Breathing in bronchial asthma in children. An attack of bronchial asthma in a child: how to recognize it and what should adults do? How is asthma diagnosed in children?

Bronchial asthma in children is not a simple disease that will require parents to have endurance and patience to treat their child. Against the background of prolonged infectious and inflammatory processes in the respiratory tract, which contribute to the modification of bronchial structures, a serious disease develops - bronchial asthma. In early childhood, when the immune and respiratory parts of a small child’s body are not yet sufficiently strong and formed, asthmatic pathology occurs quite often.

Particularly vulnerable are those children who have chronic infections in the airways and a tendency to allergic reactions. The disease is quite dangerous, as it is accompanied by severe symptoms - bronchospasm, obstruction and the formation of copious mucous sputum, which prevents the free movement of air and ultimately provokes attacks of suffocation. Pathology is classified into two types:

• allergic form of bronchial asthma;
• infectious form of bronchial asthma.

Mostly, and this is in 90% of cases, children suffer from an allergic form of asthma. The causative agents of this disease are antigens of allergic origin, for example, flowering pollen, mold fungi, dander or salivary secretions of pets, dust and other common irritants to which the body is highly sensitive.

The remaining 10% are infectious forms of bronchial asthma that occur in childhood. In this form of the disease, the main source of pathological changes in the bronchostructures is any respiratory tract infection. But the appearance of attacks does not always occur due to its cause. Prolonged respiratory illnesses can act as a preparatory factor, that is, infectious pathogenesis creates favorable conditions in the bronchi - it increases the permeability of the walls of the alveoli, which makes them vulnerable to the effects of any irritants.

Children with a genetic predisposition are predominantly prone to asthmatic diseases. According to statistics, the majority of children with bronchial asthma, approximately 60%, have relatives with similar pathological disorders. In addition to the hereditary factor, the appearance of a serious illness is closely related to the unfavorable atmosphere and its negative impact on the immune functions of the child’s body.

Symptoms of bronchial asthma in a child

Determining that a child has bronchial asthma is extremely important in the early stages of the disease. But, unfortunately, the pathology is quite similar in its symptoms to ordinary respiratory ailments. This fact prevents parents from suspecting asthmatic pathogenesis in time, which gives complete freedom for its progression. Every parent should know the main distinguishing property - bronchial asthma is never accompanied by an increase in body temperature, unlike a cold, even in the presence of a severe dry cough.

In addition, it is extremely important to pay attention to the initial symptoms, which should increase the vigilance of parents and force them to urgently take action, these are:

• secretion of mucus from the baby’s sinuses immediately after waking up, which provokes sneezing and causes the baby to constantly rub his nose;
• the appearance of an unproductive cough a short time after sleep, it does not have a very pronounced intensity;
• the cough gets worse closer to lunch or after the child has slept during the day, and some sputum is already released;
• at night you can also notice that the child coughs often;
• the clinical picture becomes more complicated 1-2 days after the onset of the above symptoms.

The initial manifestations cause a sudden spasm in the bronchi, which leads to an asthmatic attack. If the disease is present in an infant (0-12 months), the attack is accompanied by the following symptoms:

• paroxysmal cough during sleep or immediately after waking up;
• A slight relief of the baby’s condition comes from changing the position from a horizontal to a vertical position, but if you put the baby back in the crib, the intense cough resumes;
• restlessness and capriciousness of the baby - these signs precede an attack due to the formation of swelling in the nasal cavity;
• after a certain period of time, the child’s breathing becomes difficult;
• a short inhalation alternates with a painful exhalation, which is accompanied by wheezing and whistling;
• the rhythm of heavy breathing becomes frequent and confused, shortness of breath occurs.

Similar signs are observed in older children, and you can add to them:

• a feeling of tightness in the chest, the child complains of chest pain;
• breathing through the mouth provokes an intense non-productive cough;
• the child complains of difficulty breathing, lack of air;
• a sudden coughing attack always occurs when a child is in certain conditions, for example, after contact with a cat, during a street walk or during physical activity, while in a room with flowers, at a picnic near a fire, etc.

If you notice your child has breathing problems and any clinical condition listed above, you should immediately call an ambulance. A dry cough in a child with attacks, which occurs suddenly and without fever, requires urgent diagnosis to determine whether bronchial asthma is involved in its occurrence. An asthmatic crisis can occur at any time, not only at night or after sleep, in children with severe forms of the pathology.

For what reasons do children develop asthma?

Bronchial asthma occurs as a result of dysregulation of the reactivity of the bronchi, which leads to high permeability of the organ structures, reversible blockage of the windpipe (bronchi) and narrowing of the airways, all of which, accordingly, causes a failure of the respiratory act and the onset of suffocation. The main reasons for the development of such pathogenesis in the child’s respiratory system are:

• hereditary predisposition;
• chronic respiratory infections;
• the body's sensitivity to any allergens;
• overweight child.

In addition, boys suffer from asthma more often than girls due to the structural features of the pulmonary region, which includes bronchial structures with narrower pathways. If a child is overweight, there is also a risk of developing bronchial asthma. This is explained by the fact that in such children the diaphragm is located above the normal level, and its incorrect position causes breathing problems and also affects the increase in the permeability of the bronchial membranes.

But, nevertheless, the main factor, of course, after genetics, is considered to be the presence of allergies of various types. In a word, if a child’s body reacts even to a food irritant, the likelihood of developing asthmatic syndrome is high. Chronic respiratory diseases in combination with allergies increase the risk of developing bronchial asthma several times.

Both a certain allergen to which the child is sensitive, and additional substances that have strong irritating effects, but are not the root cause of the disease, can become a stimulant of attacks. So, among the main provocateurs of bronchial asthma in children of allergic origin, the following allergens are distinguished:

• food products, such as oranges, nuts, honey, chocolate, etc.;
• spores of mold organisms that enter the respiratory tract along with air or spoiled food;
• dander or specific components of salivary secretions of pets;
• household dust and insects in the house, for example, house mites in pillows or cockroaches, or rather, their waste products;
• pollen grains of plants saturating the air - in this case, acute relapses of asthma appear during the flowering season of nature;
• a certain type of medication - most often these are products containing aspirin or an antibiotic substance.

Any form of bronchial asthma in a child can be complicated by exposure to harsh substances that are not allergic antigens. Thus, the bronchi with distorted reactivity of an asthmatic child react acutely to the following stimuli:

• gas exhausts from cars;
• heavily dusty air;
• smoke from a fire, cigarettes, scented candles;
• perfumes and household products;
• cold air, dry or excessively heavy air;
• active physical exercises – running, jumping, dancing, etc.;
• infectious and viral microorganisms that infect the child.

Asthmatic attack in a child

Every parent must know how to quickly help their child in a critical situation when an attack occurs. And this applies to absolutely every parent, regardless of whether their child has bronchial asthma. It is important to be savvy in any situation, especially when dealing with a serious illness with a tendency to be fatal.

Very often, it is due to the fault of inattentive parents who did not recognize asthma disguised as a cold cough in time, the disease progresses and ultimately leads to severe attacks. They are life-threatening and cause severe psychological trauma to the baby.

How to recognize an asthma attack in children?

The main symptoms have already been discussed, but there are a lot of nuances that should prompt the child’s loved ones to take quick action - providing first aid to relieve an asthmatic attack.

• Do not ignore the child’s complaints, especially if he talks about pain in the chest and lack of air - this often indicates the onset of an asthma attack due to spasm of the bronchial muscles and severe narrowing of the air passages.

• Many children, when a sudden symptom occurs, are afraid to tell their mother about it; this is quite typical for childhood. Seeing that the child is behaving unnaturally and withdrawn, and also looks sick, calmly ask him about what worries him, but only without nerves and panic.

• Breathing is an important indicator for determining a critical situation. In a calm state, the number of breaths taken in 1 minute in a healthy child is approximately 20 times. With an increased breathing rate, it is important to find out from the child how he is feeling - whether he is experiencing discomfort in the chest and whether it is difficult for him to breathe.

• The child's pose can also tell you a lot. Due to lack of air, children take a comfortable position in order to take a deep breath, for example, raising or pressing their head to their chest, pressing their elbows tightly against the table surface, raising their shoulders, etc. Any unnatural attempts to change the position of the body to inhale, any efforts made at the moment of the respiratory act are abnormal and may indicate both non-serious vegetative-vascular disorders and the onset of asthmatic suffocation. A short breath with a characteristic retraction of the lower costal muscles will indicate a spasm in the bronchi.

• With a mild or moderate attack, wheezing and whistling sounds appear during inhalation and exhalation. In a severe form of asthmatic spasm, wheezing with a whistle occurs only at the moment of painful exhalation.

• A jerky and convulsively frequent non-productive cough always appears before an asthmatic attack. This symptom occurs due to spasm of the smooth muscles of the respiratory organs, their swelling and blockage of the bronchopulmonary structures with viscous thick sputum. A child may cough in the middle of the night for no reason at all, so don’t be too lazy to get up and look at the baby to see if everything is okay.

First aid for a child with an asthma attack

1. Without losing your own composure, reassure the baby, since an attack causes severe stress and a feeling of fear in the child; panic will only aggravate its course. If you have already had an attack once, use your inhaler quickly and call 911 right away.
2. Eliminate any source of irritation that could cause an asthmatic reaction. Open the windows, but do not allow a sudden flow of cold air. If the attack is triggered by flowering plants, quickly take the child into the nearest room. Give an antihistamine to drink, it will help relieve swelling in the airways.
3. Remove clothing from the patient's upper body. Place him on the edge of the bed. Place a chair near the bed with its back facing the child. Next, you need to place your elbows on the upper base of the backrest, tilting the child forward slightly. Children in moments of stress may resist taking the correct position, in such cases there is no need to force it, let the child sit in a way that is comfortable for him.
4. To help relax the smooth muscles of the bronchi and relieve swelling, immerse the child's feet in a bowl of warm water. The water temperature should only be warm - slightly higher than body temperature, about 45 degrees.
5. At the end of the attack, white, viscous sputum will begin to separate from the windpipe along with the cough. Next, it is appropriate to take a sputum thinner, for example, ambroxol. In the near future, the child should be registered with a specialist, having received from him the appropriate recommendations for the treatment and prevention of asthma.

