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bronchial asthma in pediatric



. asthma million Americans have 25 More than
Each year, many people with asthma require
treatment in the emergency department with a
portion requiring hospitalizations. Children younger
than 18 years of age account for a large portion of
emergency department visits and hospitalizations
due to asthma exacerbations. The magnitude of
the impacts of asthma in children is illustrated by
the fact that asthma accounts for more
hospitalizations in children than any other chronic
illness. Moreover, asthma causes children and
adolescents to miss school and causes parents to
miss days at work. As might be expected, asthma
also accounts for more school absences than any
other chronic illness.


With childhood asthma, the lungs and airways become
easily inflamed when exposed to certain triggers, such as
airborne pollen. In other cases, childhood asthma flares
up with a cold or other respiratory infection. Childhood
asthma can cause bothersome daily symptoms that
interfere with play, sports, school and sleep. In some
children, unmanaged asthma can cause dangerous
asthma attacks.
Childhood asthma isn't a different disease from asthma in
adults, but children do face unique challenges. Asthma in
children is a leading cause of emergency department
visits, hospitalizations and missed school days.
Unfortunately, childhood asthma can't be cured, and
symptoms may continue into adulthood. But with the right
treatment, you and your child can keep symptoms under
control and prevent damage to growing lungs.


Common childhood asthma signs and
symptoms include:
Frequent, intermittent coughing
A whistling or wheezing sound when
Shortness of breath
Chest congestion or tightness
Chest pain, particularly in younger

Other signs and symptoms of childhood asthma
Trouble sleeping caused by shortness of breath, coughing or
Bouts of coughing or wheezing that get worse with a respiratory
infection, such as a cold or the flu
Delayed recovery or bronchitis after a respiratory infection
Trouble breathing that may limit play or exercise
Fatigue, which can be caused by poor sleep
The first signs of asthma in young children may be recurrent
wheezing triggered by a respiratory virus. As children grow older,
asthma associated with respiratory allergies is more common.
Asthma signs and symptoms vary from child to child, and may
get worse or better over time. While wheezing is most commonly
associated with asthma, not all children with asthma wheeze.
Your child may have only one sign or symptom, such as a
lingering cough or chest congestion.
It may be difficult to tell whether your child's symptoms are
caused by asthma or something else. Periodic or long-lasting
wheezing and other asthma-like symptoms may be caused by
infectious bronchitis or another respiratory problem.


The underlying causes of childhood asthma aren't fully
understood. Developing an overly sensitive immune system
generally plays a role. Some factors thought to be involved
Inherited traits
Some types of airway infections at a very young age
Exposure to environmental factors, such as cigarette smoke or
other air pollution
Increased immune system sensitivity causes the lungs and
airways to swell and produce mucus when exposed to certain
triggers. Reaction to a trigger may be delayed, making it more
difficult to identify the trigger. These triggers vary from child to
child and can include:
Viral infections such as the common cold
Exposure to air pollutants, such as tobacco smoke
Allergies to dust mites, pet dander, pollen or mold
Physical activity
Weather changes or cold air
Sometimes, asthma symptoms occur with no apparent triggers

Risk factors
Factors that may increase your child's likelihood of developing
asthma include:
Exposure to tobacco smoke
Previous allergic reactions, including skin reactions, food allergies
or hay fever (allergic rhinitis)
A family history of asthma, allergic rhinitis, hives or eczema
Living in an urban area with increased exposure to air pollution
Low birth weight
A chronic runny or stuffy nose (rhinitis)
Severe lower respiratory tract infection, such as pneumonia
Inflamed sinuses (sinusitis)
Heartburn (gastroesophageal reflux disease, or GERD)
Being male


Asthma may cause a number of complications,
Severe asthma attacks that require emergency
treatment or hospital care
Permanent narrowing of the airways (bronchial
Missed school days or getting behind in school
Poor sleep and fatigue
Symptoms that interfere with play, sports or other

Tests and diagnosis

Asthma can be hard to diagnose. Your child's doctor will consider the
nature and frequency of symptoms and may use tests to rule out other
conditions and to identify the most likely cause of his or her symptoms.
A number of childhood conditions can have symptoms similar to those
caused by asthma. To make things more complicated, these conditions
also commonly co-occur with asthma. So your child's doctor will have to
determine whether your child's symptoms are caused by asthma, a
condition other than asthma, or both asthma and another condition.
Some conditions that can cause asthma-like symptoms include:
Acid reflux or gastroesophageal reflux disease (GERD)
Airway abnormalities
Vocal cord dysfunction
Respiratory tract infections such as bronchiolitis and respiratory syncytial
virus (RSV)
The doctor will ask for a detailed description of your child's symptoms
and health. Your child may also need medical tests.

