Bronchial asthma in children is a chronic inflammatory disorder of the airways. It is characterized by recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning. These episodes are usually associated with reversible airflow obstruction. The document discusses the pathogenesis, diagnosis and treatment of bronchial asthma in children. It outlines the goal of treatment as achieving and maintaining clinical control by preventing acute symptoms and disease recurrence while avoiding side effects. Treatment follows a step approach of increasing medication according to asthma severity.

1. Bronchial asthma inBronchial asthma in
childrenchildren

2. Plan of the lecturePlan of the lecture
• 1. Definition of bronchial asthma
• 2. Factors of developmentFactors of development
• 3. Bronchial asthma pathogenesisBronchial asthma pathogenesis
• 4.4. Clinics of asthma exacerbation
• 5. Diagnostic criteria and principles of
treatment

3. What do we know about asthma?
Bronchial asthma is a chronic inflammatory disorder of the airways in
which many cells and cellular elements play role. The chronic
inflammation is associated with airway hyperesponsiveness that leads to
reccurrent episodes of wheezing, breathlessness, chest tightness and
coughing, particularly at night or in the early morning. These episodes are
usually associated with widespread but variable airflow obstruction within
the lung that is often reversible either spontaneously or with treatment.
( Asthma definition from Global Strategy for Asthma Management and( Asthma definition from Global Strategy for Asthma Management and
Prevention 2007)Prevention 2007)

4. • Asthma is a problem worldwide with an estimated 300Asthma is a problem worldwide with an estimated 300
million affected individualsmillion affected individuals
• BA morbidity increased twice more in Europe if weBA morbidity increased twice more in Europe if we
compare it with early 80-th.compare it with early 80-th.
• BA morbidity in Ukraine is 1,6 times more for the lastBA morbidity in Ukraine is 1,6 times more for the last
decadedecade
• According to the European Allergy Association childAccording to the European Allergy Association child
morbidity in various European countries ranges frommorbidity in various European countries ranges from
5% to 22%5% to 22%
• Children from urbanized regions fell ill on BA moreChildren from urbanized regions fell ill on BA more
frequentlyfrequently

5. Predisposing Factors:Predisposing Factors:
• Genes pre-disposing to allergic reactionsGenes pre-disposing to allergic reactions
• Airway hyperresponsivenessAirway hyperresponsiveness–– The characteristicThe characteristic
functional abnormality of asthma results in airwaysfunctional abnormality of asthma results in airways
narrowing in response to a stimulus that would benarrowing in response to a stimulus that would be
innocuous in a normal personinnocuous in a normal person
• Atopy -Atopy - is hyperproduction of IgEis hyperproduction of IgE

6. Sensibilization FactorsSensibilization Factors ::
• Indoor: domestic mites, domestic and library dust,Indoor: domestic mites, domestic and library dust,
cockroaches allergenes, fish fodder, feather ofcockroaches allergenes, fish fodder, feather of
pillowspillows
• Fungi, molds, yeastsFungi, molds, yeasts
• Epidermal allergens: furred animals ( dogs, cats,Epidermal allergens: furred animals ( dogs, cats,
mica)mica)
• Outdoor: Pollens of trees,weeds, flowers , molds,Outdoor: Pollens of trees,weeds, flowers , molds,
yeastsyeasts
• Infections (predominantly viral)Infections (predominantly viral)
Prematurity play significant role due to immaturity ofPrematurity play significant role due to immaturity of
lung tissue and immune systemlung tissue and immune system

7. 0
20
40
60
80
FamilyFamily
GlycyphagidaeGlycyphagidae
MitesMites
DermatophagoidesDermatophagoides
rodensrodens
Stock mitesStock mites
Acarus siroAcarus siro
Healthy
BA Mild course
BA moderate
course
BA severe
course
Guanine concentrationGuanine concentration
in dust samplesin dust samples

8. Resolution factors ( triggers):
• Pollutants – compounds of serum, nickel, Cobalt etc.-Pollutants – compounds of serum, nickel, Cobalt etc.-
result of industrial plants activity, car exhaust gasesresult of industrial plants activity, car exhaust gases
• Tobacco smoking – active and passiveTobacco smoking – active and passive
• Viral infections ( RSV, parainfluenza, etc)Viral infections ( RSV, parainfluenza, etc)
• Food productsFood products
• Physical trainingPhysical training
• StressStress
• Meteorological factorsMeteorological factors