Treatment of bronchial asthma in children

Until now, unfortunately, pharmacology professors have not invented a remedy that would once and for all help rid a person of bronchial asthma. Treatment of a serious illness is based on the use of medications, the active substance composition of which can relieve spasm and swelling in the respiratory tract. These include bronchodilators and drugs with antihistamine, antileukotriene, and anti-inflammatory effects. In some cases, the child may need to take hormones and anticholinergic drugs.

The use of anti-asthmatic drugs is carried out according to a special scheme, which provides for a gradual increase in dosage. Therapy is selected on an individual basis: any drug is prescribed according to the specific pathology, age and characteristics of the little patient’s body. A child with bronchial asthma should be under the close supervision of a specialist; self-medication and independent choice of medication for asthma are prohibited.

Medicines for children with bronchial asthma are divided into 2 categories:

• symptomatic category of drugs – it includes quick-acting drugs that help quickly stop an attack and alleviate the course of clinical symptoms;
• basic category of drugs – it is represented by slow-acting drugs that are used for therapeutic and prophylactic purposes for a long time.

It follows that the first category is used to provide emergency assistance during an attack. It is represented by bronchodilators. The second group makes it possible to remove the antigen from the body, relieve inflammation in the respiratory tract, and help strengthen the alveolar-capillary membranes.

Drugs included in the basic category are used for a long period. The effect of taking a slow-acting medication does not appear immediately. But basic medications minimize the occurrence and severity of relapses of asthmatic attacks or even help achieve their complete cessation. So, what basic drugs are used in the treatment of asthma in children?

1. Glucocorticosteroids in the form of aerosols (inhalers) . Thanks to such medications, bronchial reactivity is regulated and membranes are strengthened, thereby achieving stable remission of the disease. Inhalers with glucocorticosteroid composition are the best solution for the treatment and prevention of bronchial asthma. In addition, they are relatively safe, since their main action is concentrated in the damaged bronchopulmonary structures.
2. Preparations based on cromones . This series refers to antiallergic and anti-inflammatory agents. The active substance is sodium cromoglycate, which is involved in stabilizing the activity of mast cells and suppressing histamine. Cromones are prescribed for episodic asthma, as well as for mild forms of the pathology. A persistent antiallergic effect is observed with prolonged therapy. Cromones are not absorbed into the blood, so they can be safely used in childhood.
3. Medicines with monoclonal antibodies . Such remedies are expensive, but very effective for severe allergic-type asthma. Monoclonal antibodies that form the basis of the drugs inhibit the synthesis of immunoglobulin E, a high level of which causes an allergic reaction in an asthmatic child and provokes bronchospasm.

The presence of bronchial asthma in a child requires treatment and ongoing supportive preventive therapy. The attending physician will prescribe complex treatment for the small patient, which will consist of taking certain medications and performing therapeutic breathing exercises in a medical facility. As an aid, the doctor may recommend acupuncture sessions, a visit to a children's sanatorium that specializes in the treatment of asthma in children by visiting salt caves or halo chambers.

Prevention of bronchial asthma in children

For a child with a genetic predisposition, as well as for children who have already been diagnosed with bronchial asthma, it is imperative to ensure the most favorable living conditions in the home. It is important to pay attention to strengthening the body’s protective functions through hardening procedures, breathing exercises and proper nutrition. Prevention is an integral part of therapy and the basis for preventing attacks and the development of the disease. Let's consider the main preventive measures if a child is prone to pathology or has asthma.

• A newborn baby should be breastfed for the first year of life. In the event that the mother, due to compelling circumstances, is not able to provide breastfeeding to the baby, it is necessary to buy artificial milk formulas with a hypoallergenic mark.

• The first acquaintance with new products should be coordinated with the pediatrician, informing him about the baby’s predisposition to bronchial asthma due to the presence of asthmatics or allergy sufferers in the family.

• Children at high risk of developing pathology should minimize the consumption of oranges and other citrus fruits, mushrooms, chocolates, nuts and give them with great caution, observing the reaction of the child’s body. As for asthmatic children, such foods should not be in the diet at all, including packaged juices and fizzy sweet drinks. Bee products are strong allergens for many children, so be vigilant.

• Free your living space from fluffy carpets and rugs, old waste paper, heavy window curtains, blankets, and feather pillows. Such things literally “absorb” dust; in addition, it is in old things that household mites, the main culprit of allergies and asthma, comfortably live and breed. It is better to keep library “wealth” in cabinets closed with glass doors; ideally, get rid of old books as much as possible.

• You cannot keep pets in your living space, not only cats and dogs, but also hamsters, parrots, and fish. The fur, feathers, waste products of such pets and even their food contain strong allergenic substances.

• Clean your apartment more often: wipe the dust with a damp cloth every day, wash the parquet floors, thoroughly vacuum every corner, especially under the child’s bed, ventilate the apartment, but just avoid cold drafts. At the same time, do not use common household chemicals; use products that are safe - soda, natural laundry soap and special powders from the hypoallergenic series.

• Make sure that there is no high humidity in the house, which provokes the formation of mold. Fungal spores saturate the air with specific substances that can cause severe symptoms of asthma.

• Completely replace feather pillows and synthetic blankets with bedding products made from environmentally friendly raw materials. Do not send items to the dry cleaner; they are treated with strong chemicals. Wash fabric items yourself using mild detergents.

• Never smoke in the presence of a child, much less in the room where he is. Tobacco smoke irritates vulnerable bronchi, which can cause sudden spasm and suffocation. Spraying hairspray and using strong-smelling perfumes are taboos for parents whose child has asthma or allergies.

• Children with bronchial asthma will benefit from hardening procedures and breathing exercises. Find out from your doctor how to carry them out at home and get involved in your child’s health. Such procedures, which strengthen the respiratory tract and increase the body's resistance to pathogens, will help reduce the progression of the disease and reduce sudden outbreaks of attacks.

• Ensure harmony and calm in the family - do not swear, do not sort things out in the presence of your child. The child's psyche reacts very receptively to a negative aura, which leads to nervousness, panic, and anxiety. This is a lot of stress, which adversely affects the functioning of the respiratory system, causing active contraction of its smooth muscles, spasm and attack.

conclusions

Bronchial asthma in a child is a serious disease that requires specialized treatment and monitoring by a pediatrician, allergist, pulmonologist, and immunologist. Therefore, any clinical symptoms that occur in the respiratory organs should be regarded by parents as a reason to immediately visit the clinic to determine the diagnosis. Modern diagnostic methods make it possible to accurately determine the root cause of pathogenesis.

The pharmacologically rich range of anti-asthmatic drugs includes effective and, importantly, safe drugs for children. Only a doctor should prescribe any medicine and calculate its dosage, since asthma occurs differently in all children, and each child’s body has its own characteristics. A competent therapeutic approach taking into account the individual factor is the key to effective treatment and successful prevention of bronchial asthma.

is a chronic allergic disease of the respiratory tract, accompanied by inflammation and changes in the reactivity of the bronchi, as well as bronchial obstruction that occurs against this background. Bronchial asthma in children occurs with symptoms of expiratory shortness of breath, wheezing, paroxysmal cough, and episodes of suffocation. The diagnosis of bronchial asthma in children is established taking into account the allergy history; conducting spirometry, peak flowmetry, chest radiography, skin allergy tests; determination of IgE, blood gas composition, sputum examination. Treatment of bronchial asthma in children involves the elimination of allergens, the use of aerosol bronchodilators and anti-inflammatory drugs, antihistamines, and specific immunotherapy.

ICD-10

J45 Asthma

General information

Bronchial asthma in children is a chronic allergic (infectious-allergic) inflammatory process in the bronchi, leading to a reversible impairment of bronchial obstruction. Bronchial asthma occurs in children from different geographical regions in 5-10% of cases. Bronchial asthma in children most often develops in preschool age (80%); Often the first attacks occur already in the first year of life. Studying the characteristics of the occurrence, course, diagnosis and treatment of bronchial asthma in children requires interdisciplinary interaction of pediatrics, pediatric pulmonology and allergology-immunology.

Causes

Bronchial asthma in a child occurs with the participation of genetic predisposition and environmental factors. Most children with bronchial asthma have a family history of allergic diseases - hay fever, atopic dermatitis, food allergies, etc.

Sensitizing environmental factors can include inhalation and food allergens, bacterial and viral infections, chemicals and drugs. Inhalation allergens that provoke bronchial asthma in children are most often house and book dust, animal hair, waste products of domestic mites, mold fungi, dry food for animals or fish, pollen from flowering trees and herbs.

Triggers of bronchial asthma in children can be viruses - the causative agents of parainfluenza, influenza, ARVI, as well as bacterial infections (streptococcus, staphylococcus, pneumococcus, Klebsiella, Neisseria), chlamydia, mycoplasma and other microorganisms that colonize the bronchial mucosa. In some children with bronchial asthma, sensitization can be caused by industrial allergens, taking medications (antibiotics, sulfonamides, vitamins, etc.).

Factors of exacerbation of bronchial asthma in children that provoke the development of bronchospasm can be infections, cold air, weather sensitivity, tobacco smoke, physical activity, and emotional stress.

Pathogenesis

The pathogenesis of bronchial asthma in children is divided into: immunological, immunochemical, pathophysiological and conditioned reflex phases. In the immunological stage, under the influence of the allergen, antibodies of the IgE class are produced, which are fixed on target cells (mainly mast cells of the bronchial mucosa). During the immunochemical stage, repeated contact with the allergen is accompanied by its binding to IgE on the surface of target cells. This process occurs with degranulation of mast cells, activation of eosinophils and the release of mediators that have a vasoactive and bronchospastic effect. During the pathophysiological stage of bronchial asthma in children, under the influence of mediators, swelling of the bronchial mucosa, bronchospasm, inflammation and hypersecretion of mucus occurs. Subsequently, attacks of bronchial asthma in children occur according to a conditioned reflex mechanism.

