What is asthma?

Asthma is a chronic disease, although sometimes it can disappear, in which inflammation occurs inside the bronchi causing a more or less significant obstruction of the same. When this happens, the lumen of the bronchi narrows, which prevents the air from leaving the lungs to the outside. This obstruction can be generated by various circumstances or by exposure to different substances in the environment. The course of the disease is variable, alternating periods with intense symptoms with others without discomfort.

Prevalence

According to WHO data, asthma currently affects 235 million people, being the seventh most prevalent disease in the world and the most common chronic disease in children.

How and why does it appear?

The initiation of the mechanism is not fully known, but it is known that substances known as chemical mediators of asthma are involved in its appearance, which are produced by eosinophils (a type of white blood cell), which in collaboration with lymphocytes and mast cells (another type of cells), are deposited in the bronchi causing inflammation. This inflammation causes a narrowing and irritation in the bronchial walls, making it difficult for air to escape.

It is necessary that there is a genetic predisposition and come into contact with substances that cause bronchial inflammation to suffer from this pathology. The bronchi of an asthmatic person are very sensitive, so a crisis can be triggered by multiple circumstances (for example, exercise, laughter, tobacco...).

Symptom

Although the symptoms are similar, childhood asthma has different characteristics from adult asthma. It will appear:

• Dyspnea: Choking or difficulty breathing. Which can be mild or intense.
• Repetitive episodes of cough, usually dry and persistent. With a clearly nocturnal predominance in children.
• Wheezing: Whistles or noises in the chest produced when air comes out through the bronchi narrowed by inflammation. These are less conspicuous in infants and preschool children than in adults.
• Tightness or tightness in the chest.

The prognostic factors that make it possible to diagnose future evolution and predict whether asthma will remit or persist over time are:

• Age at which symptoms appear.
• Family history of asthma or other allergic diseases.
• Episodes of bronchiolitis in the first year

Diagnosis

The fundamental test is spirometry with a bronchodilator test and is performed in the same way as for adults. Its drawback is that it needs the child's collaboration to follow the instructions. Until the age of six, it is difficult to obtain reliable values.

Sometimes, bronchial hyperresponsiveness tests must be used, such as the free run exercise test, a simple test that consists of running for 8 minutes and seeing how the spirometry changes after the run.

In children older than 5 years, the fraction of exhaled nitric oxide (FENO) can be measured.

disease control

By using a PEF meter (Maximum Expiratory Flow) you can control your lung function since with it you can assess whether there is a greater or lesser pulmonary obstruction. The data obtained is recorded on record sheets, along with the medication taken and the symptoms, which will help to have a good control of the disease.

Classification

It can be classified based on:

• La gravity that depends of:
• Symptom intensity.
• Need to use reliever medications.
• Results of lung function tests.
• Limitations in daily activities.
• Existence of periods of worsening, exacerbation or crisis.

In young children, due to the variability of the pathology over time and circumstances, its severity is difficult to determine. For this reason it is classified as:

• episodic:
• Occasional: Less than 4-5 annual attacks without symptoms between attacks
• Frequent: Between 6 and 8 crises per year with symptoms on intense exertion
• Persistent:
• Moderate
• Grave
• according to controls that is, depending on whether or not it allows you to lead a normal life. To determine this control, regular follow-up medical visits are necessary. To assess this control, the Child Asthma Control Questionnaire is used. It's divided in:
• well controlled
• partially controlled
• Not controlled

Allergy

Allergy is a disproportionate response of the body to a substance, called an allergen, which is harmless to other people. The organism has to be sensitized for this reaction to occur. There are many allergens that can trigger asthma, but not all people with asthma have an allergy and not all allergy sufferers have asthma.

Treatment in the asthmatic child

The treatment of the asthmatic child has as main objective the control of the disease with the minimum possible medication, since this will help the child to lead a normal life and the side effects of the medications will be avoided. Everything must be controlled by the doctor who will readjust the doses based on therapeutic needs. It is essential not to suspend any medication even if the child feels well, unless the doctor prescribes it. Although, today, asthma has no cure, it is possible to improve its long-term evolution with the help of medications and their proper administration.

It is vitally important to seek medical treatment that allows us to lead as normal a life as possible and not get used to the limitations that the disease can generate.

Asthma treatment has two clearly differentiated parts:

• Treatment to prevent attacks and avoid asthma symptoms
• Treatment of seizures

The treatment will be established based on the level of severity in which the disease is found.