9. Extrinsic asthma
The asthma episode is typically initiated by the
type1hypersensitivity reaction induced by exposure to the
extrinsic antigen.
Three types of extrinsic asthma are recognized
1.Atopic asthma
2.Occupational asthma(many forms)
3.Allergic bronchopulmonary aspergillosis (bronchial
colonization with aspergillus organisms followed by
development of IgE antibodies)
Atopic asthma is the most common type of asthma. Its onset
is usually in the 1st
two decades of life and is commonly
associated with other allergic manifestation in the patient as
well as in other family members.
Serum IgE levels are usually elevated as is the blood
eosinophils count.this forms of asthma is believed to be
driven by cd4+Tcells.

10. Intrinsic asthma
The triggering mechanisms are non-immune in
this form a number of stimuli that have little or no
effect in normal subjects can trigger broncho-
spasm. Such factors include aspirin, pulmonary
infections, especially those caused by virus
(RSV) ,cold, psychological stress, exercise and
inhaled irritatants such as ozone and sulfur
dioxide. there is usually no personal or family
history of allergic manifestation and serum IgE
levels are normal. These patients are said to
have an asthmatic diathesis.

11. Drug induced asthma
Is seen most commonly with
1.NSAID’S (COX-1 inhibitors)
2.Aspirin, Ibuprofen
3.Propranolol (because non selective Beta blockers)
• hypertrophic obstructive cardiomyopathy
• migrain
4.Timolol (eye drops, used to lower internal eye pressure in patient with
glaucoma)
Propranolol blocks the action of epinephrinic and norepinephrine on
both B1 and B2 adrenergic receptors.
Cox-1 inhibitors converts arachidonic acid to PG resulting in pain and
inflammation.
So In the case of joint pain +asthmatic condition we can use Cox-2.
•COX-2
1.Nimesulide
2.Celecoxib
3.Etoricoxib
•COX-3

12. Bronchial Asthma PathogenesisBronchial Asthma Pathogenesis
Early phaseEarly phase
AllergenAllergen Fixation on mast cellsFixation on mast cells,,
eosinophils, basophils,eosinophils, basophils,
thrombocytesthrombocytes
Cell activationCell activation Hyperproduction ofHyperproduction of
arachidonic acidarachidonic acid
Cell activationCell activation
Releasing of preformingReleasing of preforming
mediatorsmediators ((PGPG,, TxTx,, PAFPAF,,
LTLT))

13. Bronchial Asthma PathogenesisBronchial Asthma Pathogenesis
Late phasePathophysiological stageLate phasePathophysiological stage))
Releasing of primary mediatorsReleasing of primary mediators
((PGPG,, TxTx,, PAFPAF,, LTLT))
Eosinophils, neutrophils,Eosinophils, neutrophils,
thrombocytes chemotaxis to thethrombocytes chemotaxis to the
inflammatory focusinflammatory focus
Releasing of secondaryReleasing of secondary
mediatorsmediators ((PGPG,, TxTx,, PAFPAF,,
HETEHETE,, LTLT,, LXLX))
Contractility and prolifiration ofContractility and prolifiration of
smooth musclessmooth muscles
HyperalgiaHyperalgia FeverFever Thrombocytes and neutrophilsThrombocytes and neutrophils
aggrigationaggrigation
VasospasmVasospasm
MucociliaryMucociliary
transporttransport
impairmentimpairment
Mucus hypersecretionMucus hypersecretion
Increased vessel
permeability, edema
Bronchoobstructive
syndrome
MicrovasculatureMicrovasculature
impairmentimpairment
Bronchial constrictionBronchial constriction
andand
hyperresponsivenesshyperresponsiveness

14. Bronchial Asthma PathogenesisBronchial Asthma Pathogenesis
Late stageLate stage ((Pathophysiological stagePathophysiological stage))
Bronchoobstruc-
tive syndrome
MicrovasculatMicrovasculat
ureure
impairmentimpairment
Bronchial spasmBronchial spasm
andand
hyperreactivityhyperreactivity
Clinical stage of allergic reaction
(anaphylactic shock, BA attack, rhinoconjunctivitis,
Quinck edema, urticaria, etc. )