Symptoms

The course of bronchial asthma in children has a cyclical nature, in which periods of precursors, asthma attacks, post-attack and inter-attack periods are distinguished. During the warning period, children with bronchial asthma may experience anxiety, sleep disturbances, headache, itchy skin and eyes, nasal congestion, and dry cough. The duration of the precursor period ranges from several minutes to several days.

The actual attack of suffocation is accompanied by a feeling of constriction in the chest and lack of air, and expiratory shortness of breath. Breathing becomes whistling, with the participation of auxiliary muscles; wheezing can be heard in the distance. During an attack of bronchial asthma, the child is frightened, assumes an orthopneic position, cannot speak, and gasps for air. The skin of the face becomes pale with pronounced cyanosis of the nasolabial triangle and ears, and becomes covered in cold sweat. During an attack of bronchial asthma, children experience an unproductive cough with thick, viscous sputum that is difficult to separate.

Auscultation reveals hard or weakened breathing with a lot of dry wheezing; with percussion - a boxy sound. From the cardiovascular system, tachycardia, increased blood pressure, and muffled heart sounds are detected. If the duration of an attack of bronchial asthma is 6 hours or more, they speak of the development of status asthmaticus in children.

An attack of bronchial asthma in children ends with the discharge of thick sputum, which leads to easier breathing. Immediately after the attack, the child feels drowsiness and general weakness; he is lethargic and lethargic. Tachycardia gives way to bradycardia, increased blood pressure gives way to arterial hypotension.

During interictal periods, children with bronchial asthma may feel almost normal. Based on the severity of the clinical course, 3 degrees of bronchial asthma in children are distinguished (based on the frequency of attacks and respiratory function indicators). With mild bronchial asthma in children, attacks of suffocation are rare (less than once a month) and quickly stop. During interictal periods, general health is not affected, spirometry indicators correspond to the age norm.

Moderate bronchial asthma in children occurs with a frequency of exacerbations 3-4 times a month; spirometry speed indicators are 80-60% of normal. With severe bronchial asthma, asthma attacks in children occur 3-4 times a month; FVD indicators are less than 60% of the age norm.

Diagnostics

When diagnosing bronchial asthma in children, data from family and allergy history, physical, instrumental and laboratory examinations are taken into account. Diagnosis of bronchial asthma in children requires the participation of various specialists: pediatrician, pediatric pulmonologist, pediatric allergist-immunologist.

The complex of instrumental examination includes spirometry (for children over 5 years old), tests with bronchodilators and physical activity (bicycle ergometry), peak flowmetry, radiography of the lungs and chest organs.

Laboratory tests for suspected bronchial asthma in children include a clinical analysis of blood and urine, general sputum analysis, determination of general and specific IgE, and a study of blood gas composition. An important part of diagnosing bronchial asthma in children is performing allergy skin tests.

In the diagnostic process, it is necessary to exclude other diseases in children that occur with broncho-obstruction: bronchial foreign bodies, tracheo- and bronchomalacia, cystic fibrosis, bronchiolitis obliterans, obstructive bronchitis, bronchogenic cysts, etc.

Treatment of bronchial asthma in children

The main directions of treatment of bronchial asthma in children include: identification and elimination of allergens, rational drug therapy aimed at reducing the number of exacerbations and stopping asthma attacks, non-drug rehabilitation therapy.

When identifying bronchial asthma in children, first of all, it is necessary to exclude contact with factors that provoke exacerbation of the disease. For this purpose, a hypoallergenic diet, organization of a hypoallergenic lifestyle, discontinuation of medications, separation from pets, change of place of residence, etc. may be recommended. Long-term preventive use of antihistamines is indicated. If it is impossible to get rid of potential allergens, specific immunotherapy is carried out, which involves hyposensitization of the body by introducing (sublingual, oral or parenteral) gradually increasing doses of a causally significant allergen.

The basis of drug therapy for bronchial asthma in children is inhalation of mast cell membrane stabilizers (nedocromil, cromoglicic acid), glucocorticoids (beclomethasone, fluticasone, flunisolide, budesonide, etc.), bronchodilators (salbutamol, fenoterol), and combination drugs. The selection of the treatment regimen, combination of drugs and dosage is carried out by the doctor. An indicator of the effectiveness of therapy for bronchial asthma in children is long-term remission and absence of disease progression.

Prognosis and prevention

Manifestations of bronchial asthma in children may decrease, disappear, or intensify after puberty. In 60-80% of children, bronchial asthma remains for life. Severe bronchial asthma in children leads to hormonal dependence and disability. The course and prognosis of bronchial asthma are influenced by the timing of initiation and systematic treatment.

Prevention of bronchial asthma in children includes timely identification and exclusion of causally significant allergens, specific and nonspecific immunoprophylaxis, and treatment of allergies. It is necessary to train parents and children in methods of regular monitoring of bronchial obstruction using peak flowmetry.

Bronchial asthma in children, the symptoms of which can be quite easily identified, is increasingly common in childhood or even infancy. In this case, the course of the disease is chronic, accompanied by obstructions or periods of relative calm.

Scheme of pathology development

The human body has bronchi, which are part of the respiratory system. They are branched formations inside the lungs. On the outside, they are covered with a layer of smooth muscle, the contraction of which causes a decrease in the lumen of the bronchi, and relaxation causes expansion. This type of muscle fiber work is natural for the human body.. The presence of muscles is necessary to increase the clearance in cases where it is necessary to inhale more air during physical activity.

With bronchial asthma, normal muscle function is disrupted.

In the presence of an external irritant, which can be any allergen, excessive physical activity, or emotional stress, an involuntary bronchospasm occurs, which manifests itself at the wrong time.

Also, due to the occurrence of an allergic reaction and the accompanying inflammatory process, swelling of the mucous membrane occurs, accompanied by the appearance of viscous “glassy” sputum. This factor makes the situation worse many times over.

The diagnosis of bronchial asthma can be made after the first manifestations of the signs described in this article, but a full examination is required to clarify the doctor’s conclusion.

7 main reasons for the development of bronchial asthma in children

The causes of bronchial asthma in children are mostly associated with an allergic predisposition, or are a consequence of frequent colds.

Mikhailova Lyubov Igorevna, allergist, 1st city clinical hospital, Kirov

My profile is allergies, and it is for this reason that children and adults are referred to me for asthma. I will say right away that treating bronchial asthma in a child is a long and complex process. Requires taking various medications for a long time.

It is necessary to determine the allergen that causes the development of the crisis. It is difficult to explain to a child why he cannot eat eggs or honey, because he does not understand what an allergy is. With a certain persistence of parents, it is possible to exclude “harmful” foods from the diet, which helps to cope with asthma “with little blood”.

To understand how to treat bronchial asthma in a child, you should know the causes. It is customary to highlight 7 main causes of this unpleasant disease:

Forms of bronchial asthma and its division into classes

When diagnosing the disease, all pulmonologists should be guided by a document issued by WHO. All available types of bronchial asthma in this document are divided according to two criteria:

• features of the origin of the disease;
• the severity of its occurrence.

But in the light of recent scientific research, such a large division is clearly not sufficient, since new methods in the classification of asthma must take into account a large number of nuances, among which:

• the severity of the disease before the start of treatment;
• is there a response of the body to the treatment and how significant is it;
• is it possible to control the course of the disease in such a way as to prolong periods of remission and prevent the occurrence of new attacks;
• is there a relationship between the cause of the disease and the characteristics of its course;
• possible causes of complications during the course of the disease.

A clear determination of the cause of the disease can lead not only to effective therapy, but will also help to stop an attack of bronchial asthma in a timely manner. Based on the reasons for its appearance, the disease is divided into three large subgroups:

Bronchial asthma - allergic form

In such a case, the causative agent of the disease is an external irritant in the form of an allergen that enters the child’s body through the respiratory route or through food, which is less common. The following are considered respiratory allergens:

• fungal spores;
• plant pollen;
• animal hair;
• mites;
• tobacco smoke.

The initial reaction in this form always develops in the respiratory tract and manifests itself in the form of sinusitis, rhinitis, etc.

Against the background of these concomitant diseases, atopic bronchial asthma begins to develop in children. Much less frequently, food may be the cause of attacks. It is accompanied, along with the appearance of external manifestations, in the form of a rash, redness, stool disorders, coughing or asthma attacks.

How to distinguish a normal cough from an allergic one, see.

Food allergies often cause an asthma attack in children, which can lead to a condition known as anaphylactic shock. In this case, emergency care is required for bronchial asthma in children.

Infection-related asthma

Komarovsky also divides a disease such as bronchial asthma in children into an endogenous type of the disease. In this case, the factors leading to changes in the lumen of the bronchi and causing coughing and attacks are microorganisms.

According to statistics, respiratory diseases and bacterial infections of the upper respiratory tract in childhood can trigger asthmatic attacks.

It is quite easy to identify cases of this type of asthma.: all symptoms quickly disappear with hormonal therapy and in the case of the use of drugs belonging to the group of bronchodilators.

Mixed asthma

The causative agents of this type of disease are both allergens and microorganisms. Factors that provoke the disease may be:

• poor environmental conditions;
• stressful situations;
• bad habits;
• various chemical irritants.

A separate type of bronchial asthma, not included in any category, is the cough form of the disease. Due to the lack of pronounced symptoms, it is difficult to diagnose.

A similar type appears against the background of a constant cough, which may indicate diseases such as bronchial obstruction.

The prompt identification of the allergen and its complete exclusion from the child’s life will be the key to a quick recovery. Therefore, you should not delay visiting an allergist.

Symptoms giving the right to suspect the presence of asthma

Timely diagnosis of any disease is a sure chance to provide competent and correct treatment. Asthma is no exception to the general rule. Bronchial asthma in children, the symptoms of which are known, is a disease that can be overcome. The first signs that should be a “wake-up call” for parents are the following:

• systematically occurring whistling sound when the child breathes;
• frequent for no apparent reason;
• coughing or difficulty breathing upon direct contact with the source of the allergy;
• the occurrence of whistling in breathing after exercise or emotional shock;
• complete lack of required effectiveness from use.

