What happens in the bronchi
With asthma, the bronchial wall is constantly inflamed, even when the child feels well. The mucous membrane is swollen, viscous sputum is produced, and the muscle layer easily spasms. When encountering a trigger, the lumen of the bronchial tube narrows sharply, and air comes out with difficulty - hence the whistling exhalation and the feeling that the child cannot exhale. Over time, without treatment, the bronchial wall thickens and restructures, so it is important not just to relieve attacks, but to extinguish the inflammation itself.
- Chronic inflammation of the bronchial mucosa
- Swelling and increased mucus production
- Spasm of bronchial smooth muscles
- Increased sensitivity of the respiratory tract
- Reversible air flow restriction
Reasons and triggers
Asthma develops through a combination of hereditary predisposition and external influences. Children most often have an allergic mood: a reaction to house dust mites, animal hair, mold, pollen. An attack is provoked not only by allergens, but also by viral infections, physical activity, cold air, strong odors, smoke and emotions. Passive smoking is especially harmful, including smoking on the balcony and the smell of tobacco on clothes.
- House dust mites, animal dander, mold, pollen
- Respiratory viral infections
- Physical activity and running
- Cold and dry air
- Tobacco smoke, smoke from the fireplace, strong odors
- Polluted air and dust
Symptoms and how to recognize an attack
Recurrent episodes of wheezing, lingering cough after colds, night cough and shortness of breath when running can help you suspect asthma. In children under 5 years of age, the diagnosis is more difficult, based on the frequency of episodes, the presence of allergies and the response to trial treatment. During an attack, breathing quickens, exhalation lengthens, whistles are heard, and the child is restless. Severity is assessed by speech, accessory muscle involvement, and skin color rather than by the volume of whistles.
- Wheezing, especially when exhaling
- Paroxysmal dry cough at night and in the morning
- Shortness of breath and chest tightness
- Cough and shortness of breath after running, laughing, crying
- Persistent cough after every cold
- Symptoms improve after inhalation of a bronchodilator drug
Diagnostics
The basis of diagnosis is a detailed questioning about the nature and frequency of symptoms and examination. Children over 5–6 years of age undergo spirometry with a test for the reversibility of bronchial obstruction, and, if necessary, with physical activity. Additionally, the allergological status is assessed: general IgE, allergy panels, skin tests. A chest X-ray is needed not to confirm asthma, but to exclude other causes: foreign body, pneumonia, developmental defects. It is useful to keep a diary of symptoms and, in schoolchildren, to measure peak expiratory flow.
- Examination and medical history, symptom diary
- Spirometry with bronchodilation test
- Exercise test according to indications
- Total IgE and allergy panels
- Chest X-ray to rule out other causes
- Peak flowmetry in school-age children
Treatment and control
Treatment is based on two groups of drugs. Basic therapy is inhaled glucocorticoids, which suppress inflammation and are prescribed regularly, every day, even when the child is healthy. Emergency medications dilate the bronchi and are used for symptoms. These drugs do not cause addiction, and inhalation doses are many times less than systemic doses. For babies, inhalations are done through a spacer with a mask or a nebulizer. The doctor draws up a written action plan for the parents in case of deterioration. You cannot cancel or change therapy on your own: this is the most common cause of severe attacks.
- Daily basic inhalation therapy as prescribed by a doctor
- Always have an emergency medicine with you
- Spacer with mask for young children
- Written attack plan
- Eliminating triggers at home: dust, animals, smoking ban
- Annual flu vaccination and regular checkups