CHILD WITH BRONCHOSPASM

Wheezing

It 'just in case frequently in young children of preschool age, the age of asylum and which is wheezing, the "whistle", especially in the course of forms of "cooling". This condition, variously defined as "asthma-bronchitis", "bronchospasm", "asthma", is often a concern for parents particularly frightened by the fear that this "asthma" may be persistent and is a frequent reason for recourse to the pediatrician allergologo.Nel attempt to assess what might be in the future, the fate of these children should be kept in mind that asthma in children under 3 years there are basically two models of behavior and evolution:

The 2/3 of the children have wheezing (wheezing) recurrent but transient, in the sense that disappears before school age.
flows are children with respiratory smaller, ie with small airways. They present the wheezing only in the course of viral infections of the airways, when the constitutional narrowness of those conduits for the passage of air which are the bronchi is added the further shrinkage due to the fact that the wall of them, inflamed, swells.
Such children have the caliber of the small airways, wheezing present early and in the first three years of life, but later, after 3-4 years, they no longer have asthma. Over time, in practice, the caliber and increases bronchial asthma disappears.
However these children retain a tendency to become chronic bronchitis especially if by boys smoke.

1/3 of children who wheeze in the first year of life continues, however, to have wheezing at age six and later.
risk factors for these children, that is, elements that allow us to hypothesize that the child may be asthmatic, are:
_ the mother have asthma,
_ being atopic, that is tending to allergies, and have some awareness, that is, some allergy test, skin or blood positive. Obviously, this awareness, given that allergy tests are not absolute, and must be critically evaluated with common sense by an expert;
_ have atopic dermatitis,
allergic rhinitis _ or persistent
_ be exposed to secondhand smoke.
Children are "atopic" with recurrent wheezing. Eg. awareness egg in these children with recurrent breath whistling is an important predictor of persistent asthma; vice versa household dust mite sensitization is not frequent in the first year of life: only 1% of children with wheezing in the first year of life is sensitized mite. The sensitization occurs after at the age of 3 years many of these children have become allergic to it.

Between the two groups are therefore present substantial differences, especially from the point of view prognostic.
Differences between the two groups makes reason of the fact that not all children under 5 years sibilants respond to treatment with cortisone bottom of aerosolized, that are the primary treatment of the asthmatic child's true. Respond, in fact, only:
- children with asthmatic mother,
- children with allergic rhinitis,
- children with eczema,
that is, those children who, as mentioned, are considered true asthmatics. Children with reduced airway caliber, which present the wheezing only in the course of viral infections, which does not have those elements previously exposed negatives that can make them identify as true asthma, do not have improvements, ie significant reduction in the number and intensity episodes of wheezing, with the basic treatment for long periods of time, with inhaled corticosteroids.

What to do?

Young children with wheezing and / or atopic dermatitis and / or allergic mother and / or sensitization, asthma, and should therefore be considered as such treated with cycles of inflammation. The treatment with corticosteroids should be early, in order to avoid that occur in the bronchi those anatomical alterations persistent (the so-called "remodeling"), which appear very early in asthmatic children and that can compromise, also in the future, the respiratory function.
In such subjects with asthma at risk of persistence can be used cortisone aerosolized low dose with the "spacers", even if they are very small, even a year or less. Even in the infant, for example, you can use the fluticasone at a dosage of 50 _g (1 puff of Flixotide or Fluspiral 50) 2 times a day using as a spacer the Baby-Haler or the Aerochamber with mask.

Children with bronchitis asthmatiform in the course of infection by viruses, not true asthma, do not respond, as said, to the primer treatment. In these children, that is, low doses of steroids for longer or shorter periods do not prevent the exacerbation. In them may be more useful to use the cortisone in spray, with the spacer, at high doses to the time of initiation of viral infection, for 10 days. There are studies, moreover, which show that in these children treatment with a particular type of anti-inflammatory drugs, the so-called antileucotrieni (Montegen, Singulair, Lukasm), administered for a certain period of time, can reduce the frequency of asthmatic bronchitis.

In both groups, in each case, one must reduce the smoke of cigarettes in the house and they must prohibit the frequency of the nursery for the role of viral infections in triggering of wheezing both in the subject that in atopic wheezing only in the course of infection by viruses . For both groups also needs to be implemented prophylaxis mite: atopic eczema in children for the fact that it is such and sometimes sensitized to mites, for non-atopic because contact with it, even outside of a state of allergy increases the frequency and the intensity of symptoms.