ASTHMA

The diagnosis of asthma

Asthma is a reversible obstruction of the bronchi that is manifested by shortness of breath, coughing, wheezing. This obstruction is due to the contraction of the muscles in the bronchial wall and swelling of the wall due to inflammation.'s Active cases the diagnosis is not difficult, some problems may arise in the face of atypical patterns and forms are not widespread. Not infrequently asthma occurs only with persistent cough, cough stress or rice, pseudo-pneumonia, chest pain on exertion.
persistent cough does not always, however, be considered as an equivalent asthmatic vice versa often tend to do. It is also considered that a persistent cough asthma hardly lasts as long as such but over time usually appear wheezing. It is important not to forget that there are other medical conditions that can cause persistent cough and therefore persistent cough does not always mean allergy. The most common cause of persistent cough after rhinosinusitis asthma is a condition until some time ago, but a little known fact of usual reflected in daily practice, in which the cough usually is accompanied by persistent nose closed often with yellowish or greenish secretion , halitosis. In children, unlike adults, headache is not a common symptom of sinusitis and is only present in older children, when you develop the frontal sinuses.
cough stress or rice, that is a cough that occurs when the child runs or makes the stairs or laughs is already asthma and is due to the inflammation of the bronchial wall that also outside of the crisis obstructive, ie of what is commonly called acute asthma, is present. This persistent inflammation levels in clinically manifest is responsible for the so-called bronchial hyperreactivity to which various factors (especially virus infections, but also exercise, aspirin) indifferent to normal children can then trigger acute asthma attacks .
Thus, in all ages, viruses are the most important triggers of acute asthma episode, but they can act as such only because they find a piece of land prepared by this minimal inflammation caused by persistent exposure of the child to factor allergic (allergen) .
still happens often hear parents complain, "the child has a cough because sweat." In fact, the sweat has nothing to do and if anything, is the physical effort of which the sweat is an expression that causes the child's cough. But the physical effort may be capable of so much only if it acts in an allergic child that is exposed in a continuous manner to the allergen. So that kid in kindergarten because sweat running and playing and in which apparently the sweat triggers the cough is actually an allergic who have inhaled all night the mite and its faeces in its mattress and into his pillow and has , therefore, the bronchi in a state of persistent inflammation and hyperreactivity. These bronchi are waiting to physical exertion, a race, a "sweaty", (as well as a virus or cigarette smoking or aspirin etc.) To contract and give asthma (and coughing).
many children proved asthma and allergies have in their history readmissions for bronchopneumonia. This is a radiological diagnosis which often do not match objective factors. Often there is no fever and the laboratory tests have demonstrated the presence of infection. Responsible for these pseudopolmoniti is asthma which can lead to the complete obstruction (swelling of the wall, contraction of the bronchial muscles, mucous plugs) of the bronchi resulting in blockage of the air passage with what in technical term is called atelectasis and that radiologically can mimic pneumonia.
Usually, as mentioned, the diagnosis of asthma is not difficult. In doubtful cases, the doctor may carry out certain maneuvers to highlight, for example, in a child with persistent cough or cough stress, asthma clinically manifest. A very simple operation, which can be used even parents, is to run the child or make him flexing. After some physical exertion is possible, in some cases, trigger wheezing that can be perceived by the parents, approaching her ear to his mouth.
Compete only the doctor vice versa instrumental tests such as spirometry, which allows the assessment of respiratory function. In subjects with asthma frankly there are changes of some parameters which are then corrected in the course of therapy. So spirometry is useful for the diagnosis of asthma and to follow the evolution of acute asthmatic episode. It is also useful in those forms of asthma are not clear, not overt in which we have previously mentioned. In these cases, for example, after physical exertion, the simple stroke for a few minutes is the best method, the examination will show alterations in respiratory function which allow it to be sure of the nature of that certain asthmatic persistent cough, phlegm of that which does not pass etc.. Spirometry is useful, finally, to monitor over time the effectiveness of the therapy "bottom" and to establish the various stages of it and the moment in which interrupt.
Regarding allergy tests are preferable compared to those on the blood (RAST or ImmunoCAP) skin tests that the doctor will select on the basis of medical history, age, experience, the substances to be tested.