In this case, there is a division of asthma according to the severity of its manifestation:

1. Mild degree is characterized by short-term and rare manifestations of the main symptoms. Attacks are short-lived and can be easily eliminated with the help of appropriate medications.. After physical activity, there is no deterioration in the child’s condition. There is no cough at night.
2. The average degree is characterized by the regularity of attacks that occur weekly. Symptoms in the form of attacks of night cough also appear periodic. Physical exercise is only possible to a limited extent.
3. The severe degree in which infectious-allergic bronchial asthma occurs is characterized by very frequent attacks that are long-lasting. A night cough can cause an attack of suffocation in bronchial asthma. Periods of absence of symptoms are practically completely eliminated. Physical activity is contraindicated.

In cases where the crisis cannot be eliminated on your own, emergency care is required for an attack of bronchial asthma, which can be provided by emergency doctors.

Diagnostic measures

Carrying out diagnostic measures, based on the medical history (bronchial asthma in a child), includes a whole range of measures aimed at determining the type of disease, its severity, and other related parameters.

The first stage of diagnosis is to study the medical history and determine the external signs of the presence of the disease.

The next step, if asthma is suspected, is to order clinical studies, which include a blood test. During the analysis, the immunological status of the patient is determined, and tests are also carried out to identify a group of allergens that are causally significant.

Also during the diagnostic period, instrumental parameters are checked. These include testing your respiratory function. Also at this stage, studies of all internal organs are carried out through ECG and ultrasound.

Bronchial asthma: medical history on therapy is the final stage of diagnosis and represents a descriptive part of the anamnesis and genesis of the disease, as well as data from the research results obtained.

In the future, the pathogenesis of bronchial asthma in children allows not only the treatment of the patient in case of crises, but also the prevention of bronchial asthma in children during periods of remission.

Bronchial asthma in children, symptoms and treatment

After making a diagnosis and determining that the child suffers from this particular disease, basic therapy for bronchial asthma in children is required.

There are several treatment options, among which are traditional medicinal methods and folk methods, mainly consisting of herbal medicine.

Treatment of bronchial asthma in children using traditional methods and the use of inhalers cannot be considered the only way to overcome the disease, but can only be effective in combination with taking medications.

If bronchial asthma is observed in children, only the attending physician can give clinical recommendations based on a number of factors.

For drug treatment, there are two groups of therapeutic courses:

• symptomatic, when treatment is limited to relieving attacks that occur;
• basic, when medications are taken over a long period of time, aimed at eliminating the cause of the disease.

For symptomatic treatment, medications are used that have a vasodilating effect, allowing you to quickly increase the lumen of the bronchi and make breathing easier.

These include drugs:

• Bitolterol;
• Terbutaline;
• Theophylline;
• Ipratropium bromide, and a number of others.

It is possible to take medications in inhalation form, which simplifies the process of taking the medication, but the effectiveness is reduced, since most of the active substance settles in the pharynx, and only 20% “reaches” the bronchi.

Among the existing methods to improve the process of entry of the active substance into the bronchi during inhalation treatment, one can note the use.

This type of inhaler is capable of converting a medicine from liquid form into a fine aerosol within a short time, which has a positive effect on the absorption of the active substance.

Kiryanov Mikhail Vladislavovich, pulmonologist, clinic of modern medicine "Unimed", Vladimir

Treatment of bronchial asthma is always a rather difficult process, requiring lengthy diagnosis and all possible assistance from the child’s parents and doctor.

For the most part, in my practice, asthma cases are caused by various allergens. In our clinic, it is possible to quickly take tests to determine allergens, which helps me, as a doctor, get the results and understand what course of treatment is necessary.

One of the recent discoveries for me was the drug Erius, which is the most effective among other antihistamines. Its use in most cases helps prevent an attack if an allergen enters the body.

The use of drugs for symptomatic treatment does not have a long-term positive effect and in most cases addiction is observed. To avoid this effect, careful dosage compliance is required.

For basic therapy, several groups of drugs are used, including:

• designed to reduce allergic manifestations;
• antibiotics to get rid of existing infectious pathogens;
• hormonal spectrum drugs;
• helping to stabilize the cell membrane.

The most effective allergy medications are:

• Tavegil;
• Suprastin;
• Zodak;
• Erius.

To stabilize cell membranes, the following are used:

• Ketotifen;
• Tailed;
• Intal.

In some cases, the attending physician may prescribe drugs such as Acolat or Singulair, which in themselves are not intended to stop an attack or affect the lumen of the bronchi, but help the body cope with increased sensitivity to allergens.

The most commonly used drugs, their dosage and administration characteristics are shown in the table.

Nursing process as part of planned treatment

A very important point for the treatment of asthma is the nursing process for bronchial asthma in children, carried out when the child is transferred to the hospital.

Nursing care for bronchial asthma in children is a way to improve the general condition of the patient, treat an attack of bronchial asthma, and prevent complications.

There are three forms of such care:

• dependent, when therapy is carried out as directed by a doctor;
• interdependent, when the nurse acts as part of a team;
• independent, when care is carried out as part of monitoring the patient’s physical condition and diet.

Nursing care for a child with asthma includes:

• initial preparation for conducting research and taking tests;
• monitoring the execution of doctor’s instructions;
• planning the optimal schedule for patient care;
• organization of leisure time. Treatment of children is a special process and requires the nurse to advise parents to organize the child’s leisure time, which includes transferring toys or books to the hospital.

Prevention

As preventive measures, it is most often recommended to follow a few simple rules:

1. Regular exposure of the child to fresh air.
2. Eliminating the possibility of contact with potential sources of allergies.
3. Carrying out preventive measures to improve immunity.
4. Taking exercise therapy courses.
5. Carrying out regular wet cleaning in the rooms where the patient lives.
6. Stopping others from smoking.
7. The use of synthetic fillers for pillows and blankets, as well as reducing the amount of upholstered furniture in the apartment.
8. Constant fight against rodents and domestic insects.

Frequent exposure to fresh air reduces the risk of disease. Therefore, you should travel outside the city more often, visit the forest or village.

Compliance with the rules will minimize the risk of bronchial asthma in a child.

In most cases, the cause of bronchial asthma is allergies. It manifests itself in the form of inflammation of the respiratory tract, in which acute bronchospasm is accompanied by an increase in mucus secretion.

Symptoms of the disease

Every parent should know how asthma can manifest. The signs in a child are usually pronounced. The baby begins to experience bronchospasm, which doctors call bronchial obstruction. This is expressed as follows. The child begins to have a paroxysmal dry cough. Over time, viscous sputum begins to be released.

You can tell that obstruction has begun by your breathing. If in a healthy child the duration of inhalation and exhalation is approximately the same, then with the development of an asthmatic attack shortness of breath appears. It is characterized by a short inhalation and a long exhalation. In this case, the patient experiences wheezing, which can be heard from afar.

There are also so-called first signs of asthma in children, which are observed even before the onset of an attack. So, the baby begins to cough, there is nasal congestion and itchy skin.

During an attack, older children may complain of a feeling of lack of air, squeezing in the chest area. Children's sleep is disturbed, they become whiny, irritable, lethargic.

Provoking factors

To prevent the development of the disease, you need to know what exactly can lead to problems. Experts include air pollution, changes in atmospheric pressure, flowering of allergy-hazardous plants, and even an unfavorable psychological atmosphere in the house as provoking factors.

If you have people in your family with hereditary allergic diseases, then you first need to find out how asthma may manifest in a child. You need to know the symptoms so as not to miss the onset of problems. Also at risk are children with exudative-catarrhal diathesis.

An allergen that leads to bronchospasm can be plant pollen, certain foods, tobacco smoke, medications, and household dust. The reaction can begin from inhaling cold air or from physical exertion.

At the first contact, the body seems to get acquainted with a foreign substance, but at subsequent “meetings” it begins to react violently. The immune system produces antibodies, and they, in turn, release biologically active substances, which cause asthma to develop in children. Signs and symptoms such as shortness of breath, persistent cough and difficulty breathing are difficult to miss.

Characteristic features of the disease in infants

Before an asthma attack, all children experience the so-called. At this time, abnormalities in the respiratory system can be noticed. Liquid mucus begins to secrete from the nose, itching appears and associated constant sneezing and dry cough. The doctor can listen for isolated dry wheezing and see swollen tonsils. These are the first signs of asthma in a child under one year old.

The disease also affects the nervous system. The baby becomes restless, irritable, and his sleep deteriorates. Disturbances are also observed in the digestive system - constipation may begin or loose stools may appear.

Asthma develops in children, usually against the background of respiratory diseases. Only in exceptional cases can its appearance be caused by stress. In this case, the symptoms of asthma appear gradually. This is due to the fact that swelling of the bronchial mucosa and hyperemia increase at a slow pace.

The attack itself can last from several minutes to several days. It will be accompanied by wheezing, which can be heard even at a considerable distance, and expiratory shortness of breath.

It is worth noting that sometimes the first signs of asthma in children under one year of age go unnoticed. They may appear sporadically without any regularity, at different times. However, they can go away on their own, without any therapy. And in the period between attacks, parents do not notice any deviations.

Preschool children

It is also not always possible to suspect the development of the disease in older children. Signs of asthma in a 2-year-old child may be blurred. For example, their breathing may become faster and more irregular during sleep. This also happens during physical activity.

Characteristic manifestations of the disease also include frequent sneezing, periodic coughing, and restless sleep. Often children do not even notice that they are coughing in their sleep. This happens reflexively. If the child sleeps separately, then the parents may not even hear the cough. Therefore, it is necessary to observe the child, if the kindergarten teacher says that the baby coughs during sleep.

Preschoolers cannot always describe their feelings, so parents must monitor their condition. For example, signs of asthma in a 5-year-old child may appear during active play. You should consult a doctor if your baby begins to cough after a short run. Active movement can cause chest pain and a feeling of squeezing.

