Childhood asthma is the most common chronic disease in childhood in developed countries. Asthma manifests with recurrent episodes of shortness of breath, coughing, audible wheezing (wheezing noises in the chest, commonly known as chest wheezing) and chest tightness.
Parents of children with wheezing in the first years of life often ask their pediatrician and child allergist: “Is my child asthmatic and will he/she be asthmatic when he/she grows up? The answer is sometimes not simple, but keep in mind that up to 50% of children wheeze in the first year of life, although only 20% will show symptoms later in life.
Risk factors for developing asthma
Asthma results from the interaction of genetic factors with multiple environmental factors, including breastfeeding, the presence of allergens, passive exposure to tobacco, environmental pollution, respiratory infections and obesity. Atopy (predisposition to allergen sensitization) is the most important risk factor for asthma in children. In fact, children with cow’s milk and especially egg allergy have a much higher prevalence of childhood asthma.
Multiple studies in asthmatic children have tried to identify different subgroups of children with asthma and with different characteristics, with the aim of knowing the prognosis of asthma at later ages.
In general, children with earlier onset of symptoms, during the first year of life, tend to have a tendency for asthma remission at later ages. When asthma symptoms appear later in life and especially in children with allergen sensitization (allergic), there is a tendency for asthmatic symptoms to persist later in life.
Can an asthmatic child lead a normal life?
The most important objective of asthma treatment is for the child to lead a normal life, which includes playing sports, attending camps, traveling, etc. In fact, sports are recommended for any asthmatic child, and should only be avoided during periods of asthma attacks.
Diagnosis of childhood asthma
In younger children the diagnosis of asthma is clinical and is made through the evaluation of symptoms and clinical examination.
In children older than five years or more, pulmonary function tests are very useful for diagnosis. Measurement of markers of airway inflammation, such as exhaled nitric oxide, is also useful in monitoring asthma.
Allergological study is very important to know the cause of asthma, especially in children older than three years, since it is at this age that children usually show sensitization to inhaled allergens.
Treatment of childhood asthma
There are different approaches to childhood asthma:
- Preventive measures. Allergens and other asthma triggers should be avoided as far as possible, although in most cases this is difficult to achieve. It has been shown that in children allergic to dust mites, despite strict avoidance measures, their effectiveness is limited. The same occurs with exposure to fungi and animal epithelia, since they are very ubiquitous in our environment.
- Pharmacological treatment. There are two groups of drugs: maintenance drugs, which control inflammation, and rescue drugs. Both groups of drugs are well tolerated, with few side effects. Maintenance drugs are inhaled corticosteroids and leukotriene antagonists. Rescue drugs are bronchodilators, the most commonly used being salbutamol, and constitute the first-line relief treatment. They are usually used on demand. The inhaled route with inhalation chambers is the preferred route for bronchodilators and inhaled corticosteroids.
- Immunotherapy. This is the only treatment that modifies the course of allergic asthma, that is, that can produce definitive remission of respiratory symptoms. It should be considered in those children whose symptoms are clearly related to the relevant allergen in the allergological study.
- Health education. The usefulness of health education programs, which should be given to parents and, depending on the age, also to the child, has been demonstrated, as they have been observed to reduce the risk of exacerbations, school absenteeism, emergency room visits, etc. Caregivers, teachers, coaches and others who are in contact with the asthmatic child should also be instructed to recognize attacks and administer rescue medication when appropriate.