It is not always what it seems asthma asthma

We have seen how the core symptoms of asthmatic children are cough, shortness of breath, wheezing. But not always persistent cough or shortness of breath or wheezing are indicative of asma.Per the acute cough is obvious that it is more often of different problems bronchial asthma: all inflammatory processes of the airways, at every level play, they cough in the core symptom. For the so-called persistent cough have just now seen that it may be responsible for other conditions: first rhinosinusitis but also pertussis, or whooping cough, and psychogenic cough, nervous, are often interpreted as toxic and allergic to them, often, the pediatrician is consulted allergist (see coughs persistent).
Regarding the symptom distress ("wheezing") should not be forgotten that there is a very distressing condition that relates mainly teenage girls, but not only, which often is, unfortunately, is interpreted as asthma. It is generally anxious girls who have shortness of breath, breathlessness fact, and that sometimes, talking, you stop to take a deep breath. These girls, unfortunately, are sometimes labeled as asthma, sometimes due to the random presence of an allergy test positive, maybe to an allergen, as sometimes I've ever seen, with seasonality in any manner inconsistent with the symptoms, at other times for a spirometry complacently "given" as a positive, another situation that I have observed. This is called "hyperventilation syndrome." These patients, usually girls, in fact almost never cough or cough at night, they never or almost never disturbed night's sleep, do not cough stress, symptoms vice versa are often seen in patients with asthma and, in particular, are always present in the forms of asthma apparently seem as important as those of the girls. If you invite these people to hold their breath they are not able to hold him almost at all, while the asthmatic unable to do so for some time. Moreover, their grief often does not respond to therapy or seems to respond to it in an "unusual" or "suspicious" in the eyes of the medical expert. The asthmatic that does not improve with a therapeutic treatment correctly or does not perform the therapy or, simply, is not asthmatic.
Also with regard to the symptom wheezing (whistling or wheezing) the presence or absence of this symptom does not have value absolute. Not always the asthmatic hisses and not everything that gives wheezing is asthma. In really severe asthma attacks the patient is so clogged that the hiss can not be present and, on the other hand, there are other situations that can accompagnar wheezing. For example, bronchiolitis or other situations as rare defects or the presence of foreign bodies in the respiratory tract.
Different from wheezing, which occurs in expiration, is the screeching, noise much more rough and intense, which is present in inspiration. Inspiratory stridor along with barking cough, and to seal his voice low are typical symptoms of laryngitis or pseudocroup. As the expiratory wheezing and stridor during inspiration are very different children with pseudocroup are often labeled as asthmatic and this one in particular when the episodes are recurrent. These children, especially at night, suddenly begin to present a strong cough, barking, and a very noisy breathing for an intense stridor during inspiration. Often during inspiration can be observed the rientramento of the lower part of the neck. The misunderstanding of laryngitis interpreted as asthma is as mentioned frequently and often these children are considered for a long time asthma and treated as such. In fact, the barking cough and a low voice did not belong to asthma and gnashing is very different from expiratory wheezing. Sometimes you just simulate in front of the parents the two different noise to clarify the problem.

Asthma mean just allergies?

Being asthmatic does not necessarily mean they are allergic. A discriminating factor fundamental to suspect allergy in an asthmatic child is age. While among children with recurrent wheezing of preschool, kindergarten and asylum, only about a third is allergic to, among older children allergy is present in much higher percentage. Hardly a child aged six years and older with asthma are allergic and the more difficult the higher age. Preschool children with "bronchospasm" the plaintiff are often a source of concern for parents who fear the possibility of persistence asthma and are concerned about the repeated use of drugs, particularly corticosteroids. In fact, as I said only a third of children with recurrent wheezing is asthma consists of real, two-thirds of these children are called sibilants in viruses, that is, children who have the expiratory wheezing only in the course of viral infections due to narrowness of their age-related bronchi and marked thickening of the wall due to inflammation following infection of the virus. Growing children and increasing the caliber of the bronchi, the phenomenon no longer occurs, and these children stop having asthma (bronchospasm or asthmatic bronchitis, or, if you prefer). It is non-allergic children without a family history of allergic diseases, these children do not need a primer treatment, prolonged in time, of those children hissing preschoolers have the characteristics of true asthma. For them, to reduce the frequency and intensity of episodes you may use so-called antileucotrieni or inhaled corticosteroids (virtually free of side effects).
hissing in preschool children who have a tendency to remain with asthma over the years can be suspected on the basis of certain criteria, the most important being the family have allergies (but it must be true allergies, proven and not assumed), having atopic dermatitis, being positive to skin tests for allergies or blood some inhaled allergen (eg, dust mites, pollen, cat dander). The children on the basis of these criteria can be considered as targeting the persistence over time of their asthma should be considered and treated as asthma true "background" to avoid the appearance and the accentuation of some irreversible changes of the bronchi resulting in a persistent decline respiratory function and that are very early in their appearance.

