2. Bronchial asthma in children is a chronic respiratory disease
characterized by increased bronchial reactivity, resulting in
constriction of the airways and obstruction of the airflow. The
disease is characterized by recurrent episodes of wheezing,
shortness of breath, chest tightness, and coughing, which are
typically worse at night or in the early morning.
The exact cause of bronchial asthma in children is not fully
understood, but it is believed to be a complex interplay between
genetic and environmental factors. Children with a family history
of allergies or asthma are more likely to develop the condition.
Exposure to environmental allergens such as pollen, dust mites,
animal dander, and mold can trigger an asthma attack.
Respiratory infections, exercise, cold air, and emotional stress
can also trigger asthma symptoms. In addition, certain
medications, such as aspirin and nonsteroidal anti-inflammatory
drugs (NSAIDs), can trigger asthma symptoms in some children.
3. Other risk factors for developing asthma include premature
birth, low birth weight, exposure to tobacco smoke, and
exposure to air pollution. Children who have a history of
frequent respiratory infections or who have eczema or food
allergies may also be more likely to develop asthma.
4. The pathogenesis of bronchial asthma involves a series of steps, which can be
described as follows:
Sensitization: The first step in the development of bronchial asthma is
sensitization to allergens or other environmental triggers. During this stage,
the immune system recognizes an allergen as foreign and produces
antibodies in response.
Triggering: When a child is exposed to the allergen or other trigger again, it
can cause an acute immune response in the airways. This response leads to
the release of inflammatory mediators such as histamine, leukotrienes, and
cytokines.
Inflammation: The inflammatory response causes the airways to become
inflamed, leading to swelling and narrowing of the airways. The inflammation
also increases mucus production, further contributing to airway obstruction.
Bronchoconstriction: In response to the inflammation, the smooth muscles
that surround the airways contract, causing the airways to narrow even
5. Remodeling: Over time, repeated episodes of inflammation and bronchoconstriction
can lead to structural changes in the airways, such as thickening of the airway walls
and hypertrophy of the smooth muscles. These changes can make the airways even
more sensitive and hyperresponsive, leading to worsening symptoms over time.
Hyperresponsiveness: In addition to the structural changes in the airways, children
with bronchial asthma also have increased airway hyperresponsiveness. This
means that the airways are more likely to constrict in response to a wide range of
triggers, including exercise, cold air, and emotional stress.
Repeated episodes: The cycle of inflammation, bronchoconstriction, and airway
remodeling can lead to repeated episodes of bronchial asthma over time, with
increasing severity and frequency of symptoms.
6. Bronchial asthma can be classified in several ways, including:
1.Based on clinical severity:
•Intermittent asthma
•Mild persistent asthma
•Moderate persistent asthma
•Severe persistent asthma
2.Based on underlying immunological mechanisms:
•Allergic asthma
•Non-allergic asthma
•Mixed asthma
3.Based on the age of onset:
•Early-onset asthma (before age 5)
•Late-onset asthma (after age 5)
7. 4.Based on the triggers:
•Allergic asthma triggered by allergens such as pollen, dust
mites, or pet dander
•Non-allergic asthma triggered by irritants such as smoke,
pollution, or exercise
•Occupational asthma triggered by exposure to workplace
substances
5.Based on the response to treatment:
•Controlled asthma with minimal medication
•Partially controlled asthma requiring moderate doses of
medication
•Uncontrolled asthma requiring high doses of medication and/or
frequent hospitalizations
8. The clinical features of bronchial asthma in children can vary depending on the
severity of the disease and the age of the child. Common clinical features of
bronchial asthma in children include:
• Wheezing: A high-pitched whistling sound when breathing out, which is often
the most prominent symptom of asthma in children.
• Shortness of breath: Difficulty breathing, which can make the child feel like
they can't catch their breath.
• Chest tightness: A feeling of tightness or pressure in the chest.
• Coughing: A persistent cough, which is often worse at night or in the early
morning.
• Rapid breathing: Rapid breathing or tachypnea, which can be a sign of severe
asthma.
• Difficulty feeding: Infants with asthma may have difficulty feeding and may not
gain weight as expected.
9. • Fatigue: Asthma symptoms can be exhausting for children,
especially if they are experiencing frequent attacks.
• Exercise-induced symptoms: Asthma symptoms may be triggered
or worsened by physical activity.
• Nighttime symptoms: Asthma symptoms may be worse at night,
which can disrupt sleep and lead to daytime fatigue.
