Bronchial asthma at children – the chronic allergic respiratory disease which is followed by an inflammation and change of reactivity of bronchial tubes, and also the bronchial obstruction arising on this background. Bronchial asthma at children proceeds with the phenomena of expiratory short wind, the whistling rattles, pristupoobrazny cough, suffocation episodes. The diagnosis of bronchial asthma at children is established taking into account the allergologichesky anamnesis; carrying out spirometry, pikfloumetriya, X-ray analysis of bodies of a thorax, skin ; definitions of IgE, gas composition of blood, phlegm research. Treatment of bronchial asthma at children assumes elimination of allergens, use of aerosol bronchial spasmolytics and anti-inflammatory medicines, antihistamines, carrying out a specific immunotherapy.
Bronchial asthma at children
Bronchial asthma at children – the chronic allergic (infectious and allergic) inflammatory process in bronchial tubes leading to reversible violation of bronchial passability. Bronchial asthma occurs at children of different geographical regions in 5-10% of cases. Bronchial asthma at children develops at preschool age (80%) more often; quite often the first attacks arise on the first year of life. Studying of features of emergence, a current, diagnostics and treatment of bronchial asthma demands cross-disciplinary interaction of pediatrics, children's pulmonology and allergology immunology from children.
The reasons of bronchial asthma at children
Bronchial asthma at the child arises with the participation of genetic predisposition and factors of the environment. Most of children with bronchial asthma has a burdened heredity on allergic diseases - a pollinoz, atopic dermatitis, food allergy, etc.
Inhalation and food allergens, bacterial and viral infections, chemical and medicinal substances can act as the sensibilizing factors of the environment. As the inhalation allergens provoking bronchial asthma at children house and book dust, hair of animals, waste products of domestic ticks, mold fungi, a dry feed for animals or fishes, pollen of the blossoming trees and herbs act more often.
Food allergy serves as the reason of bronchial asthma at children in 4-6% of cases. Most often it is promoted by early transfer to artificial feeding, intolerance of animal protein, products of plant origin, artificial dyes, etc. Food allergy at children often develops against the background of gastrointestinal diseases: gastritis, enterokolit, pancreatitis, intestinal dysbiosis.
At children viruses – causative agents of paraflu, flu, a SARS, and also a bacterial infection (a streptococcus, staphylococcus, a pneumococcus, a klebsiyella, a neysseriya), hlamidiya, mycoplasmas and other microorganisms colonizing mucous bronchial tubes can be triggers of bronchial asthma.
At some children with bronchial asthma the sensitization can be caused by industrial allergens, reception of medicines (antibiotics, sulfanylamides, vitamins, etc.).
As the factors of an exacerbation of bronchial asthma at children provoking development of a bronchospasm infections, cold air, meteosensitivity, tobacco smoke, physical activities, an emotional stress can act.
In pathogenesis of bronchial asthma at children allocate: immunological, immunochemical, pathophysiological and conditioned-reflex phases. In an immunological stage under the influence of allergen class IgE antibodies which are fixed on cages targets are produced (mainly, corpulent cages mucous bronchial tubes). In an immunochemical stage the repeated contact with allergen is followed by its linkng with IgE on a surface of cages targets. This process proceeds with degranulation of corpulent cages, activation of eosinophils and allocation of the mediators having vazoaktivny and bronkhospastichesky effect. In a pathophysiological stage of bronchial asthma children under the influence of mediators have a hypostasis of a mucous membrane of bronchial tubes, a bronchospasm, an inflammation and hyper secretion of slime. Further attacks of bronchial asthma at children arise on the conditioned-reflex mechanism.
Symptoms of bronchial asthma at children
The course of bronchial asthma at children has cyclic character in which allocate the periods of harbingers, suffocation attacks, the poslepristupny and mezhpristupny periods. During the period of harbingers at children with bronchial asthma the concern, a sleep disorder, a headache, an itch of skin and eyes, a nose congestion, dry cough can be noted. Duration of the period of harbingers – from several minutes to several days.
Actually the attack of suffocation is followed by feeling of a sdavleniye in breasts and shortages of air, short wind of expiratory type. Breath becomes whistling, with participation of auxiliary muscles; at distance rattles are heard. During an attack of bronchial asthma the child is frightened, adopts the provision , cannot talk, catches air a mouth. Face skin becomes pale with the expressed cyanosis of a nasolabial triangle and auricles, becomes covered cold then. During an attack of bronchial asthma at children unproductive cough with the hardly separated dense, viscous phlegm is noted.
At an auskultation the rigid or weakened breath decides on a large number of the dry whistling rattles; at percussion - a box sound. From cardiovascular system tachycardia, increase HELL, muting of warm tones comes to light. With duration of an attack of bronchial asthma of 6 o'clock and more, speak about development in children of the asthmatic status.