What is asthma and how to cure it

Bronchial asthma is a disease characterized by airway obstruction manifested by wheezing, coughing, wheezing, and some children with asthma may have, for some time, only cough persistente.Il term asthma and terms asthmatic bronchitis, bronchospasm, wheezing , broncostruzione, whistles etc.. are equivalent, and currently there is a tendency to simply use the term asthma and not others, because parents often used the word asthma is more impressive, to avoid confusion and to raise awareness among parents about the need for treatment also prolonged.
L ' Asthma is not necessarily an allergic disease: an average of asthma is an allergic disease in only 50% of the cases and under 3-4 years only 1/3 of the cases.
Crisis asthma with wheezing, coughing, intense, wheezing is just the tip of the iceberg: the asthmatic child often even outside of the crisis has wheezing or cough when he runs, when he laughs, in smoky environments, in humid environments. This is because the real substance of asthma consists in a state of mild but persistent inflammation of the bronchi, even outside of the crisis, which is accompanied with a tendency of the bronchial tubes to become clogged as a result of various factors in people not asthmatic, ie without this condition is persistent irritation of the bronchi, not capable of giving any effect.
Reasons for this condition exaggerated reactivity of the bronchi are, as mentioned, inflammation determined by allergies (but not only), viruses, pollution environmental especially from cigarette smoke, from atopic dermatitis.
When this situation exists exaggerated reactivity, whatever the factor that determines, are numerous situations that may act by triggering factors and lead to obstruction of the bronchi that is, the crisis of asthma . The factors most often responsible for the outbreak of the crisis in children with bronchial hyperreactivity are viruses (also highly allergic child in the cause that most often triggers asthma attacks is the infection of the upper airways), breathing substances against which your child is allergic, environmental pollution, cigarette smoke, exercise, aspirin.

From all these current knowledge about the nature of asthma derive different result from the practical point of view, the treatment of the disease:
1) The treatment of acute asthma crisis is not the whole treatment of the disease, the child with asthma should certainly be taken care of when the crisis but above all it must be taken care of when he has the crisis, precisely to prevent crises recur;
2) It 'important not only eliminate all the factors that can trigger the crisis, but also all the factors that can make the condition of persistent inflammation of the bronchial tubes that is the basis of the tendency to crisis is also essential that when this inflammation is present (its presence is demonstrated by coughing and / or from care after exercise, coughing when you laugh etc, or spirometry examination performed after physical exertion) is cured long to eliminate it.

THEREFORE FROM THE STANDPOINT OF PRACTICAL
1) For all the children for whom more than once was made ??by the attending physician diagnosis of asthmatic bronchitis, bronchospasm, asthma, regardless of whether they are of allergic children or less, some measures are always Required:
A. ELIMINATE THE CIGARETTE SMOKE IN THE HOUSE, IN THE CAR, IN ENVIRONMENTS ATTENDED THE CHILD;
B. ELIMINATE conditions in which the CHILD LIVES THE POWDER HOME (this even if your child is not allergic to dust mites);
C. AVOID IF POSSIBLE AND AT LEAST UNTIL THE hyperreactivity 'BRONCHIAL ARE UNDER CONTROL THE FREQUENCY OF ASYLUM (Asylum is the main cause of frequent viral infections of the small child).

2) If it is proved to be a condition of allergy to inhalant or food:
IMPLEMENT ALL THE MEASURES WHICH ALLOW TO REDUCE EXPOSURE TO SUBSTANCES IN RESPECT OF WHICH HAS BEEN ESTABLISHED A CONDITION OF ALLERGY (POWDER, pollens, molds, PETS , FOOD)

3) Treat the underlying airway inflammation responsible for asthma attacks with a tendency to:
A. cortisone MAINLY BY INHALATION (PREFERABLY WITH AEROSOL SPRAY CANS or DOSATO WITH SPACER) LONG UP TO ENSURE AT LEAST 2-3 MONTHS OF BEING OR UNTIL SPIROMETRY STRESS NOT STANDARDIZE. I inhaled corticosteroids can be used for a long time because they are virtually free of side effects (Flixotide or FLUSPIRAL or LUNIBRON or PULMAXAN or CLENILEXX);
B. ANTILEUCOTRIENI, FOR THE SAME PERIOD (SINGULAIR or MONTEGEN);
C. Can sometimes be useful also ANTIHISTAMINES. The latest generation of antihistamines have even a modest anti-inflammatory action and can reduce viral infections of the airways.