Signs of asthma in schoolchildren

The older the child, the more detailed and accurate he can describe his condition. Therefore, identifying the disease in schoolchildren is a little easier. But this can only be done if you know what signs of asthma children may have.

As in preschoolers, in school-age children the disease is indicated by coughing during sleep and after physical activity. Patients may report a pressing sensation in the chest area. In addition, having grasped the connection between physical activity and emerging discomfort, children try to run as little as possible, avoiding any active games. Even in the absence of complaints, it is necessary to monitor students who refuse to attend physical education lessons, try not to run, and sit quietly during breaks.

If a child has a coughing fit, it is difficult for him to sit upright. He tries to alleviate his condition, bends, hunches, leans forward. You may also notice excessive pallor. Preschoolers and children of primary school age may become frightened and even cry during an attack.

Adolescence

As a rule, by the age of 12-14 years the diagnosis has already been established. At this age, it is important to teach your child to recognize when asthma begins. The signs in a child are usually always similar. He should always have with him a special inhaler prescribed by a doctor. Parents are required to ensure that the medicine does not run out and change the used container in a timely manner.

Symptoms of the disease in children of middle and high school age are not particularly different from those that occur in children. But teenagers are already able to control the disease, which means they can prevent an exacerbation.

It is worth noting: despite the fact that many people experience attacks while playing sports, teenagers with asthma need physical activity. Just before exercise you need to take the medicine prescribed by your doctor and monitor your breathing. It should be smooth and rhythmic.

Allergens can cause attacks. But teenagers should already know which substances provoke the disease. They should avoid them if possible. If allergic attacks are provoked by seasonal plants, then it is necessary to take medications on a regular basis to block their development.

Often at this age the process of remission begins. All signs of asthma disappear, and parents decide that their child has simply “outgrown” the disease. But in fact, bronchial hyperreactivity persists. If a teenager encounters several provoking factors, the disease may return. Sometimes this happens in adulthood. Quite often there are situations in which asthma disappears in adolescence and reappears in old age.

Diagnostics

To accurately determine whether a child has asthma, it is not enough to know the first signs and main symptoms of this disease. Shortness of breath, rapid and difficult breathing, and obsessive cough can also occur with obstructive bronchitis. Therefore, you cannot do without consulting doctors. First of all, you need to visit a pediatrician. He will already give directions for all the necessary tests and refer you to an allergist. If necessary, you may also need to consult a pulmonologist.

In addition to general studies of blood and urine, it can also be taken for In asthma, an increased content of eosinophils, Kurschmann spirals (mucus from the respiratory tract), Charcot-Leyden crystals (lysophospholipase released from eosinophils), Creole bodies (accumulation of epithelial cells) can be detected.

To make a diagnosis, the doctor must understand the details of the baby’s life. He needs to know how and when attacks begin. Even from this description, sometimes it becomes clear to a specialist what exactly is an allergen for the baby. It is also important for the doctor to know how the child reacts to bronchodilators. Asthma will be indicated by a temporary improvement in the condition during their use.

Diagnostics consists of special tests. One of the most common are skin allergy tests. For these purposes, potential allergens are applied to slightly scratched areas of the baby's forearm. After 20 minutes, the doctor evaluates the results. They look at which areas of the skin are reddened the most.

This makes it possible to identify the allergen, but does not make it possible to understand whether the functioning of the respiratory system is impaired. Parents themselves can determine this, knowing the signs of bronchial asthma. The cough form in children requires a more thorough diagnosis. To determine the working volume of the lungs, a special examination is performed - spirometry. It is used to assess the degree of dysfunction of the respiratory system.

To do this, measure the volume of exhalation and inhalation made with effort and the total capacity of the lungs. For the first time, these measurements are taken without any medications. The examination is then repeated after taking bronchodilator medications. If lung volume increases by more than 12%, then the test is considered positive.

Bronchial hyperreactivity after physical activity is also assessed. If the forced expiratory volume decreases by 20%, this indicates that the young patient has asthma. The child’s symptoms, however, can be so pronounced that such a detailed examination is not always prescribed.

Clinical manifestations

It is worth understanding that in children it is often impossible to make a diagnosis due to the fact that obstructive syndrome occurs with bronchitis. Within a few days, they develop a cough, symptoms appear indicating breathing problems, and wheezing is heard. As a rule, treatment consists not only of taking brochodilators, but also antibiotics and antihistamines. With subsequent acute respiratory viral infections, symptoms of pulmonary obstruction may appear.

Signs of asthma in infants are quite vague, so special attention is paid to the medical history, asking parents about the onset of the disease and physical examination.

The course of the disease itself can be divided into 3 conventional stages:

1. The attack itself. Acute suffocation develops due to difficult entry. It is preceded by a pre-attack stage, which can last from several minutes to 3 days.
2. Period of exacerbation. It is characterized by difficulty breathing, the appearance of periodic whistles, an obsessive cough and difficulty with sputum discharge. During this time, acute attacks may recur periodically.
3. Remission. The period is different in that the child can lead a normal life and does not have any complaints. Remission can be complete, incomplete (determined by external respiration parameters) or pharmacological (maintained when taking certain medications).

It is important to be able to identify the first signs of asthma in children in order to prevent the development of an acute attack. If it was not possible to prevent it, then the parents and the child’s immediate environment should know what needs to be done. It is also important to understand that attacks are distinguished by the severity of bronchospasm.

The safest is a mild degree. With such an attack, a spasmodic cough begins, breathing is slightly difficult. The child’s general well-being remains good, and speech is not impaired.

With a moderate attack, the symptoms are more pronounced. The child’s well-being deteriorates, he becomes capricious and restless. The cough is paroxysmal in nature and produces thick, viscous sputum that is difficult to clear. Breathing is noisy and wheezing, there is shortness of breath. At the same time, the skin turns pale, lips acquire a bluish tint. Children can only speak in single words or short phrases.

A severe attack is characterized by the appearance of shortness of breath, which can be heard from a distance. Babies' heartbeat quickens, cold sweat appears on the forehead, general cyanosis of the skin is observed, and blue lips appear. Signs of asthma in children 6 years of age and older are characterized by the fact that the patient cannot speak, he is able to utter only a few short words. Children, as a rule, cannot explain their condition; they only cry and express concern in all available ways.

The most severe cases are called status asthmaticus. This is a condition in which a severe attack of the disease cannot be stopped for 6 or more hours. The child develops resistance to prescribed medications.

Features of the course of the disease

It is important to know how asthma can manifest itself before an attack begins. Signs in a child may be: moodiness, irritability, tearfulness, headache, obsessive dry cough.

In most cases, attacks begin in the evening or at night. Initially, there is a cough, noisy breathing, and shortness of breath. Children often get scared, start crying, and rush around in bed. The initial manifestations of asthma in children are often expressed in the form of broncho-obstructive syndrome due to acute respiratory infections. Also, against the background of colds, an attack of asthmatic bronchitis may begin. It is characterized by shortness of breath, which makes it difficult to breathe, and a wet cough.

Atopic bronchial asthma is characterized by the rapid development of an attack. Timely use of bronchospasmolytics allows it to be stopped. But with the infectious-allergic form, attacks develop slowly, symptoms increase gradually. It is not immediately possible to stop an attack by taking bronchospasmolytics.

After the condition normalizes, the sputum begins to cough up, and the shortness of breath goes away. In some cases, the condition improves only after vomiting.

Parents' actions

Regardless of the age of the child who has been diagnosed with asthma, his relatives should take care to prevent the development of attacks and reduce their frequency. To do this, you must strictly follow all medical recommendations, take prescribed medications and avoid potential allergens.

In kindergarten, all teachers, nurses, and music workers must be aware of the situation. It is also important to tell them a list of allergens that cause asthma in a child. It is also advisable to tell them the symptoms of the onset of an attack. In this case, they will be able to promptly send the child to a medical professional or call the parents.

If caregivers know what the child is allergic to, they can help avoid contact with these substances. For example, you can replace flowers in a preschool if some of them provoke the onset of an attack. Teachers are also able to monitor the baby’s nutrition. Of course, even two-year-old babies need to be explained what they should not eat. But children cannot always control this themselves.

At school, teachers should also be aware of the child’s problems. First of all, you need to tell the class teacher that the child has asthma. In children, signs and symptoms may appear gradually. For example, if there was contact with an allergen at school, the child may sleep restlessly at night, cough while resting, and his breathing may become irregular. In this case, it is necessary to ask the child in detail about what he did during the day, what he ate and what rooms he was in.

The physical education teacher also needs to be warned. But if the doctor sees the need, he will refer the child to a commission where he can be given partial or complete exemption from physical activity at school.

But keep in mind: the child must be gradually accustomed to an active lifestyle. Asthma is not a barrier to playing most sports. Even some Olympic champions suffered from this disease in childhood. It is important to simply teach your child to monitor his condition and be able to recognize the first signs of bronchial asthma. The defense mechanism must work well in children. You just need to explain to the child that it is important, even if minor discomfort occurs, to stop and restore breathing.

Treatment tactics

It is impossible to figure out on your own what to do if the first signs of asthma appear. Treatment should be prescribed by an allergist; sometimes complex work and the involvement of a pulmonologist are required. The correct behavior of parents is also important. There is no need to panic, but you should not be inactive either. It is necessary to have a conversation with the baby, discuss the possible causes of the development of the disease, tell him what can be done and what cannot be done.

How to deal with a condition such as bronchial (Komarovsky, by the way, claims that it is simply necessary) is to use medications to prevent the development of an attack and put the patient into a state of remission.

The condition can be controlled with glucocorticosteroids. First, you need to use fast-acting inhalation agents. Therapy should be supportive. If it is not possible to achieve the desired effect using Nedocromil or cromoglycic acid, then inhalations of glucocorticosteroids are done.

Therapy should be aimed at:

Elimination of clinical manifestations;

Improving respiratory function;

Reduced need for bronchodilators;

Preventing the development of life-threatening conditions.