15. MUCOUSMUCOUS
EDEMAEDEMA
Sputum hyperproductionSputum hyperproduction
BronchialBronchial
spasmspasm

16. Slice of normal bronchiSlice of normal bronchi
Slice of Spasmodic bronchiSlice of Spasmodic bronchi

17. NeutrophilNeutrophil

18. Smooth muscle dysfunction
Inflammation
ПАТОГЕНЕЗ БРОНХИАЛЬНОЙ АСТМЫBronchial Asthma two component disease

19. Bronchial asthma – two
component disease
Smooth muscle
dysfunction
Respiratory tract
inflammation
Bronchial constrictionBronchial constriction
Bronchial hyperreactivityBronchial hyperreactivity
HyperplasiaHyperplasia
Inflammatory mediators releasingInflammatory mediators releasing
Inflammatory cells infiltrationInflammatory cells infiltration
Mucous membrane edemaMucous membrane edema
Cell prolifirationCell prolifiration
Epithelium damageEpithelium damage
Basal membrane thickeningBasal membrane thickening
Exacerbation symptoms

20. Clinics of asthma exacerbation
• cough
• typical attacks of chest tightness, exhalative dyspnea, wheezing,
dry cough, viscous sputum
• Percussion findings are
• hyperresonance, tympanic sound due to emphesema
• Ausculatation:
• -rough respirative sounds, different rales like dry,
whistling, moist bubbling usually bilateral different in
quantity
• Can be accompanied by
• -Hypoxia and hypercapnia signs like- cyanosis
• - cardiovascular abnormalities ( tachycardia, murmurs,
rhythm abnormalities).

21. Sputum analysis
1.curschman’s
spirals:
Refers to finding in
sputum of spiral
shaped mucus
plugs
•Airway epithelium
has tendency to
curl upon itself in
the brochial
asthma cases.
•Curved airway
epithelium.

22. Sputum analysis
Creole bodies:
Found in a
patient’s sputum
they are ciliated
columnar cells
sluggshed from
the bronchial
mucosa of a
patient with
asthma (60% in
pediatric
asthma.)

23. Blood analysis
•Neutrophiles (band cells increased)
•Eosinophils also increased
•Serum IgE increased (Extrinsic asthma)

24. Skin allergy test: (prick test)
• Is a method for medical diagnosis of allergies that
attempts to provoke a small controlled allergic response.
• In the prick test ,a few drops of the purifired allergen are
gently pricked on to the skin surface usually the forearm.
• This test is usually done in order to identify allergies to
pet dender ,dust, polleen,food or dust mites.
• Intradermal injection are done by injecting a small amount
of allergen just beneath the skin surface.
• The testis also done to assess allergies to drug like
penicillin or bee venom.
• If an immune-response is seen in the form of a rash
urticaria or anaphylaxis it can be concluded that the
patient has a hypersensitivity (or allergy) to the allergen.

25. Skin allergy test

26. It is very important that the subject should stay in the
observation of physician for at least an hour or two the
subject may develop some signs and symptoms like:
low grade fever
Light headedness or dizziness
Wheezing or shortness of breath
Extensive skin rash
Swelling of face ,lips, mouth
Difficalties swallowing or speaking
For emergency condition the medications used are
Histamine antagonists
Epinephrine
Glucocorticoids
The skin rash or hives maybe itchy and best treated by
applying over the counter hydrocortisone cream.

27. Peakflow meter
Used to measure
a persons
maximum speed
of expiration.

28. Pulmonary function test are carried out mostly by using spirometer
The air in the lungs is classified in to 2 divisions
1. lung volumes 2.lung capacities
1.lung volumes:
a)tidal volume-500ml(0.5liter)tv
b)Inspiratory resere volume-3300ml(3.3liters)IRV
c)Expiratory reserve volume-1000ml(1liter)ERV
d)Residual volume-1200ml( 1.2liter)RV
2.Lung capacities:
a)Inspiratory capacity(IC) IC=TV+IRV
IC=500+3300=3800ml
b)Vital capacity (VC) VC=IRV+TV+ERV
VC=3300+500+1000=4800ml
c)Functional residual capacity(FRC)
FRC=ERV+RV
FRC=1000+1200=2200ml
d)Total lung capacity (TLC)
TLC=IRV+TV+ERV+RV
TLC=3300+500+1000+1200=6000ml(6 liters)
Spirometer

29. spirometer

30. spirometer

31. Late diagnostics of bronchialLate diagnostics of bronchial
asthmaasthma
• Complicate bronchial asthma courseComplicate bronchial asthma course
prognosisprognosis
• Worsen life quality in bronchial asthmaWorsen life quality in bronchial asthma
patientspatients
• Increase cost of treatment of bronchial asthmaIncrease cost of treatment of bronchial asthma
What do we know about asthma?What do we know about asthma?