In children 6 years of age and
older, doctors diagnose asthma with
the same tests used to identify the
disease in adults. Lung function tests
(spirometry) measure how quickly and
how much air your child can exhale.
Your child may have lung function tests
at rest, after exercising and after taking
asthma medication. Allergy skin testing
also may be needed.

In younger children, diagnosis can
be difficult because lung function tests
aren't accurate before 6 years of age.
Some children simply outgrow
asthma-like symptoms over time. Your
doctor will rely on detailed information
you and your child provide about
symptoms. Sometimes a diagnosis
can't be made until later, after months
or even years of observing symptoms.

If you suspect your child has asthma, it's
important to see a doctor as soon as
possible. Early diagnosis and proper
treatment can prevent disruptions from daily
activities such as sleep, play, sports and
school. It may also prevent dangerous or life-
threatening asthma attacks.

For children younger than age 3 who have
symptoms of asthma, the doctor may use a
wait-and-see approach. This is because the
long-term effects of asthma medication on
infants and young children aren't clear. If an
infant or toddler has frequent or severe
wheezing episodes, a medication may be
prescribed to see if it improves symptoms

Allergy skin tests for allergic asthma
If your child seems to have asthma that's
triggered by allergies, the doctor may
want to do allergy skin testing. During a
skin test, the skin is pricked with extracts
of common allergy-causing substances
and observed for signs of an allergic
reaction. This test may help identify
whether your child is allergic to animal
dander, mold, dust mites or other
allergens. This information can be useful
in taking steps to help your child avoid
his or her particular asthma triggers.

he goal of asthma treatment is to keep symptoms under control
all of the time. Well-controlled asthma means that your child has:
Minimal or no symptoms
Few or no asthma flare-ups
No limitations on physical activities or exercise
Minimal use of quick-relief (rescue) inhalers, such as albuterol
Few or no side effects from medications
Treating asthma involves both preventing symptoms and treating
an asthma attack in progress. Preventive, long-term control
medications reduce the inflammation in your child's airways that
leads to symptoms. Quick-relief medications quickly open swollen
airways that are limiting breathing. Most children with persistent
asthma use a combination of long-term control medications and
quick-relief medications, taken with a hand-held inhaler.
In some cases, medications to treat allergies also are needed.
The right medication for your child depends on a number of
things, including his or her age, symptoms, asthma triggers and
what seems to work best to keep his or her asthma under control.

Long-term control medications

In most cases, these medications need to be taken
every day. Types of long-term control medications
Inhaled corticosteroids. These medications include
fluticasone (Flovent Diskus, Flovent HFA),
budesonide (Pulmicort Flexhaler), mometasone
(Asmanex), ciclesonide (Alvesco), flunisolide
(Aerobid), beclomethasone (Qvar) and others.
Inhaled corticosteroids are the most commonly
prescribed type of long-term asthma medication.
Your child may need to use these medications for
several days to weeks before they reach their
maximum benefit. Long-term use of these
medications has been associated with slightly slowed
growth in children, but the effect is minor. In most
cases, the benefits of good asthma control outweigh
the risks of any possible side effects.

Leukotriene modifiers. These oral
medications include montelukast
(Singulair), zafirlukast (Accolate) and
zileuton (Zyflo, Zyflo CR). They help
prevent asthma symptoms for up to 24
hours. In rare cases, these
medications have been linked to
psychological reactions, such as
agitation, aggression, hallucinations,
depression and suicidal thinking. Seek
medical advice right away if your child
has any unusual reaction.

Combination inhalers. These medications
contain an inhaled corticosteroid plus a long-
acting beta agonist (LABA). They include
fluticasone and salmeterol (Advair Diskus,Advair
HFA), budesonide and formoterol (Symbicort), and
mometasone and formoterol (Dulera). In some
situations, long-acting beta agonists have been
linked to severe asthma attacks. For this reason,
LABA medications should always be given to a
child with an inhaler that also contains a
corticosteroid. These combination inhalers should
be used only for asthma that's not well controlled
by other medications.

Theophylline. This is a daily pill that helps keep
the airways open. Theophylline (Theo-24,
Elixophyllin, others) relaxes the muscles around
the airways to make breathing easier. It's not used
as often now as in past years

Quick-relief medications

Also called rescue medications, quick-relief medications
are used as needed for rapid, short-term symptom relief
during an asthma attack or before exercise if your
child's doctor recommends it. Types of quick-relief
medications include:

Short-acting beta agonists. These inhaled
bronchodilator (brong-koh-DIE-lay-tur) medications can
rapidly ease symptoms during an asthma attack. They
include albuterol (ProAir HFA, Ventolin HFA, others),
levalbuterol (Xopenex HFA) and pirbuterol (Maxair
Autohaler). These medications act within minutes, and
effects last several hours.