The disease is characterized by hyperreactivity (increased reactivity) of the bronchi to various environmental factors and reversible bronchial obstruction caused by bronchospasm, increased secretion of mucus, and swelling of the bronchial wall. Clinical manifestations of asthma are attacks of suffocation, wheezing, cough.

Bronchial asthma is a fairly common disease; in various regions of Russia, 5-10% of children suffer from it. The disease most often begins in children aged 2-5 years, but can begin at any age.

Bronchial asthma, starting in childhood, can continue into adulthood. Bronchial asthma cannot be contracted from other asthma patients.

In some children, by the time they reach puberty, the symptoms of bronchial asthma disappear, and parents decide that the child has “outgrown” asthma. But bronchial hyperreactivity persists even with long-term remission, so it is impossible to talk about recovery. Under the influence of many environmental factors, the apparent balance can be disrupted, and the symptoms of the disease will return at any time.

Bronchial asthma cannot be cured, but it is possible to treat and prevent attacks, learn to control the development of the disease, and then patients will be able to lead a normal, active lifestyle, go to school, play sports, etc.

There are allergic (atopic), infectious-allergic and mixed forms of bronchial asthma.

Bronchial asthma is a form of respiratory allergosis in which the “shock organ” (the location of the allergic process) is the bronchi and bronchioles (small bronchi).

Causes of bronchial asthma

Exogenous allergens that cause sensitization of the body and contribute to the development of bronchial asthma can be substances of non-infectious origin: household dust, house dust and mites found in it, etc.; epidermal antigens (wool, animal dander, fluff, feathers, etc.); nutritional supplements; medicinal allergens (antibiotics, vitamins, etc.); household chemicals (washing powders, various varnishes, paints, perfumes, etc.).

Allergens of infectious origin - bacteria, viruses, fungi - are involved in the formation of infectious-allergic and mixed forms of asthma.

The effect of causative factors is aggravated by the pathological course of pregnancy, prematurity, and poor nutrition.

Hereditary predisposition is important for the development of atopic asthma.

Factors causing exacerbation of bronchial asthma: non-infectious exogenous allergens, respiratory viral infections, physical activity, emotional stress, changes in meteorological conditions (cold, high humidity, thunderstorms, etc.), tobacco smoke, living in environmentally unfavorable areas, inadequate treatment.

The pathogenesis of bronchial asthma is based on immunological processes that occur when allergens interact with the body’s immune complex system.

The occurrence of an allergic (atonic) form of asthma is often caused by exposure to many allergens on the body (polyvalent sensitization of the body is observed).

Symptoms and signs of bronchial asthma

During bronchial asthma, the following periods are distinguished: attack, exacerbation and remission.

An attack is an acute condition of expiratory suffocation (suffocation as a result of difficulty in exhaling).

In children, an attack is often preceded by a period of warning signs (pre-attack state), which can last from several minutes to 2-3 days. This period is characterized by increased irritability, tearfulness, sleep disturbances, and appetite. Some children develop profuse mucous discharge from the nose, an obsessive dry cough, headache, etc.

An attack of suffocation most often begins in the evening or at night with the appearance of a dry cough, noisy wheezing with difficulty exhaling and the participation of auxiliary muscles. The children are scared and tossing around in bed. Body temperature is normal or slightly elevated. The skin is pale, moist, cold, cyanosis (blue) of the lips, rapid heartbeat.

The duration of the attack ranges from several minutes to a day.

After the attack stops, the cough becomes wet, sputum is coughed up freely, and shortness of breath stops. Sometimes you feel better after vomiting.

The initial manifestations of bronchial asthma in young children are of the nature of broncho-obstructive syndrome due to acute respiratory infections.

A variant of the attack in young children is asthmatic bronchitis, which usually develops against the background of acute respiratory infections and is characterized by a wet cough, shortness of breath with difficulty exhaling.

In atopic bronchial asthma, an attack develops quickly. Prescribing bronchospasmodics for a mild attack allows you to quickly stop it.

With infectious-allergic bronchial asthma, the attack develops more slowly, all symptoms increase gradually. Under the influence of bronchospasmolytics, the effect does not occur immediately.

Based on the severity of bronchospasm and changes in general condition, mild, moderate, severe attacks and status asthmaticus are distinguished.

Mild attack characterized by slight difficulty breathing, spasmodic cough. Spoken speech is not impaired, the child’s general health is not bad.

Moderate attack accompanied by a pronounced violation of the general condition. The child is restless and capricious. The cough is paroxysmal, with thick, viscous sputum, which is difficult to clear. Noisy, wheezing breathing, shortness of breath with accessory muscles. The skin is pale, the lips are bluish. Children speak in single words or short phrases.

At severe attack children are restless. Cold sweat on the head. Shortness of breath is pronounced, breathing can be heard from a distance. Cardiopalmus. Blue lips, general cyanosis. The child cannot speak and has difficulty pronouncing individual words.

Asthmatic status- the most severe manifestation of asthma, characterized by the presence of an intractable attack for more than six hours, the development of resistance to the therapy used.

Exacerbation of bronchial asthma characterized by prolonged (days, weeks, sometimes months) difficulty breathing, periodic whistling breathing, dry, obsessive cough with poor discharge of scanty sputum. Against the background of exacerbation, acute asthma attacks may recur.

During remission, the child has no complaints and leads a normal life. Remission can be complete or incomplete, depending on indicators of external respiratory function and “pharmacological” - if it is maintained only against the background of drug therapy.

Criteria for the severity of bronchial asthma:

• stereodependent bronchial asthma (with long-term use of systemic glucocorticoids);
• long-term (for one year or more) use of high doses of inhaled glucocorticoids;
• history of status asthmaticus;
• combination of bronchial asthma with neurological diseases (epilepsy, etc.) and diabetes mellitus.

The main risk factors for developing a life-threatening condition are:

• severe course of bronchial asthma;
• overdose of bronchodilators;
• underestimation of the severity of the child’s condition;
• sudden withdrawal or unreasonable reduction in the dose of hormonal drugs;
• late prescription or ignoring of hormonal therapy if there are indications for its use;

Treatment of bronchial asthma

Treatment of bronchial asthma includes planned therapy during exacerbation of the disease and remission and emergency measures during an attack of bronchial asthma and status asthmaticus.

All treatment of bronchial asthma should be carried out under the supervision of an allergist and through self-monitoring.

Self-monitoring of the state of bronchial obstruction and the results of using a particular drug to treat asthma is carried out using peak flowmetry.

A peak flow meter is a portable device that can be used to determine the peak (maximum) expiratory flow rate, that is, the speed at which a child can exhale air from the lungs (PEF). By the maximum exhalation speed one can judge the degree of narrowing of the bronchi.

Peak flowmetry is performed for children over five years of age. Using a peak flow meter, it is necessary to determine the patency of the bronchi daily (at least 2 times a day) for a long time. These observations make it possible to notice breathing disorders before they manifest themselves clinically - in the form of shortness of breath or suffocation.

Maintaining a graph of peak flow meter readings while simultaneously noting what medications the patient received and in what doses, what he ate, how environmental conditions changed, how the child’s general condition changed (cough, shortness of breath, etc.), makes it possible to analyze the effectiveness of drug therapy and evaluate , what is the impact of causally significant allergy factors on the child.

Rules for conducting peak flowmetry

Measurements must be taken standing.

Measurements should be taken at the same time, before taking medications.

When assessing the effectiveness of drug therapy, measurements should be taken before taking or inhaling the drug and 20 minutes after its inhalation (administration).

The mouthpiece of the peak flow meter is taken into the mouth, tightly clasping it with the lips.

Do not cover the mouthpiece with your tongue.

Do not touch the scale with your fingers.

To take a measurement, you need to take a sharp and strong breath into the device (as if you were blowing out a candle), note the results and repeat the exhalation three times.

Of the three indicators, you need to select the maximum result and mark it on the graph.

It is advisable that the child take an active part in filling out the peak flow diary chart, since in this case he will clearly see how bronchial patency changes under the influence of a particular medication, when changing diet, etc. After stabilization of the condition, peak flow measurement can be performed once per day in the morning.

How are peak flow measurements assessed?

To assess peak flow metry indicators when maintaining a graph, a system of green, yellow and red zones is used. Normal limits for peak expiratory flow (PEF) values ​​depend on the child’s height and are assessed by comparison with nomogram data.

Green Zone- this is the norm, bronchial patency is 80-100%, deviations during the day are less than 20%.

If PEF indicators are in the green zone, it means that bronchial asthma is in remission: there are no asthma symptoms. If the child receives basic therapy and PEF data remain stable for at least three months, then gradual withdrawal of basic therapy is possible.

Yellow zone- peak flow metry indicators are reduced to 60-80%, daily fluctuations are 20-30%. These data indicate a worsening of the condition and the possible development of an attack. It is necessary to increase the dose of basic therapy and take bronchospasmolytics (salbutamol, berodual). Consultation with the attending physician is required.

Red zone- bronchial patency indicators are below 50%, daily fluctuations in PSV are more than 30%. This is an alarm! It is necessary to take emergency medications and call a doctor.

Treatment bronchial asthma depends on the causes that cause it, on the individual characteristics of the child, his living conditions, habits, and the presence of concomitant diseases.

The general principles of treatment of bronchial asthma include the following elements: creating a hypoallergenic lifestyle, that is, conditions under which exposure to allergens will be minimized; using a hypoallergenic diet.

Treatment of bronchial asthma should be systematic, long-term and always under close medical supervision.

Treatment includes emergency care during an asthma attack and basic therapy carried out outside of an acute asthma attack to prevent it (prophylaxis) and/or reduce the frequency and severity of attacks.

In this case, drugs are used that suppress allergic inflammation in the bronchi. Basic therapy is carried out continuously, for a long time (at least three months, sometimes year-round). Medicines used for basic therapy are divided into two groups - non-hormonal and hormonal.