4) IF THE CRISIS OF ASTHMA DRUGS TO BE USED BY INHALATION, EVEN IN THIS CASE, PREFERABLY BY SPRAY CANS WITH SPACER (Ventolin or BRONCOVALEAS). The use of inhaled is always preferable to administration of these products because they can be administered orally, directly on the bronchi, very high doses with modest general side effects. The use of oral products (eg Ventolin tablets or syrup) has lower efficacy of inhalation, more side effects and should be limited to those few cases in which the child can not use the spray or aerosol. The cortisone by mouth or injection should be used only if there is no improvement with spray cans.

Asthma attacks: how to behave

The next schemes are part of a series of written instructions that are used to provide parents of children with asthma. Their presence here does not of course represent an invitation to direct use, without consulting the doctor, but only useful to know which is today the most appropriate approach to the management of asthma acuto.Dalla reading them you can deduce some fundamental concepts:
- The drug of first use must be a bronchodilator, ie salbutamol (Ventolin or Broncovaleas)
- The bronchodilator should be administered by inhalation and by mouth. The administration of Ventolin orally (as tablets or syrup) that still today sometimes you see is not advisable to do: it is a definitely less effective treatment and with more side effects;
- The preferable system of administration of the bronchodilator drug is, for each child's age and even in the very young child, that of the metered-dose inhaler (spray). The bottle should always be used with a spacer of variable capacity depending on the age of the child: the use of the spray without spacer is, at any age, completely illogical
- However, it can be used, but as a second choice, especially in very young child the aerosol classical
- First of all it is important to assess the severity of the crisis and in that sense can be useful in the child who is able to do, make it count.


IN CASE OF EMERGENCY MEDIUM-LIGHT (the child can count to 7-8 without stopping)

Ventolin or BRONCOVALEAS * PUFF 5 TIMES A DAY FOR
48 to 72 HOURS WITH SPRAY BOTTLE AND SPACER (Baby-Haler or Aerochamber or Volumatic)

OR

AEROSOL TIMES A DAY WITH

- BRONCOVALEAS DROPS **

- SOL. PHYSIOLOGICAL 3 CC (= 3/5 OF BOTTLE LIBENAR)

FOR 48-72 HOURS

* Number of puffs = weight in kg / 5. For example:
- for a child of 10 kg, 2 puffs 5 times a day
- for a child of 20 kg, 4 puffs 5 times a day
- for a child of 30 kg, 6 puff 5 times a day

** Number of drops = 0.6 drops / kg
- for a child of 10 kg, 6 drops
- for a child of 20 kg, 12 drops - not more than 12 drops per session

IN CASE OF SERIOUS CRISIS (the child can only count up to 3-5)

Ventolin or BRONCOVALEAS PUFF *** EVERY TWENTY MINUTES FOR THREE
TIMES, THEN, IF AFTER dosing THERE 'SIGNIFICANT IMPROVEMENT, TO GIVE MOUTH N ° **** TABLETS Bentelan
If there is still no improvement: ADMISSION HOSPITAL

4-6-8-10 *** puff depending on the weight
**** 0.1-0.2 mg / kg

EACH INDIVIDUALLY WITH PUFF VA INHALED 7-8 ACTS inspiratory.
NB: Do not worry about the seemingly excessive number of spray: it is apparently excessive amount but not at all suited to the weight, remember, for example, that 1 pill Ventolin is 2 mg of product that is to 8 drops of Broncovaleas and both correspond to as many as 20 spurts of Ventolin spray - 20 sprayed per day of Ventolin sprays are equivalent to one tablet of Ventolin or 8 drops of Broncovaleas throughout the day.

DURING THE CRISIS THE DETERMINATION OF DOUBLE cortisone INHALATION MAY BE CHARGED AS A TREATMENT OF FUND.

