveness of antiasthmatics.
The main manifestation of bronchial asthma is an attack of suffocation. Usually, such an attack appears against the background of ARVI. First, difficulty in breathing can occur at high temperature, coughing (especially at night), runny nose. Then attacks of obstructed wheezing become more frequent, arise out of communication with catarrhal diseases - in contact with an animal or under physical exertion, near plants with a pungent odor or with changing weather.
When an attack of bronchial asthma occurs in children, exhalation is difficult. Normally, the duration of inspiration and expiration is the same in time, and with asthma, the exhalation is twice as long as the inspiration. Breathing is rapid, wheezing, noisy, audible from a distance. The thorax during an attack is a little bloated, the face acquires a purple hue.
The child takes a forced pose: he sits, leaning forward slightly, leaning on his hands, his head is drawn, his shoulders are raised (the so-called "coachman's pose"). The inhalation is short, not supplying sufficient oxygen. With a prolonged attack, pain in the lower parts of the chest may appear, which is caused by an increased load on the diaphragm. The attack can last from several minutes to several hours. Cough is initially dry, painful, and then thick, viscous sputum can be released.
Sometimes an atypical variant of bronchial asthma develops - a cough variant: a classic attack of suffocation does not occur, the symptom of the disease is a painful cough with thick and viscous sputum, which occurs mainly at night.
Older children complain about lack of air, and babies cry, are anxious. The attack often develops very quickly, instantly after contact with the allergen. But some children may be preceded by "harbingers": nasal congestion, complaints of itching in the throat, coughing, rashes on the skin and skin itching, as well as irritability, drowsiness or anxiety.
Oxygen starvation of tissues (including the brain) contributes to the lag of the child suffering from bronchial asthma, intellectual, physical and sexual development. Such children are emotionally labile, they can develop neuroses.
According to the classification of bronchial asthma in children distinguish between light, moderate and severe course of the disease, depending on the frequency of seizures, their severity and the need for the use of antiasthmatic drugs.
- symptoms occur sporadically;
- Asthma attacks are short-term, occur spontaneously and are stopped by the intake of bronchodilators;
- at night there are no manifestations of the disease or they are rare;
- The physical load is transferred normally or with minor disturbances;
- In the period of remission, the function of external respiration is not violated, there is no manifestation of the disease.
- seizures occur once a week;
- attacks moderate, often requires the use of bronchodilators;
- nighttime symptoms are regular;
- there is a restriction of the tolerance of physical exertion;
- without basic therapy, remission is incomplete.
- Attacks are noted several times a week (can occur and daily);
- Attacks are severe, protracted, daily use of bronchodilators-corticosteroids is necessary;
- night manifestations are repeated every night, even several times a night, sleep is disturbed;
- the tolerance of exercise is sharply reduced;
- there are no periods of remission.
If the attack can not be stopped within a few hours - this is an asthmatic status that requires immediate hospitalization of the child.
To begin with, you should set the allergen (provoking factor) and completely exclude any contact of the child with it:
- regularly conduct a wet cleaning of the premises (if necessary with anti-killing agents); When cleaning, use a vacuum cleaner with a water filter; use air cleaners for air filtration;
- to buy for the child pillows and blankets with hypoallergenic synthetic fillers;
- Exclude games with soft toys;
- place books in glass cabinets;
- remove excess soft furniture, and necessary to cover the cloth without pile;
- in case of significant air pollution, change the place of residence;
- in the period of flowering, the asthmatic seizures of plants are reduced to a minimum stay of the child in the fresh air - only in the evening, after the fall of dew, or after a rain; hang a special mesh on the windows;
- with "asthma physical effort" to significantly reduce the load, including jumping and running;
- with "aspirin" asthma, exclude the use of medication provoking an attack.
Medical treatment of bronchial asthma is divided into two groups: symptomatic treatment (arresting suffocation) and basic therapy.
Treatment of bronchial asthma in children is a very complicated process: medication can be chosen only by a doctor. You can not engage in self-medication, as improper use of drugs can aggravate the course of the disease, lead to more prolonged and frequent attacks of suffocation, the development of respiratory failure.
Symptomatic treatment includes drugs that have a bronchodilator effect: ventolin, berotek, salbutamol. In severe cases, corticosteroids are also used. Important is not only the choice of the drug, but also the method of its administration.
The most commonly used method is inhalation (the drug enters the lungs in the form of an aerosol). But it is difficult for young children to use an inhalator spray: the child may not understand the directions and inhale the drug incorrectly. In addition, with this method of administration, most of the drug remains on the back wall of the pharynx (no more than 20% of the drug reaches the bronchi).
Currently, there are a number of devices that improve the delivery of medication to the lungs. For the treatment of children, these adaptations are optimal: they allow the use of the drug in a smaller dose, which reduces the risk of side effects.
Spacer is a special chamber, an intermediate reservoir for aerosol. The medicine enters the chamber from the can, and from it is already inhaled by the child. This allows you to take a few breaths, in the lungs gets 30% of the drug in the form of an aerosol. The spacer is not used to administer the drug in the form of a powder.
Along with the spacer, the system "easy breathing" is used: the inhaler is turned on automatically (there is no need to press on the inhaler on the valve at the time of inspiration). The cloud of the aerosol is emitted at a lower rate and the drug does not settle in the pharynx, and twice as much medicine penetrates the lungs.
Cyclochaler, diskhaler, turbuhaler - these are the same as spacer, devices, only for the introduction of powder.