Organization of hypoallergenic life

The goal of organizing a hypoallergenic lifestyle is to protect your home from the most common allergens, that is, to create conditions under which exposure to allergens will be minimized. To do this, it is necessary to carry out the following activities.

Keep books and clothes in locked cabinets.

Replace down and feather pillows, wool and cotton blankets with synthetic ones, which should preferably be washed regularly (once a month).

Try to buy fewer soft toys for your children. Existing soft toys should be cleaned regularly, knocking dust out of them: after wrapping the toys in damp gauze, clean them with a vacuum cleaner. Every three weeks, place them in the freezer overnight in a plastic bag. This will reduce the number of ticks, since ticks cannot tolerate low temperatures, as well as high ones.

It is useful to ventilate bedding and clothes in the summer and dry them in the sun.

To wash bed linen, it is advisable to use special products - acaricides that kill ticks.

At least twice a month, you need to thoroughly vacuum upholstered furniture and floors, and carry out wet cleaning of the premises. During cleaning, the child should not be in the room and especially should not do the cleaning himself.

Make sure the indoor air is fresh and clean. Ventilate frequently. To clean the air in your home, you can use an anti-allergic air purifier based on a classic HEPA filter, which effectively removes particles of dust, wool, smoke, and fungal spores from the air.

A very important factor for combating dust is a properly selected vacuum cleaner. Conventional vacuum cleaners collect only visible dirt - sand, debris, etc., and all microparticles return back, turning into a cloud of microfine dust. New generation vacuum cleaners equipped with a HEPA filter and Botisafe TM antibacterial screen trap and kill bacteria and allergens that get inside during cleaning. An example of such a vacuum cleaner is the Dyson vacuum cleaner.

The child must be protected from contact with household chemicals (washing powder, various varnishes, paints, etc.), as well as perfumes. Use hypoallergenic cosmetics - soaps, shampoos, creams from the Mini-Risk or Freedom series.

Carry out a thorough cleaning of the toilet and bathroom from mold. Remember that mold is a strong allergen. Do not lay linoleum in the bathroom, as mold may begin to grow underneath it.

Don't have pets - there are no non-allergenic animals! Do not keep birds at home; if you have aquarium fish, do not use dry food.

If you have pets and you cannot part with them, regularly brush and wash your pets with a special anti-allergenic shampoo. Don't let them sleep in the bedroom.

Try to keep your home free from cockroaches and ants.

Basic therapy

To suppress allergic inflammation in the bronchi, various non-hormonal and hormonal drugs are used.

Non-hormonal anti-inflammatory drugs

1. Mast cell membrane stabilizers- medicinal substances that inhibit the degranulation of mast cells and prevent the release of mediators of allergic inflammation (histamine and other biologically active substances) from them, inducing allergic and inflammatory reactions. They also inhibit the development of delayed hypersensitivity reactions.

Mast cell membrane stabilizers eliminate and suppress swelling of the bronchial mucosa and prevent (but do not stop!) the increase in bronchial smooth muscle tone.

Thus, they do not relieve an attack of suffocation or difficulty breathing, but they prevent the development of an attack, make the intervals between attacks longer, and the attacks themselves easier.

The main indication for the use of these drugs is the prevention of bronchospasm. The preventive effect of their use develops gradually, over 2-12 weeks.

Basic therapy is carried out continuously and for a long time (at least three months, if indicated - year-round).

Substances in this group include:

• ketotifen;
• cromohexal (eye drops, nasal spray);
• cromogen (metered dose aerosol for inhalation);
• nedocromil (tailed) - dosed aerosol for inhalation;
• intal (cromoglicic acid, sodium cromoglycate) - capsule containing powder for inhalation;
• intal plus - dosed aerosol;
• Zyrtec - drops for oral administration.

In 1986, Tailedmint was created - a new inhaler with a device that creates a cloud of medicine in front of the mouth and thereby improves drug delivery to the bronchi and bronchioles by 1 1/2 times.

Intal is usually prescribed 4 times a day, Tailed - 2 times. The drugs must be discontinued gradually, under the control of bronchial patency (BOP).

In case of mild exacerbation of bronchial asthma that occurs during basic therapy, you can replace Intal with Intal Plus, which contains, in addition to sodium cromoglycate, salbutatamol (a bronchospasmolytic that relieves bronchospasm). Intal plus is used for a short course; after the exacerbation has resolved, you should return to the main drugs of basic therapy.

For children in remission from pollen allergies, it is advisable to start using Intal or Tailed 10-14 days before the plants begin to bloom.

2. Antihistamines- the group of antihistamines includes drugs that prevent the interaction of histamine with tissue receptors sensitive to it (receptor - lat. receiving; as well as the endings of sensitive nerve fibers). By interacting with histamine receptors, they prevent histamine from binding to it and thus prevent the development of the disease or weaken its effects.
The term "antihistamines" usually refers to I receptor blockers; they are used for the treatment and prevention of allergic diseases. Drugs in this group reduce or relieve spasm of bronchial smooth muscles, reduce capillary permeability, preventing the development of edema, reduce itching, etc.

The first drugs that block H receptors were introduced into clinical practice in the 40s of the 20th century - these are the first generation drugs: diphenhydramine, piolfen, suprastin, tavegil, etc. To achieve an antihistamine effect, it is necessary to use fairly high doses of drugs, with This is where their side effects are more likely to appear - sleeping pills, sedative (calming) effects. As a result of their influence on other receptors, dryness of the mucous membranes of the oral cavity and respiratory tract appears, which contributes to the appearance of a dry cough.

In recent years, blockers of H1-histamine receptors have been created, which are characterized by a high selectivity of action on H1-receptors - these are second- and third-generation antihistamines: Claritin (syn. loratadine), kestin, ebastine, Telfast (syn. fexadine), etc. They have the following advantages over first-generation drugs: rapid onset of action and long-lasting effect (up to 24 hours), no decrease in the therapeutic effect with long-term use. They can be used regardless of food intake; they do not cause dryness of the oral mucosa or respiratory tract.

First generation antihistamines are not advisable to use during exacerbation of bronchial asthma due to their side effects. They can be used as intramuscular injections during an asthma attack for a short course.

In cases of exacerbation of bronchial asthma, second-generation antihistamines are used - they are prescribed for oral administration once a day and can be used for a long time (for one month or longer).

When choosing an antihistamine, use the recommendation of an allergist. Don't self-medicate!

Hormonal basic therapy

With frequent prolonged exacerbations of bronchial asthma and its severe course, it is advisable to prescribe hormonal therapy using glucocorticoids.

Glucocorticoid hormones are produced by the adrenal glands and have powerful anti-inflammatory effects. They help reduce swelling of the bronchial mucosa, eliminate spasm of bronchial smooth muscles, and improve sputum discharge.

Many parents are frightened by the very word “hormones”, and they refuse this type of treatment. But you need to know that the use of glucocorticoids in the form of inhalation of metered-dose aerosols has revolutionized the treatment of bronchial asthma, making it possible to effectively control the course of the disease, significantly alleviate the condition of patients during exacerbations and lengthen the periods between attacks.

Modern forms of inhaled glucocorticoids, entering directly onto the mucous membranes of the respiratory tract, act locally and have a pronounced anti-inflammatory and antiallergic effect. The use of drugs improves respiratory function indicators. The high local activity of the drugs with the almost complete absence of systemic action allows them to be successfully used in the treatment of bronchial asthma.

The most commonly used drugs in this group are Alcedin, Becotide, Beclomet, Ingacort. These drugs are not indicated for rapid relief of bronchospasm. The effect of their use develops gradually (over 3-7 days). To prevent the occurrence of candidiasis (fungal infection of the mucous membrane of the tongue, respiratory tract), it is necessary to regularly rinse your mouth with boiled water after inhalation. Alcedine for children over 6 years of age is prescribed 1-2 inhalations (50-100 mcg) 2-4 times a day, depending on the age and response of the patient.

If symptoms of bronchial obstruction persist despite the use of inhaled glucocorticoids, you can use combination drugs Seretide or Symbicort, which contain a substance that relieves bronchospasm for 12 hours and a hormone that reduces allergic inflammation.

Seretide is intended for long-term use and is withdrawn gradually under the supervision of a physician. It is especially indicated for frequent exacerbations of asthma, when salbutamol helps, but not for long.

Hormonal therapy is prescribed only by a doctor. Strictly controlled, withdrawn gradually and carefully. Sudden withdrawal of a hormonal drug is unacceptable!

With properly carried out basic therapy with the selection of appropriate drugs, complete control of bronchial asthma is achieved:

• daytime asthma symptoms disappear;
• morning peak flow meter reading is above 80%;
• no night awakenings from coughing or choking;
• no emergency room visits;
• there is no need to use bronchodilators (drugs that relieve bronchospasm).

Emergency care for an attack of bronchial asthma

Emergency treatment for an attack of bronchial asthma includes the use of bronchospasmolytics (dilators that dilate the bronchi), pathogenetic therapy agents that affect allergic inflammation. Creating a calm environment around the child is of great importance: it is necessary to reassure the patient, instill in him confidence that under the influence of treatment he will feel better. Take a small child in your arms, give him a semi-sitting position, try to divert his attention to something interesting. You can give a hot foot bath if the child does not perceive it negatively. With older children, calmly talk about something pleasant. Let the child relax and breathe as rarely and evenly as possible. The desire to breathe frequently and shallowly during an attack will only aggravate the attack. Without wasting time, take two inhalations of a bronchospasmodic (salbutamol). If there are no inhaled bronchodilators at home, you can give your child aminophylline. Give your child a warm drink through a straw.

If a child has developed an attack of bronchial asthma for the first time and you have no experience in treating it, if there is no fast-acting bronchodilator medication in the house, do not hesitate, urgently call an ambulance.

Three groups of drugs have a bronchodilator effect

1. Adrenergic drugs- substances that excite adrenergic receptors, that is, they act like adrenaline.
(5-Adrenergic agonists are substances that excite only beta-adrenergic receptors. They act like adrenaline, but are more selective and have fewer side effects.

