Definition
Definition
Asthma is a common illness in children, most often manifested by episodes of respiratory discomfort accompanied by wheezing.
Generalities
This condition is characterized by attacks of dyspnea (difficulty breathing), signaled by wheezing, indicating a sudden closure of the bronchial tubes under the action of the muscles surrounding them (smooth muscles), which is associated with hypersecretion of the mucous membranes (abnormally high production of thick fluid, covering the cells lining the lungs ), and of the airways, that is to say:
Classification
Childhood asthma can be differentiated into:
- Mild asthma (once a month).
- Moderate asthma (once a week).
- Severe asthma (more than once a week).
Symptoms
Symptoms
- Background of rhinitis, accompanied by cough (late evening or night).
- Difficulty breathing, resulting in sitting up in bed.
- Active mobilization of all the muscles of the thorax to breathe (drawing in), especially during expiration. This drawing in is visible by the depression that appears between the child's ribs, above the sternum.
- Whistling audible to those around you and to the doctor, during auscultation of the lungs.
- Appearance of sweats in more serious cases.
- Blue nail coloring reflecting a cyanosis .
Epidemiology
According to recent studies, childhood asthma has been steadily increasing in recent years and appears to be more severe than in the past. It affects approximately 10 to 12% of the total child population.
Asthma can affect children of all ages, even infants before 12 months, a period when it is particularly difficult to diagnose asthma.
Medical exam
Labo
- Search forimmunoglobulins.
- IgE by blood test (more rarely by skin tests).
- More specific IgE ( RAST phadiatop) which are generally high, allowing the diagnosis to be confirmed.
Technical
In terms of the evolution of the asthma attack, it is possible to put forward the following notions which must be taken into account for the management of critical asthma.
- First of all it is necessary to reassure the child, and give him puffs of aerosols containing beta 2-adrenergic in metered dose aerosol. This can be done using a inhalation chamber, and asking the child to breathe normally. Still during this first step, after letting the child take 10 breaths, you must take a second puff.
- Secondly, if there is no improvement after 10 minutes, it is necessary to repeat the doses at 10-minute intervals, and up to six doses.
- Thirdly, if there is no improvement after the third dose, and within half an hour of starting the dyspnea (respiratory discomfort), the child must then be given Celestene, for example, or others corticosteroids such as Solupred, or Cortancyl, in drops or tablets.
- It will be necessary to call the SAMU, only if there is no improvement after carrying out the previous steps.
Additional examination
A chest X-ray allows:
- To support the diagnosis of asthma.
- To possibly discover another anomaly (pneumonia, foreign body in a bronchus).
It shows a very enlarged chest, and allows the diagnosis of old or severe asthma.
Respiratory function testing is difficult to perform before the age of 4 or 5. This test provides an idea of the progression of the disease and the effectiveness of treatment over time.
It is done as follows:
- The child must take a maximum breath, then expel the air as quickly and forcefully as possible. At this point, we obtain the Maximum Expiratory Volume per Second (FEV1).
- The second parameter obtained is the Peak Expiratory Flow (D.E.P). In the presence of asthma, these two parameters are lowered. Respiratory function testing is sometimes carried out after inhaling medication, or after physical exercise, to confirm the diagnosis of exercise-induced asthma.
Cause
Cause
- Smoking or both!
- Family history :
- Lung infections (especially in infants).
- Presence of house dust (harboring many mites).
- Presence of pets (dogs, cats, and mainly hamsters).
- Bedding with allergenic characteristics (feathers or kapok).
- Toxic products (painting for example).
- Medicine allergy suffereryou (antibiotic).
Treatment
Treatment
Treatments for childhood asthma include:
- Reduce, or if possible eliminate, contact with allergenic substances (allergens).
- Removal of tabagisme (passive and active).
- Reduce the quantity of as much as possible mites : prefer the vacuum cleaner to the broom, humidified heating, to forced air or underfloor heating).
The drugs used are:
- The beta 2 stimulants.
- La theophylline, which tends to be gradually abandoned, because its handling is not easy (need for a certain quantity in the blood, dosage).
- Le disodium cromoglycate.
- The corticosteroids.
These medications are taken alone or in combination, orally or by inhalation. Beta-2 agonists can be taken as a spray (not exceeding 4 or 5 sprays per day, starting at age 5 or 6) or as a syrup. Cromoglycate ( Lomudal*) is a daily, long-term preventive treatment administered under strict medical supervision. Corticosteroids (cortisone derivatives) are primarily used in spray form. Oral cortisone is reserved for the treatment of severe asthma.
- La desensitization is not always effective.
- La respiratory physiotherapy may have some long-term effectiveness, especially in recovering costal and diaphragmatic mobility. It also aims to strengthen the abdominal muscles and make minimal coughing effective in achieving decongestion.
Evolution
Differential diagnosis
Childhood asthma should not be confused with other diseases (differential diagnosis):
- La cystic fibrosis : the sweat test (chemical study of sweat) is the only test that allows a diagnosis to be made with certainty.
- Le gastroesophageal reflux : the radiography of the esophagus, and that of the stomach, accompanied by the pHmetry (study of the pH : acidity of the esophagus for twenty-four hours, thanks to the use of a probe positioned in it), allow the diagnosis of reflux of acidic gastric liquid into the esophagus, sometimes the bronchi. It happens that the gastroesophageal reflux is the sole cause of asthma in children.
- La bronchiolitis and the wheezing bronchiolitis are indeed the translation of an obstruction of the bronchioles (reduced airflow in the bronchi), but are of viral origin and occur mainly in winter.
Prevention
Prevention of childhood asthma attacks involves:
- Aerate home as often as possible.
- Remove :
- The feather mattress.
- Bedside rugs.
- The stuffed toys on the bed.
- Use sprays that have a preventative action against dust mites in the bedroom and bedding.
- Avoid any animal considered allergenic.
- Avoid playing in dusty rooms.
- Avoid fields during the grass flowering period.
- Take cures in the climatic resorts (Briançon, Font-Romeu, etc.).
- Favor certain sports activities, avoid judo, dance, volleyball (indoor sports).
Sometimes, a doctor needs to issue a medical certificate for a child with asthma. This certificate must specify whether or not the child is fit to participate in sports activities. If the child is fit, given their health condition, it is necessary to indicate that they require a proper warm-up and, if necessary, the administration of a bronchodilator, specifying the active ingredient (its composition) before and during exercise.