Nebulizer (inhaler) - an apparatus that allows you to transfer the drug into an aerosol. There are compressor (jet and pneumatic) and ultrasonic nebulizers. They allow inhalation of the drug solution for a long time.
Unfortunately, drugs for symptomatic treatment have a temporary effect. Frequent, uncontrolled use of bronchodilators can provoke the development of asthmatic status, when the bronchi do not react to the drug. Therefore, older children who can use inhalers themselves should carefully control the dose of the medicine - children, because of fear of developing an attack, may overdose the bronchodilator drug.
As a basic therapy, several groups of drugs are used: antihistamines (tavegil, suprastin, klaritin, loratadine, etc.); drugs that stabilize the cell membrane (ketotifen, tayled, intal, etc.); antibiotics (for sanation of chronic foci of infection). Hormonal medications can also be prescribed to treat inflammation in the bronchi and prevent asthma exacerbation. Basic therapy is also chosen by the doctor individually, taking into account the characteristics of the child's body and the severity of the course of asthma.
Inhibitors of leukotrienes (acolate, singular) and cromones (ketoprofen, cromoglycate, etc.) are also used. They do not affect the lumen of the bronchi and do not stop the attack. These drugs reduce the individual sensitivity of the child's body to allergens.
Prescribing supportive therapy or basic therapy, parents should not cancel themselves. Do not also arbitrarily change the dosage of drugs, especially if corticosteroids are prescribed. Dose reduction is carried out when there was not a single attack for six months. If a remission occurs within two years, the doctor cancels the drug completely. If there is an attack after stopping the drug, the treatment starts anew.
It is important to timely treatment of chronic foci of infection (tonsillitis, caries, adenoids, sinusitis), diseases of the digestive tract.
From non-pharmacological methods of treatment should be indicated on physiotherapy, exercise therapy, massage, acupuncture, various breathing techniques, hardening of the child, the use of a special microclimate of mountains and salt caves. In the period of remission, sanatorium treatment is applied (the season and the type of the resort is consistent with the doctor) at the resorts of the Southern coast of Crimea, in Kislovodsk, Elbrus region, and others.
There is one more kind of struggle with a bronchial asthma: an allergen-specific immunotherapy (ASIT). It can be received by children over the age of five. The essence of the method: introduce into the body a very small dose of the allergen, which causes an asthma attack in the child. Gradually, the dose of the administered allergen is increased, as if "accustom" the body to the allergen. The course of treatment lasts 3 or more months. As a result of treatment, asthma attacks stop.
Phytotherapy supplements and increases the effectiveness of traditional medication treatment, contributes to a longer period of remission. Used phytocoenosis from the leaves of the nettle and coltsfoot, the herbs of the rosemary, licorice roots and elecampane. Fresh broth should be cooked daily. Take decoctions for a long time, the application and dose will be agreed with the attending physician. Parents should not test alternative methods of treatment on their own!
With exacerbations of obstructive bronchitis and attacks of bronchial asthma, you can use decoctions and infusions from plants with expectorant action (plantain, horsetail, chamomile, dandelion, sporach, calendula, nettle, yarrow, St. John's wort, licorice root, mother-and-stepmother). During the rehabilitation period, you can take an infusion of licorice root, glycyram, and pertussin for a month.
For aromatherapy, you can recommend an aroma lamp for 10 minutes a day. Essential oils (lavender, tea tree, thyme) should be used very carefully, in micro doses. You can, for example, add 5 drops of essential oil to 10 ml of massage oil and grind the baby's chest.
Homeopathic treatment is also used in the treatment of bronchial asthma. A competent homeopathic physician selects an individual treatment regimen for the child. Independently parents give drugs bought in a homeopathic pharmacy, you can not!
In Russia, special asthma schools have been opened in which both sick children and parents are taught: they teach correct assistance during an attack, explain the essence of rehabilitation, the rules of massage and physical therapy, and talk about non-traditional methods of treatment. Children are taught to use the inhaler correctly. Psychologists work in this school with children.
A child suffering from bronchial asthma needs to provide diet food:
- vegetable and cereal soups must be cooked on beef second broth;
- rabbit meat, lean beef are allowed in boiled form (or steamed);
- fats: sunflower, olive and butter;
- Porridge: rice, buckwheat, oatmeal;
- potatoes boiled;
- fresh fruits and vegetables green;
- fermented dairy products;
- White bread.
It is necessary to limit the use of carbohydrates (confectionery, sugar, baking, sweets). It is recommended to exclude food-allergens from the diet (honey, citrus fruits, strawberries, chocolate, raspberries, chicken eggs, fish, canned food, seafood). It is also better to do without chewing gum.
Parents can keep a food diary where all the foods eaten by the child during the day are recorded. Comparing the food received and the appearance of seizures, it is possible to identify the food allergens of the child.
Bronchial asthma, which arose in childhood, even its severe form with frequent attacks, can completely disappear in the adolescent period. Self-healing occurs, unfortunately, only in 30-50% of cases.
Timely diagnosed bronchial asthma in a child, strict implementation of all medical and preventive measures is the key to success.
To which doctor to apply
When a child has difficulty breathing, it is necessary to consult a pediatrician. He will send the baby to an allergist or pulmonologist. In addition, it will be useful to consult a dietician, a physiotherapy specialist, a physiotherapist, an immunologist, an ENT doctor, and a dentist (to eliminate foci of chronic infection). With long-term use of glucocorticosteroids, even in inhalation form, it is necessary to consult periodically with the endocrinologist, so as not to overlook the inhibition of the function of the child's adrenal glands.