Ipratropium (Atrovent). Your doctor might
prescribe this inhaled medication for immediate
relief of your child's symptoms. Like other
bronchodilators, it relaxes the airways, making it
easier to breathe. Ipratropium is mostly used for
emphysema and chronic bronchitis, but it's
sometimes used to treat asthma attacks.

Oral and intravenous corticosteroids. These
medications relieve airway inflammation caused
by severe asthma. Examples include prednisone
and methylprednisolone. They can cause serious
side effects when used long term, so they're only
used to treat severe asthma symptoms on a
short-term basis.

treatment for allergy-induced
If your child's asthma is triggered or worsened by allergies, your child
may benefit from allergy treatment as well. Allergy treatments include:

Omalizumab (Xolair). This medication is specifically for people who
have allergies and severe asthma. It reduces the immune system's
reaction to allergy-causing substances, such as pollen, dust mites and
pet dander. Xolair is delivered by injection every two to four weeks.

Allergy medications. These include oral and nasal spray
antihistamines and decongestants as well as corticosteroid, cromolyn
and ipratropium nasal sprays.

Allergy shots (immunotherapy). Immunotherapy injections are
generally given once a week for a few months, then once a month for a
period of three to five years. Over time, they gradually reduce your
child's immune system reaction to specific allergens.

Don't rely only on quick-relief
Long-term asthma control medications such as inhaled
corticosteroids are the cornerstone of asthma
treatment. These medications keep asthma under
control on a day-to-day basis and make it less likely
your child will have an asthma attack.
If your child does have an asthma flare-up, a quick-
relief (rescue) inhaler can ease symptoms right away.
But if long-term control medications are working
properly, your child shouldn't need to use a quick-relief
inhaler very often. Keep a record of how many puffs
your child uses each week. If he or she frequently
needs to use a quick-relief inhaler, take your child to
see the doctor. You probably need to adjust his or her
long-term control medication

Inhaled medication devices
Inhaled short- and long-term control medications are used
by inhaling a measured dose of medication.

Older children and teens may use a small, hand-held
device called a pressurized metered dose inhaler or an
inhaler that releases a fine powder.

Infants and toddlers need to use a face mask attached to
a metered dose inhaler or a nebulizer to get the correct
amount of medication.

Babies need to a use a device called a nebulizer, a
machine that turns liquid medication into fine droplets.
Your baby wears a face mask and breathes normally while
the nebulizer delivers the correct dose of medication.

Asthma action plan
Work with your child's doctor to create a
written asthma action plan. This can be an
important part of treatment, especially if your
child has severe asthma. An asthma action
plan can help you and your child:

Recognize when you need to adjust long-
term control medications
Keep tabs on how well treatment is working
Identify the signs of an asthma attack and
know what to do when one occurs
Know when to call a doctor or seek
emergency help
Depending on his or her age, your child may use a hand-held
device to measure how well treathe or she can breathe (peak
flow meter). Using a written asthma action plan can help you
and your child remember what to do when peak flow
measurements reach a certain level. The action plan may use
peak flow measurements and symptoms to categorize your
child's asthma into zones, such as the green zone, yellow
zone and red zone. These zones correspond to well-
controlled symptoms, somewhat-controlled symptoms and
poorly controlled symptoms. This makes tracking your child's
asthma easier.

Your child's symptoms and triggers are likely to change over
time. You'll need to carefully observe symptoms and work
with the doctor to adjust medications as needed. If your
child's symptoms are completely controlled for a period of
time, your child's doctor may recommend lowering doses or
taking your child off a medication (stepping down treatment).
If your child's asthma isn't as well controlled, the doctor may
want to increase, change or add medications (stepping up


Careful planning and steering clear of asthma triggers are the best
ways to prevent asthma attacks.

Limit exposure to asthma triggers. Be proactive in helping your
child avoid the allergens and irritants that trigger asthma
Don't allow smoking around your child. Exposure to tobacco
smoke during infancy is a strong risk factor for childhood asthma,
as well as a common trigger of asthma attacks.

Encourage your child to be active. As long as your child's
asthma is well controlled, regular physical activity can condition the
lungs to work more efficiently.

See the doctor when necessary. Check in on a regular basis.
Don't ignore signs that your child's asthma may not be under
control, such as needing to use a quick-relief inhaler too often.
Asthma changes over time. Consulting your child's doctor can help
you make any needed treatment adjustments to keep symptoms
under control

- conditions/childhood
- asthma/basics/definition/con