• Symptoms triggered by allergens: Asthma symptoms may be
triggered by exposure to allergens such as pollen, dust mites, or
animal dander.
10. Aura is a term that is often used to describe the warning signs or
symptoms that precede a seizure or a migraine headache.
However, in the context of bronchial asthma, the term aura is not
commonly used.
Instead, children with bronchial asthma may experience early
warning signs that an asthma attack is coming, such as coughing,
wheezing, shortness of breath, or chest tightness. These
symptoms can be a sign that the child's airways are becoming
inflamed and narrowed, which can lead to an asthma attack if left
untreated.
Recognizing these early warning signs and taking action can help
prevent an asthma attack or reduce its severity. In some cases,
children with asthma may also use peak flow meters to monitor
their lung function and identify changes that may indicate an
impending asthma attack.
11. The diagnosis of bronchial asthma in children is typically based on
a combination of clinical evaluation, medical history, and diagnostic
testing. Here are some common methods for diagnosing asthma in
children:
• Clinical evaluation: The healthcare provider will ask about the
child's symptoms, including coughing, wheezing, shortness of
breath, and chest tightness. They will also ask about the child's
medical history and any family history of asthma or allergies.
• Physical exam: The healthcare provider will perform a physical
exam to check for signs of asthma, such as wheezing or
decreased lung function.
• Pulmonary function tests (PFTs): PFTs are a type of diagnostic
testing that measures lung function. In children with asthma,
PFTs may show decreased lung function, reduced airflow, or
other abnormalities.
12. • Allergy testing: Allergy testing may be performed to identify
potential triggers of asthma symptoms.
• Bronchoprovocation testing: This type of testing involves
inhaling a substance that is known to trigger asthma symptoms,
such as methacholine or histamine. If the child's lung function
decreases in response to the substance, it may be a sign of
asthma.
• Trial of asthma medications: A trial of asthma medications may
be performed to see if the child's symptoms improve with
treatment.
13. The treatment of bronchial asthma in children typically involves a
step-by-step approach based on the severity of the asthma
symptoms. The goal of treatment is to control the child's
symptoms, prevent asthma attacks, and improve their overall
quality of life. Here are the general steps of asthma treatment for
children:
Step 1: Mild Intermittent Asthma
•Short-acting beta-agonist (SABA) inhaler as needed for symptom
relief
•No daily controller medications needed
Step 2: Mild Persistent Asthma
•Low-dose inhaled corticosteroid (ICS) as a daily controller
medication
•SABA inhaler as needed for symptom relief
14. Step 3: Moderate Persistent Asthma
•Low-dose ICS as a daily controller medication
•Add-on therapy with a long-acting beta-agonist (LABA) inhaler or
leukotriene modifier
Step 4: Severe Persistent Asthma
•High-dose ICS and LABA as daily controller medications
•Consideration of additional add-on therapy, such as omalizumab or oral
corticosteroids
15. The treatment of Mild Intermittent Asthma usually involves the use of short-acting beta-
agonist (SABA) inhalers as needed for symptom relief, without the need for a daily
controller medication. Here are some details about the use of SABA inhalers for Mild
Intermittent Asthma:
• Short-acting beta-agonist (SABA) inhaler: A SABA inhaler is a quick-relief
medication that is used to relieve acute asthma symptoms, such as wheezing,
coughing, and shortness of breath. It works by relaxing the muscles in the airways,
which allows more air to flow through. Examples of SABA inhalers include albuterol
and levalbuterol.
• Preparations of SABA inhalers: SABA inhalers are available in various preparations,
such as metered-dose inhalers (MDIs), dry powder inhalers (DPIs), and nebulizers.
The choice of inhaler depends on the child's age, ability to use the device, and
personal preference.
• Proper inhaler technique: It is important for children and their caregivers to use the
SABA inhaler properly to ensure that the medication reaches the lungs. The
healthcare provider should demonstrate the proper inhaler technique, which
includes shaking the inhaler, exhaling fully, and then inhaling the medication deeply
into the lungs. The child should hold their breath for several seconds before
exhaling slowly.
• Asthma action plan: Children with Mild Intermittent Asthma should have a written
asthma action plan in place, which outlines when to use the SABA inhaler and when
16. Mild Persistent Asthma requires daily controller medications in addition to as-needed
quick-relief medications. Here are some commonly used drugs for Mild Persistent
Asthma:
• Inhaled corticosteroids (ICS): ICS are the most effective daily controller medication
for Mild Persistent Asthma. They work by reducing inflammation in the airways,
which helps to prevent asthma symptoms from occurring. Examples of ICS include
beclomethasone, budesonide, and fluticasone.