HEREINAFTER THERAPY FOR CONTACTING THE DOCTOR.

Common Mistakes

- I do not consider that in the treatment of children with asthma, both in the acute phase (children with wheezing breath more or less), and the treatment of the bottom, the best technique to administer inhaled drugs is the one with the spray can and the spacer . In older child may be used also the so-called dispensers of dry powders. The aerosol classic, with normal or ultrasonic device, always represents a worse system, a second choice, which should be reserved for very special cases. The child who makes inhalation therapy must use the cans with the spacer or devices operating in dry powder aerosol and not the classic. - Use the metered spray (cans) without a spacer. The child is not able to coordinate inhalation with the sprayed; ie fails to inhale deeply in sync with the release of the drug from the canister. The use of the spacer allows you to inhale the drug more easily in subsequent breaths. The use of the spray without spacer is, at any age, illogical.

- Consider inhaled corticosteroid medication in the acute phase. In the acute phase, the child wheezing, the Clenil, the Prontinal, the Fluspiral, the Flixotite, the Pulmaxan, the Spirocort not serve: serve the Broncovaleas or Ventolin. The corticosteroid for inhalation use, at usual doses, does not exhibit any effect in the treatment of asthmatic crisis. The drug of the acute phase is therefore the bronchodilator (salbutamol: Broncovaleas or Ventolin). In other words in aerosol therapy of acute attack can also use the cortisone (Clenil A and others), but must be imperatively present salbutamol which is only effective at this stage. The cortisone, conversely, is the drug of the primer treatment.

- The fear of the Ventolin or Broncovaleas. Very often in the treatment of the acute phase the doctor prescribes 1-2 puffs of these drugs 1-2 times per day. These doses are totally ineffective at any age, even in infants. The number of puff must be greater and their administration much more frequently. Remember that 20 puffs of Ventolin correspond to one tablet of the same Ventolin and 8 drops of Broncovaleas. How many drops of Broncovaleas inhale every day, children are the classical aerosol? How many puffs correspond?

- Use the bronchodilator (Ventolin tablets or syrup) orally: the efficacy is lower and the side effects are greater.

- The use of Tefamin not give further improvement and can have serious side effects.

- Do not be a basic treatment in asthmatic children. Asthma is a chronic inflammatory disease with occasional exacerbations broncostruttive. Asthma therapy is the treatment of minimal inflammation and not only access persistent asthma.

- The exercise-induced asthma is an expression of bronchial hyperreactivity, ie minimal inflammation persistent. In children with asthma or cough insurgents during exercise, running, etc.. must be done so the basic treatment with inhaled corticosteroid, in these children can be added salbutamol as a preventative before an effort, for example. a race scheduled. Possibly if the effort is not foreseeable, you can use salmeterol (long-acting bronchodilator: Serevent) instead of salbutamol.

- The Clenil A, the Spirocort, the Pulmaxan, the Prontinal, are suspensions, should not be used, because they are not sprayed, with ultrasonic equipment. But also with the devices normal determine the formation of particles too large and too large to reach the most distant parts of the lung.

- Keep the mouthpiece away from your mouth. A distance of a few centimeters. from the face determines a reduction dell'inalato of about 80%.

- Drill the aerosol when the baby sleeps because you shake and cry during the session: the crying baby inhales certainly a lesser extent, but certainly more than a sleeping baby.

- Make the aerosol breathing through the nose: the nasal filter blocks droplets that do not arrive where they should, the peripheral parts of the lungs.

- Keep the mouthpiece in your mouth but breathe through the nose.

- Add in the aerosol mucolytics (Fluibron and Fluimucil): the Fluibron (Ambroxol) is useless, the Fluimucil (acetylcysteine) can cause asthma, it is, in other words, irritation of the bronchi. The asthmatic should not thin the secretions must dilate the bronchi.

- Spray the salbutamol with the acetylcysteine ??(Fluimucil) and with the nedocromil sodium (Tilade). These associations involving the formation of precipitates that are not sprayed.

- Inhaled Antibiotics are not allowed. Exceptions are patients with cystic fibrosis for a limited number of antibiotics (eg, aminoglycosides). It makes no sense the indiscriminate use of antibiotics by aerosol in respiratory disease.

- The asthmatic should not practice therapy sulfur because sulfur is an irritant and may trigger asthma attacks.