children

Lesbay Dana
Sattarbekova Saltanat
Maidanbek Zhalgas
Bronchial Asthma
Bronchial asthma (BA) is a
heterogeneous disease characterized
by chronic inflammation of the
airways, the presence of respiratory
symptoms such as wheezing,
shortness of breath, chest congestion,
and cough, which vary in time and
intensity and present with variable
airway obstruction.
 Classification
Based on natural course:

- Recurrent wheezing: caused by viral infections;

usually resolves before patients are school-aged
- Chronic asthma: allergy associated; usually persists
into adulthood
- Asthma with declining lung function: associated with
hyperinflation in childhood and male sex

Based on disease severity while not on asthma medication

- Intermittent
- Persistent:
- Mild
- Moderate
- Severe

Based on response to treatment

- Well controlled
- Not well controlled
- Very poorly controlled
Etiology
● A combination of genetic and environmental factors cause asthma
● Genetic factors: > 100 gene associations (no monogenicity)
● Environmental factors associated with asthma:
- Recurrent childhood wheezing: common respiratory viruses such as
rhinoviruses, respiratory syncytial virus, adenovirus, influenza virus,
parainfluenza virus, and human metapneumovirus
- Home allergens can initiate airway inflammation in susceptible children.
Early childhood risk factors for persistent asthma:
● Asthma in parents
● Allergy including atopic dermatitis,
allergic rhinitis, and food allergy
● Severe lower respiratory tract infection
such as pneumonia or bronchiolitis
● Wheezing (not as a result of colds)
● Male sex
● Low birth weight
● Passive tobacco smoking
Asthma triggers:
Allergens:
- Dust mites
- Animal dander
- Molds
- Cockroaches
- Seasonal pollens
- Seasonal molds
Air pollutants:
- Environmental tobacco
smoke
- Ozone
- Nitrogen dioxide
- Dust
- Sulfur dioxide
Strong odors such as perfumes
Occupational/lifestyle exposures:
- Farms and barns
- Paint fumes
- Cold, dry air
- Physical exercise
- Emotional stress
- Hyperventilation
Comorbid conditions:
- Rhinitis
- Sinusitis
- Gastroesophageal reflux
Drugs:
- Beta blockers
- Aspirin and nonsteroidal
anti-inflammatory drugs
Pathophysiology
Complex interactions between the following 2
components lead to airway obstruction:
- Increased smooth muscle tone
- Airway inflammation, edema and exudate
with eosinophils and other inflammatory
cells such as neutrophils, monocytes,
lymphocytes, mast cells, and basophils
Inflammation is mediated by helper T cells
that produce proinflammatory cytokines
(interleukin 4 [IL-4], IL-5, and IL-13) and
chemokines.
Exposure to triggers and lack of appropriate
therapy further induces a combination of the
following
- Inflammation
- Airway hypersensitivity response
- Basement membrane thickening
- Subepithelial collagen deposition and
fibrosis
- Smooth muscle hypertrophy
- Mucus hypersecretion
 CLINICAL PICTURE:
1) recurrent(повторяющийся) or persistent unproductive cough(which may worsen
at night or be accompanied by distant wheezing or difficulty breathing)
2) cough occurs during physical exertion, laughter, crying or contact with tobacco
smoke, contact with animals or pollen, etc.; physical activity, stress in the absence
of a respiratory infection at the moment
3) prolonged cough during the newborn period and cough in the absence of a cold
4) Remote wheezing: repetitive wheezing, including wheezing during sleep or when
exposed to triggers (physical exertion, laughter, crying, tobacco smoke, polluted
air)
Shortness of breath or shortness of breath: occur with physical exertion, laughter,
crying
Decreased activity: does not run, but can play or laugh with other children and at
the same intensity; gets tired during walks (asks for hands)
During an objective examination during the exacerbation of
bronchial asthma in children, bronchoobstructive syndrome
occurs:
→ obsessive dry unproductive cough
→ expiratory shortness of breath diffuse dry whistling, mainly on
exhalation, sometimes in combination with various-sized wet
wheezing in the chest against the background of uneven weakened
breathing chest swelling
→ boxy shade of percussion sound often the child takes a forced
position (orthopnea), is pale, well-being is disturbed
Diagnosis
History

• Cough after exercise or sometimes in the early morning, disturbing sleep.