32. Everyday symptoms NO
Need for reliever/rescue medication NO
Days with “bad” morning PEF NO
Night attacks NO
Decreased activity NO
Exacerbations NO
Sudden hospitalization NO
Side effects from therapy NO
What can be achieved due to full asthma control

33. Classification of Asthma severityClassification of Asthma severity
DegreeDegree Day exacerbationsDay exacerbations
NocturnalNocturnal
symptomssymptoms PeakflowmetryPeakflowmetry
SevereSevere
persistentpersistent
Frequent.Frequent.
Limitation ofLimitation of
physical activitiesphysical activities
FrequentFrequent
Less thanLess than 60%60%
predictedpredicted,, variabilityvariability
more thanmore than 30%30%
ModerateModerate
persistentpersistent
Everyday attackEveryday attack
Exacerbation affectExacerbation affect
activity and sleepactivity and sleep
More thanMore than
once peronce per
weekweek
60-80%60-80% predictedpredicted
variability morevariability more
thanthan 30%30%
MildMild
persistentpersistent
Symptoms more thanSymptoms more than
once a week but lessonce a week but less
than once a daythan once a day
More thanMore than
twice a monthtwice a month
More or equal toMore or equal to 80%80%
predicted,predicted,
variabilityvariability 20-30%20-30%
IntermittentIntermittent
Less than once a weekLess than once a week
brief exacerbationsbrief exacerbations
ventilation lungventilation lung
functions betweenfunctions between
attacks is normalattacks is normal
Not moreNot more
than twice athan twice a
monthmonth
Not less 8Not less 80%0%
predictedpredicted
variability less thanvariability less than
20%20%
Протокол по лечению и диагностке астмы у детей GINA 2003

34. The goal of asthma treatment is to achieve andThe goal of asthma treatment is to achieve and
maintain clinical controlmaintain clinical control
• Treatment of asthma is directed toTreatment of asthma is directed to
1.1. Prevention of acute and chronic asthmaPrevention of acute and chronic asthma
symptomssymptoms
2.2. Prevention of disease recurrencePrevention of disease recurrence
3.3. To avoid side effects from asthma medicationTo avoid side effects from asthma medication
4.4. To maintain normal or almost normalTo maintain normal or almost normal
parameters of respirationparameters of respiration
5.5. To achieve proper quality of lifeTo achieve proper quality of life

35. • Step approach of BA treatment means increasing ofStep approach of BA treatment means increasing of
medication according to severity of asthma. Physicianmedication according to severity of asthma. Physician
can start with maximal treatment approach or increasecan start with maximal treatment approach or increase
medications steadily until desired therapeutic effectmedications steadily until desired therapeutic effect
will be achieved. Only after gaining clinical remissionwill be achieved. Only after gaining clinical remission
not less than for 3 month medication may benot less than for 3 month medication may be
decreased.decreased.
• The main goal of step treatment approach is completeThe main goal of step treatment approach is complete
control of disease by minimal quantity of medicationscontrol of disease by minimal quantity of medications

36. BA treatment in acute periodBA treatment in acute period::
• Termination of the contact with allergenTermination of the contact with allergen
• Oxygen therapyOxygen therapy
• InhaledInhaled ВВ22--adrenomymeticsadrenomymetics ((salbutamolsalbutamol ((ventolinventolin),),
terbutalin,terbutalin, berotecberotec or combinedor combined ВВ22--adrenomimeticsadrenomimetics + М-+ М-
cholinolyticscholinolytics ((berodualberodual,, combiventcombivent))
• If 3 intakes ofIf 3 intakes of ВВ22--adrenomymetics within an hour are notadrenomymetics within an hour are not
efficient IV infusion of theophyllines and systemicefficient IV infusion of theophyllines and systemic
corticosteroids are necessarycorticosteroids are necessary