• Children with occasional episodic asthma will not require controller treatment and will use inhaled bronchodilators when symptoms are present.
• Children with frequent episodic asthma will use the controller medicine or medicines indicated by their doctor.
• Children with persistent asthma will require high doses of medication and greater medical supervision.
• Children with exercise-related asthma improve with adjusted maintenance treatment. Sometimes it is advisable to administer a bronchodilator about 20 minutes before exercising.

Maintenance medication only works if taken for long periods of time. The drugs used are:

• Inhaled glucocorticoids
• Leukotriene receptor antagonists
• Association of inhaled glucocorticoids with long-acting bronchodilators
• Anti-IgE monoclonal antibodies

Allergy vaccination may be helpful in some cases

How to avoid and treat crises?

• It is best to avoid its appearance, but once the action appears it will depend on its severity, which will depend on:
• Respiratory rate (number of breaths per minute)
• Intensity of work of breathing (amount of effort needed to be able to breathe)
• Presence of wheezing (wheezing in the chest)
• Oxygenation measured with pulse oximeter

In all crises, regardless of their severity, treatment will begin as quickly as possible where the child is, and then, if necessary, they will go to the medical center. The slight ones can be treated entirely in the place where you are, while the moderate and severe ones must be treated in a health center.

The medication used will be inhaled bronchodilators through a pressurized cartridge, with a spacer chamber appropriate to the age of the child, and oral or intravenous glucocorticoids. If it is necessary to administer large doses of medication or bronchodilator with oxygen, nebulizers will be used.

More Information

SEPAR Foundation. Publication “Controlling Asthma”

http://www.separ.es/biblioteca-1/bibliotecaparatodos

European Lung Foundation. http://www.europeanlung.org/

Portal on Asthma in Children and Adolescents http://www.respirar.org/

health portal http://www.asmainfantil.com

Catalan Asmatological Association (AAC)
La Palma St. Genís, 1
08035 Barcelona
Phone: 934 510 993 / Phone: 609 166 166
Contact: asthmatics@asmatics.org
Web: www.asmatics.org

Association of Allergy and Asthmatics of Jaén (ALERJA)
C/ Architect Berges, 34 A, Low
23007 Jaen
Phone: 675 82 87 15.
Contact: asalerja@yahoo.es
Web: www.alerja.es

Association of Allergy and Asthmatics of Malaga (ALERMA)
C/ Góngora, 28 Low
Málaga 29002
Phone: 657 57 52 24
Contact: alerma2009@gmail.com
Web: www.asalerma.es

Association of Asthmatics of the Principality of Asturias (AAPA)
Avda. de Galicia, 10, 7th
33005 Oviedo (Asturias)
Phone: Phone: 608 471 472
Contact: palicio@telecable.es

Association of Asthmatics of Palma de Mallorca
Portugal Avenue
07001 Palma de Mallorca
Phone: Phone: 977 717 102

Association of Asthmatics of Madrid (ASMAMADRID)
C/ Moreto, 4, 1st floor, Classroom 1
28014 Madrid
Phone: Phone: 618 515 101
Contact: asmamadrid@asmamadrid.org
Web: www.asmamadrid.org

Association of Asthmatics and Allergies of the province of Huelva
Via Paisagista, s/n
21003 Huelva
Phone: 959 280163
Web: www.asmaler.galeon.com

Spanish Association of Allergy to Food and Latex
Manzanares Avenue, 58 28019 Madrid
Phone: 915 609 49
Contact: aepnaa@aepnaa.org
Web: www.aepnaa.org/aepnaa.html

Galician Association of Asthmatics and Allergies (ASGA)
C/ Mayor Abella, 24, low
15002 A Coruna
Phone: Phone: 981 228 008
Contact: maeve@mundo.com
Web: www.accesible.org/asga

Navarra Association of Allergy and Asthmatics (ANAYAS)
C/ Sancho el Fuerte, 26, 1º, office 9
31008 Pamplona (Navarre)
Phone: Phone: 948 277 903

Outdoor Asthmatics Association
PO Box 2094 Granada
Phone:Phone: 958 441 240
Contact: rafagarciaga@terra.es
Web: www.airelibre.org

European Federation of Allergy and Airways Diseases Patients' Associations (EFA)
35 Rue du Congres
1000 Brussels (Belgium)
Phone: +32 (0) 2 227 2712
Fax + 32 (0) 2 218 3141