• Shortness of breath.

• Limitation in exercise performance

Examination

In the child with chronic problems consistent findings include:

• Barrel-shaped chest.

• Hyperinflation.

• Wheeze and prolonged expiration

Chest X-ray

Not needed if there has been recent imaging. It may show:

• Hyperinflation.

• Flattened hemi-diaphragms.

• Peribronchial cuffing.

• Atelectasis.

Spirometry

• Peak expiratory fl ow rate (PEFR) <80% predicted for height.

• FEV1/FVC <80% predicted.

• Concave scooped shape in flow volume curve.

• Bronchodilator response to β-agonist therapy (i.e. 15% increase in FEV1 or PEFR).

● Before 5 years of age, assessment and monitoring of asthma severity with
the analysis of respiratory function, including PEF, is not possible, and
therefore the diagnosis of asthma and the determination of the severity
of asthma in children under 5 years of age is based on anamnestic and
clinical criteria.
● It is necessary to evaluate the daily lability of the bronchi (DLB) according
to peak flowmetry. An increase in this indicator by more than 20%
indicates an uncompensated condition of the child.
● Specific diagnosis of causally significant allergens is carried out using skin
prick or prick tests (Prick tests) with “suspected” allergens.
● The theoretical premise of skin tests is that specific IgE are fixed on cells
not only of the shock organ, but also of the skin. When fixed antibodies
come into contact with an antigen, an immune conflict occurs in
miniature, causing a reaction in the form of a blister on the skin.
 TREATMENT TACTICS AT THE OUTPATIENT LEVEL

Treatment of asthma should be a cyclical, continuous process, including

assessment of the patient's condition, correction of therapy (drug and non-
drug) and mandatory monitoring of the response to the treatment. The task
of treating AD is to achieve control with long-term remission and prevent
exacerbation. Each child, along with a universal strategy, must take into
account individual characteristics for the choice of means and methods of
treatment.
Non-drug treatment
Mode: creation of hypoallergenic life (consists in the elimination of household,
epidermal, pollen allergens, which are most often transformed into asthmatic status).

Diet: hypoallergenic diet (excluding food allergens, food additives).

Respiratory gymnastics and physical therapy for training the respiratory muscles
of the patient in the inter-approach period of asthma (in children, respiratory
gymnastics with forced exit is more indicated);

Psychotherapy

- helps to identify the psychological characteristics of patients, timely diagnosis and

psychotherapeutic correction of neuropsychiatric status.
 Medical treatment
Medicines used for the pharmacotherapy of asthma can be divided into two large classes, depending on the
purpose of their appointment: drugs for rapid relief of symptoms (first aid drugs) and means for long-term
control of the disease (means of basic - supportive, anti-inflammatory therapy).
Drugs used for rapid relief of symptoms Medications used for long-term asthma control

inhaled short-acting β2-agonists (salbutamol) is
used as first-line ambulance medications
unanimously recommended for children of all ages
(UDA).Drugs of this group are usually prescribed
"on demand", however, frequent (more than 1
inhaler per month) or prolonged use indicates the
need to reconsider basic therapy.
The drug in the form of an aerosol is prescribed for
the relief of an asthma attack once by 0.1 mg, for
children over 12 years of age by 0.1-0.2 mg; for the
prevention of asthma attacks – 0.1 mg 3-4 times a
day; for the prevention of an asthma attack of
physical exertion before physical exertion – 0.1 mg.
The drug in the form of a solution for inhalation use
is prescribed at a dose of 2.5 mg 3-4 times a day. If
necessary, it is possible to increase the dose to 5
mg 3-4 times a day.
are inhaled corticosteroids. IGCS as drugs for the daily
control of persistent asthma relieve symptoms and improve
pulmonary function, reduce the need for emergency
medications and the frequency of exacerbations, reduce the
number of hospitalizations for asthma exacerbations in
children of all ages and improve the quality of life.
IGCS (budesonide, beclomethasone dipropionate,
fluticasone propionate, cyclesonide, mometasone furoate)
differ in activity and bioavailability and have minimal overall
effect on the body. With a mild course of BA, the duration of
IGCS is 2-3 months, with moderate BA – 4-6 months, with a
severe course of at least 6-8 months.