37. Medications for basic BA therapyMedications for basic BA therapy
• Cromoglycium acid derivates
• Glucocorticosteroids (systemic, inhaled)
• Long acting inhaled b2-agonists
• Leukotriene modifiers

38. Antiinflammatory medications- derivates of
cromoglycium acid
• Inhibit mast cells degranulation processInhibit mast cells degranulation process
• Retard IgE- linked secretion of histamine, cellRetard IgE- linked secretion of histamine, cell
activation of late phase mediators in asthmaticactivation of late phase mediators in asthmatic
reactionreaction
• Increase sensibility of cells forIncrease sensibility of cells for bb--agonistsagonists
• Retard development of early and late allergic responseRetard development of early and late allergic response
phasephase..
• Decrease hyperresponsiveness of bronchiDecrease hyperresponsiveness of bronchi
• Usage of these medications are helpful in efficientUsage of these medications are helpful in efficient
control of BA, caused by domestic aero-allergenescontrol of BA, caused by domestic aero-allergenes

39. Derivates of cromoglycium acidDerivates of cromoglycium acid
• Mast cells membranes stabilizers:
cromoglycium acid
(intal,chromohexal,chromogenum)
• Nedocromyl sodium (tailed,tailed-mint)

40. Inhaled corticosteroidsInhaled corticosteroids
• Inhaled corticosteroids (ICS) has the most manifestedInhaled corticosteroids (ICS) has the most manifested
anti-inflammatory activityanti-inflammatory activity
• Reduce BA symptomsReduce BA symptoms
• Decrease quantity of exacerbationsDecrease quantity of exacerbations
• Decrease severity of airways inflammation and bronchiDecrease severity of airways inflammation and bronchi
hyperresponsivenesshyperresponsiveness
• Improve lung functionImprove lung function..
• Among anti-inflammatory drugs ICS most efficient inAmong anti-inflammatory drugs ICS most efficient in
reducing BA symptoms, prevention of itsreducing BA symptoms, prevention of its
exacerbation, reduce inflammation of airways mucousexacerbation, reduce inflammation of airways mucous
membrane and bronchi responsivenessmembrane and bronchi responsiveness..

41. • Systemic corticosteroidsSystemic corticosteroids
((hydrocortisonehydrocortisone,,dexamethasonedexamethasone,,
methylprednisolone, prednisolonemethylprednisolone, prednisolone,, polcortolonepolcortolone))
• Inhaled corticosteroidsInhaled corticosteroids
• BeclomethasoneBeclomethasone ((becodiskbecodisk,, becotidebecotide,, aldecinealdecine ))
• Fluticasone propionateFluticasone propionate ((seretideseretide,, flicsotideflicsotide))
• BudesonideBudesonide
• FlunisolideFlunisolide ((InhacortInhacort))
• Triamcinalone acetate (Pulmicort)Triamcinalone acetate (Pulmicort)

42. Leukotriene modifiersLeukotriene modifiers
• AcoladAcolad ((ZaferlucastZaferlucast))
• SingularSingular ((MontelucastMontelucast))

43. Long acting b-2-
agonistsагонисты:
1.1.SalmeterolSalmeterol ((SereventSerevent,,SereventSerevent
rotadiskrotadisk))
2.2.ClenbutiroleClenbutirole ((SpiropentSpiropent))
3.3.FormoterolFormoterol (Formoteroloxis, Foradil(Formoteroloxis, Foradil))

44. Reliever MedicationsReliever Medications
Broncholytic medicationsBroncholytic medications
(bronchospasmolytics)(bronchospasmolytics)
• Short acting bShort acting b ––adrenomymeticsadrenomymetics
• SalbutamolSalbutamol (( ventolin-ventolin-
nebulasnebulas,,ventolinventolin,, bolmaxbolmax,, salomolsalomol,,
salbensalben,, saltossaltos,, terbutalinterbutalin))
1.1. PhenoterolPhenoterol ((BerotecBerotec))
2.2. HexaprenolineHexaprenoline ((ProdolProdol))

45. Reliever MedicationReliever Medication
• MethylxantinesMethylxantines
• ((euphyllineeuphylline,, theophyllinetheophylline))
• M-cholynoblockersM-cholynoblockers
• -- Ipratropium bromideIpratropium bromide ((Atrovent)Atrovent)