• Combination inhalers: Combination inhalers contain both an ICS and a long-acting
beta-agonist (LABA) in a single inhaler. LABAs help to relax the muscles in the
airways, which helps to prevent asthma symptoms from occurring. Combination
inhalers are recommended for children with Mild Persistent Asthma who are not well
controlled on ICS alone. Examples of combination inhalers include
fluticasone/salmeterol and budesonide/formoterol.
• Leukotriene modifiers: Leukotriene modifiers are oral medications that work by
blocking the action of leukotrienes, which are inflammatory substances in the
airways. They are used as an alternative to ICS for children who cannot tolerate or
refuse inhaled medications. Examples of leukotriene modifiers include montelukast
and zafirlukast.
• Immunomodulators: Immunomodulators are biologic medications that work by
targeting specific components of the immune system involved in asthma
17. Moderate Persistent Asthma requires daily controller medications to manage inflammation and prevent
symptoms. Here are some commonly used medications for Moderate Persistent Asthma:
• Inhaled corticosteroids (ICS): ICS are the most effective daily controller medication for asthma. They
work by reducing inflammation in the airways, which helps to prevent asthma symptoms from
occurring. Examples of ICS include beclomethasone, budesonide, and fluticasone.
• Combination inhalers: Combination inhalers contain both an ICS and a long-acting beta-agonist
(LABA) in a single inhaler. LABAs help to relax the muscles in the airways, which helps to prevent
asthma symptoms from occurring. Combination inhalers are recommended for children with Moderate
Persistent Asthma who are not well controlled on ICS alone. Examples of combination inhalers include
fluticasone/salmeterol and budesonide/formoterol.
• Leukotriene modifiers: Leukotriene modifiers are oral medications that work by blocking the action of
leukotrienes, which are inflammatory substances in the airways. They are used as an alternative to
ICS for children who cannot tolerate or refuse inhaled medications. Examples of leukotriene modifiers
include montelukast and zafirlukast.
• Theophylline: Theophylline is an oral medication that works by relaxing the muscles in the airways and
improving breathing. It is used in addition to ICS for children with Moderate Persistent Asthma who are
not well controlled on ICS alone.
• Immunomodulators: Immunomodulators are biologic medications that work by targeting specific
components of the immune system involved in asthma inflammation. They are reserved for children
with severe asthma that is not well controlled on other medications. Examples of immunomodulators
include omalizumab and mepolizumab.
18. Severe Persistent Asthma requires daily controller medications to manage inflammation
and prevent symptoms, along with frequent monitoring and adjustment of treatment. Here
are some commonly used medications for Severe Persistent Asthma:
• High-dose inhaled corticosteroids (ICS): ICS are the most effective daily controller
medication for asthma. For Severe Persistent Asthma, higher doses of ICS may be
required to control inflammation in the airways. Examples of high-dose ICS include
fluticasone propionate and budesonide.
• Combination inhalers: Combination inhalers containing high-dose ICS and a long-acting
beta-agonist (LABA) are recommended for Severe Persistent Asthma. Examples of
combination inhalers include fluticasone/salmeterol and budesonide/formoterol.
• Oral corticosteroids (OCS): OCS may be used in addition to high-dose ICS for children
with Severe Persistent Asthma who continue to experience symptoms despite optimal
controller medication use. OCS work by reducing inflammation in the airways and can
be effective in controlling severe asthma exacerbations. However, they are associated
with significant side effects and should be used with caution and under close medical
supervision.
19. • Immunomodulators: Immunomodulators are biologic medications
that work by targeting specific components of the immune system
involved in asthma inflammation. They may be used in addition to
high-dose ICS and LABA for children with Severe Persistent Asthma
who continue to experience symptoms despite optimal controller
medication use. Examples of immunomodulators include
omalizumab and mepolizumab.
• Bronchodilators: Short-acting beta-agonists (SABA) and long-acting
beta-agonists (LABA) may be used as rescue medications to provide
quick relief of asthma symptoms. They work by relaxing the muscles
in the airways, which helps to improve breathing. However, they are
not effective at treating the underlying inflammation in the airways
and should not be used as a substitute for daily controller
medications.