The attack of bronchial asthma at children comes to the end with an otkhozhdeniye of a dense phlegm that leads to breath simplification. Right after an attack the child feels drowsiness, the general weakness; it is slowed down and sluggish. Tachycardia is replaced by bradycardia, raised HELL – arterial hypotonia.
During the mezhpristupny periods children with bronchial asthma can feel almost normally. On weight of a clinical current distinguish 3 degrees of bronchial asthma at children (on the basis of the frequency of attacks and indicators of FVD). At easy degree of bronchial asthma at children suffocation attacks rare (is more rare than 1 time a month) and are quickly stopped. During the mezhpristupny periods the general health is not broken, indicators of spirometry meet age standard.
Medium-weight degree of bronchial asthma at children proceeds with a frequency of aggravations of 3-4 times a month; high-speed indicators of spirometry make 80-60% of norm. At heavy degree of bronchial asthma suffocation attacks at children arise 3-4 times a month; indicators of FVD make less than 60% of age norm.
Diagnosis of bronchial asthma at children
At diagnosis of bronchial asthma at children consider data of the family and allergologichesky anamnesis, fizikalny, tool and laboratory inspection. Diagnosis of bronchial asthma demands participation of various experts from children: pediatrician, children's pulmonologist, children's allergist-immunologist.
The complex of tool inspection includes carrying out spirometry (to children 5 years are more senior), tests with bronchial spasmolytics and physical activity (veloergometriy), pikfloumetriya, a X-ray analysis of lungs and bodies of a thorax.
Laboratory researches at suspicion of bronchial asthma at children include clinical blood test and urine, the general analysis of a phlegm, definition of the general and specific IgE, a research of gas composition of blood. As an important link of diagnosis of bronchial asthma at children serves statement of skin allergic tests.
In the course of diagnostics the exception of other diseases is required from the children proceeding with a bronkhoobstruktion: foreign matters of bronchial tubes, trakheo-and bronkhomalyation, the mukovistsidoz obliterating a bronkhiolit, obstructive bronchitis, bronkhogenny cysts, etc.
Treatment of bronchial asthma at children
At children treat the main directions of treatment of bronchial asthma: identification and elimination of allergens, the rational medicamentous therapy directed to decrease in quantity of aggravations and knocking over of attacks of suffocation, non-drug recovery therapy.
At detection of bronchial asthma at children, first of all, it is necessary to exclude contact with the factors provoking an exacerbation of a disease. For this purpose the hypoallergenic diet, the organization of hypoallergenic life, cancellation of medicines, parting with pets, change of the residence, etc. can be recommended. Long preventive reception of antihistamines is shown. At impossibility to get rid of potential allergens the specific immunotherapy assuming an organism hyposensitization by introduction (sublingual, oral or parenteral) gradually increasing doses prichinno of significant allergen is carried out.
The basis of medicinal therapy of bronchial asthma at children is made by inhalations of stabilizers of membranes of corpulent cages (a nedokromil, kromoglitsiyevy acid), glucocorticoids (a beklometazon, a flutikazon, a flunizolid, a budezonid, etc.), bronchial spasmolytics (salbutamol, a fenoterol), the combined medicines. Selection of the scheme of treatment, a combination of medicines and a dosage is carried out by the doctor. As an indicator of efficiency of therapy of bronchial asthma at children serves long remission and lack of progressing of a disease.
At development of an attack of bronchial asthma in children repeated inhalations of bronchial spasmolytics, a kislorodoterapiya, nebulayzerny therapy, parenteral introduction of glucocorticoids are carried out.
During the mezhpristupny period to children with bronchial asthma physical therapy courses (aeroionoterapiya, induktotermiya, DMV-therapies, magnetotherapies, an electrophoresis, an ultrafonoforez), balneotherapies, massage of a thorax, acupressure, respiratory gymnastics, a speleoterapiya, etc. are appointed.
Homeopathic therapy at bronchial asthma at children in some cases allows to warn a recurrence of a disease and to lower a dose of hormonal medicines. Selection and purpose of medicines is carried out by the children's homeopathist.
The forecast and prevention of bronchial asthma at children
Displays of bronchial asthma at children can decrease, disappear or amplify after puberty. At 60-80% of children bronchial asthma remains for the rest of life. The heavy course of bronchial asthma at children results in hormonal dependence and an invalidization. The current and the forecast of bronchial asthma are influenced by terms of the beginning and systematicity of treatment.
Prevention of bronchial asthma at children includes timely identification and an exception prichinno of significant allergens, specific and nonspecific immunoprevention, treatment of allergoz. Training of parents and children in methods of regular control of a condition of bronchial passability by means of a pikfloumetriya is necessary.