There are (short- and long-acting β-adrenergic agonists:

• Short-acting β 1-adrenergic agonists - salbutamol (Ventomin, salamol), fenoterol (Berotec), terbutamine (bricanil);
• Long-acting β 2 -adrenergic agonists - foradil, serevent, valmax, clenbutinol.

Long-acting drugs cause long-term (up to 12 hours) dilation of the bronchi. Their onset of action occurs within 5-10 minutes from the moment of inhalation.

It must be remembered that the use of adrenergic agonists should not exceed 3-4 times a day by mouth or 6-8 inhalations!

Uncontrolled use of P2-adrenergic agonists and an overdose of drugs leads to tremor (fine trembling) of the hands, dizziness, insomnia, nervousness, palpitations, nausea, and vomiting. If side effects occur, the drug must be discontinued.

2. Anticholinergic drugs- drugs that prevent the interaction of acetylcholine with cholinergic receptors. M-cholinergics are substances that block M-cholinergic receptors in the area of ​​the endings of parasympathetic nerve fibers, resulting in dilation of the bronchi, decreased secretion of the bronchial glands, dilation of the pupils, etc. This group includes the following drugs: atropine, platiphylline, ipratropium bromide (Atrovent ).

3. Xanthines- theophylline, aminophylline, aminophylline. These substances have a pronounced bronchodilator effect: they dilate the bronchi, inhibit the release of allergy mediators from mast cells, promote better sputum discharge (increase mucociliary clearance). These drugs are prescribed in the absence or inability to use an inhaler, in the absence of other medications.

4. Combined drugs: Berodual (Berotec + Atrovent), Ditek (Berotec + Intal), Intal Plus (Intal + Salbutamol), Seretide (Serevent + Flixotide), Sim-bocort (Formoterol + Budesonide).

These drugs in one inhaler contain two active ingredients that complement each other. They are usually used 1-2 times a day.

As first aid during an attack of suffocation, it is advisable to use short-acting P2-adrenergic agonists - salbutamol (Ventolin, Salamol), fenoterol (Berotec), terbutaline (Brikanil). These drugs have the most pronounced and fast-acting bronchodilator effect, activate mucociliary clearance, inhibit the secretory activity of mast cells, reduce vascular permeability and swelling of the bronchial mucosa and have a minimal number of side effects. They are best prescribed in the form of inhalations (the effect will occur in 5 minutes). A single dose of salbutamol for emergency care is 2-4 breaths. But it can be difficult to synchronize inhalation and pressing the head of the inhaler during an attack when the child is agitated. With proper inhalation, 30-35% of the medicine reaches the bronchi. If inhalation is carried out incorrectly, then only 15% of the drug enters the bronchi.

To better get the drug into the bronchi, you can use a special device - a spacer - a plastic balloon, one end of which is connected to the inhaler, the other ends with a mouthpiece. The medicine is injected into the spacer and then gradually inhaled by the child, who simply needs to calmly take 3-4 breaths.

The most effective method of inhalation is the use of a nebulizer. Nebulizer (lat. Peviva - fog) - a device that turns liquid into fog; aerosol under the influence of compressed air (compressor) or ultrasound (ultrasonic).

Nebulizers can be used by children of any age, since they do not require forced inhalation and synchronization of breathing with hand movement (pressing the cylinder valve during inhalation).

Using a nebulizer, you can use the following bronchospasmolytics: Berotec, Berodual, Atrovent), salbutamol, terbutaline, etc.

Medicine solutions for nebulizers are contained in bottles with a drip dispenser. These are gluco-corticoids (pulmicort).

Prescribed to children under 5 years old at 0.1 ml/kg, over 5 years old - 2.5 ml per inhalation.

Inhalation through a nebulizer continues for 5-10 minutes until the solution is completely consumed; the second and third inhalations can be carried out after 20-30 minutes.

When using medications using nebulizers in Uzbek patients, an attack can be stopped with 1-2 inhalations, without resorting to other means.

Do not use drugs in nebulizers that are not intended for them.

Inhalers for powder forms of drugs - spinhaler, multidisc, turbuhaler, diskhaler. They have dose counters that allow you to monitor your medication intake and avoid overdose.

“Easy Breathing” inhaler - the aerosol comes out of the inhaler at the beginning of inhalation, without the need to press on the can. The bronchodilator “Salamol Eco easy breathing” and the hormonal drug “Beclazon Eco easy breathing” are used.

Remember that only a doctor can select the optimal bronchodilator drug for a child with bronchial asthma, depending on the period of the disease, the characteristics of its course and the individual characteristics of the child, as well as determine its dose and method of administration (inhalation or orally).

After stopping an attack of bronchial asthma in the post-attack period, when a cough may still persist against the background of slightly difficult breathing, it is necessary to continue treatment of asthma. The child should receive a bronchospasmolytic drug under the control of peak flowmetry. If PEF indicators are persistently in the green zone, you can begin gradual withdrawal of the drug while constantly monitoring PEF and switch to basic therapy.

Non-drug methods of treating bronchial asthma

Breathing exercises are a treatment method aimed at increasing the functionality of the respiratory apparatus by restoring free economic breathing. The therapeutic effect of breathing exercises on the body consists in the formation of physiological respiration and increases the reserve capabilities of external and internal (tissue) respiration.

There are a huge number of breathing exercises.

Yogis judiciously alternate full breathing with holding their breath to provide the body with the necessary amount of carbon dioxide.

K. Buteyko’s system of breathing exercises is based on the importance of carbon dioxide for the body. He substantiated his method of treating a number of diseases, including bronchial asthma, by refusing deep, volumetric breathing. The essence of the method is to constantly limit the depth of inhalation and exhalation. Only trained specialists can teach this technique.

Breathing exercises according to the method of A. Strelnikova promotes aeration of those parts of the lungs that are normally inactive, thereby achieving a high level of oxygen supply to the body.

A. Strelnikova’s method of breathing exercises is quite simple: a sharp breath is taken through the nose so that the wings of the nose are compressed, then a passive exhalation is made through the mouth.

Breathing exercises are one of the ways to treat bronchial asthma.

With a long course of bronchial asthma, the tension of all respiratory muscles increases, which leads to their fatigue. It is necessary to help the body - to increase the strength of the respiratory muscles and get rid of phlegm accumulated in the bronchi.
To treat tired and tense respiratory muscles, including the diaphragm, a set of exercises has been developed, which ensures their normal functioning, relieves tension - the so-called diaphragmatic breathing (belly breathing), and to improve the coughing up of phlegm, dynamic exercises with forced elongation are used. exhale.

Here are a few of these exercises:

Exhalation with resistance - it can be done during exacerbation of bronchial asthma and in remission. To perform it, you need a vessel filled with water and a straw (cocktail straw). After a deep breath, you should exhale as slowly as possible through the straw into the water. It is advisable to repeat the exercise 3-5 times a day for 5-10-15 minutes.

Diaphragmatic breathing exercise. Starting position - lying on your back (but you can also sit). On the count of one, two, three, you need to take a powerful, long, deep exhalation involving the abdominal muscles (you need to strongly draw in your stomach), and on the count of four, take a diaphragmatic breath through your nose, protruding your stomach to the maximum. Then, quickly contract your abdominal muscles (remove your belly) and cough loudly.

You can use a breathing simulator - a device in which, when exhaling, the resistance of a metal ball is overcome, or a Frolov breathing simulator.

But we must remember the main thing - you need to breathe in fresh air every day so that you feel easier breathing. Long daily walks are needed!

During the period of remission, children should engage in physical education, but these activities are not recommended to be done outdoors during the cold season, and in case of pollen allergies - from April to October. It is advisable to periodically monitor bronchial patency using peak flowmetry (PFM).

The child can also engage in some sports - swimming, gymnastics, but it is important that the room is not dusty and stuffy.

First aid for an asthma attack

During an asthmatic attack, it is difficult to exhale. It seems as if the child is unable to get the air out of his lungs. Inhalations are not difficult.

Asthma can be recognized by whistling sounds when exhaling. It can help if, during an attack, patients lean their hands on a table or chair. Asthmatic attacks are usually not life-threatening if appropriate medications are available.

Medications

The necessary medications are packaged in small pressurized aerosol bottles (special term: metered dose inhaler) and are intended for inhalation. For asthmatics, these metered-dose inhalers are usually always on hand in case of extreme anxiety.

Educators should ask parents how and in what dosage such medications should be used. Usually one injection is enough: first you need to remove the protective cap from the bottle, then turn the inhaler upside down (so that the inscriptions on the bottle become readable) and bring it to the child’s mouth. When inhaling the drug, the child must clasp the nozzle with his lips. At the same time, as a result of pressing the bottle, a dose of medicine is sprayed out of it. The active substance must enter the lungs.

Your doctor may also prescribe suppositories to use during attacks.

When a person has lived with asthma for many years, addiction to medications occurs and it becomes more difficult to stop attacks, but children usually respond well to appropriate medications.

Asthma on exertion

Strong physical activity, for example when playing sports, can trigger asthmatic attacks. Good physical training has a beneficial effect on this type of asthma.

Allergic asthma

Currently in Germany, approximately every fifth child of kindergarten age suffers from allergies. Many kindergartens already maintain lists of substances or foods to which individual children have an allergic reaction. When it comes to the severity of allergies, there are big differences.

So, if a child has a mild form of allergy, then contact with the allergen can, for example, only worsen the condition of existing skin eczema. But immediate allergic reactions are especially dangerous. They are often caused by nuts, marine proteins (crabs, shellfish), medications, animal dander, and insect bites. In this case, redness, itching and asthmatic breathing are possible. This is called allergic asthma. With hay fever (rhinitis), allergic asthma is also possible.

Asthma treatment

It is almost impossible to cure asthma within the framework of traditional medicine. Traditional medicine is limited only to relieving symptoms during acute attacks. Long courses of cortisone cannot be considered treatment.

The most successful therapy is classical homeopathy, since it does not drive the disease deeper, but fights its root causes. In some cases, concomitant psychotherapy is required to pave the way to healing.