46. Combined medications:
• Phenoterol + Ipratropium bromide = berodual
• Salbutamol + Ipratropium bromide = combivent
• Cromoglycate sodium + Salbutamol = Intal
• Cromoglycate sodium + Phenoterol = Ditec

47. Medications for NebulizerMedications for Nebulizer
therapytherapy
• NebulizerNebulizer –– is inhalation device for sprayingis inhalation device for spraying
aerosol into very small disperse particlesaerosol into very small disperse particles

48. The main goal of nebulizer therapyThe main goal of nebulizer therapy
• Delivering of medication therapeutic dosage inDelivering of medication therapeutic dosage in
aerosol formaerosol form
• Gaining of pharmacodynamic answer inGaining of pharmacodynamic answer in
shortest periodshortest period

49. Indications for nebulizer therapyIndications for nebulizer therapy
• It is used for intensive care in obstructive lungIt is used for intensive care in obstructive lung
diseases, changed secretory capacity of bronchi, indiseases, changed secretory capacity of bronchi, in
coughcough
• It can be used in hospitals, in ambulatory care or atIt can be used in hospitals, in ambulatory care or at
homehome
Absolute indication for nebulizer therapy isAbsolute indication for nebulizer therapy is
• inneffective proceeding broncholytic therapy,inneffective proceeding broncholytic therapy,
• pMDI usage impossibility,pMDI usage impossibility,
• infants and toddlers,infants and toddlers,
• purposeful delivery of medications into bronchi andpurposeful delivery of medications into bronchi and
alveolialveoli

50. Advantages of nebulizer treatmentAdvantages of nebulizer treatment
• It isn’t necessary coordinate respiratory with aerosoleIt isn’t necessary coordinate respiratory with aerosole
puffspuffs
• Possibility to use high dosages of medicationsPossibility to use high dosages of medications
• Continuous delivery of medication by compressorContinuous delivery of medication by compressor
• Absence of freon- gase that can induce bronchialAbsence of freon- gase that can induce bronchial
reactivityreactivity
• Fast deliveryFast delivery
• PortabilityPortability
• Nebulizer therapy imperfection: high cost, limitedNebulizer therapy imperfection: high cost, limited
quantity of medications for treatment, devicequantity of medications for treatment, device
maintenance, necessity of electric energy sourcesmaintenance, necessity of electric energy sources..

51. Medications for nebulizerMedications for nebulizer
therapytherapy
Ventolin ( in nebulas 2,5 ml/2,5 mg nondeluted form)Ventolin ( in nebulas 2,5 ml/2,5 mg nondeluted form)
BerodualBerodual ((solution for inhalations 20 ml vial)solution for inhalations 20 ml vial)
• Mild exacerbationMild exacerbation 0,1 – 0,020,1 – 0,02 ml/kg once)ml/kg once)
• Moderate exacerbation 0,15-0,3 ml/kgModerate exacerbation 0,15-0,3 ml/kg
• Severe attackSevere attack 0,150,15 ml/kg every 20 minml/kg every 20 minкаждые 20 мин 3каждые 20 мин 3
dosagesdosages,, thenthen 0,15 – 0, 30,15 – 0, 3 ml/kg evryml/kg evry 33--44 hourshours..
• Prolonged therapy forProlonged therapy for 24 – 4824 – 48 hourshours,, byby 0,250,25 ml/kg everyml/kg every
44--66 hourshours..

52. Allergen specific immunotherapyAllergen specific immunotherapy
• Nowadays this method is the most effective treatmentNowadays this method is the most effective treatment
because of opportunity to influence for naturalbecause of opportunity to influence for natural
allergic process progression and BA developmentallergic process progression and BA development
prevention in patients with allergic rhinitisprevention in patients with allergic rhinitis..
• Standardized allergic vaccines are usually usedStandardized allergic vaccines are usually used..
• Under the influence of allergenspecific immunotherapyUnder the influence of allergenspecific immunotherapy
hyperreactivity of bronchi is decreased and it is helpfulhyperreactivity of bronchi is decreased and it is helpful
for BA course full control obtainingfor BA course full control obtaining..

53. To decrease efficacy of BA therapy
• Educational programs ( for affected children and theirEducational programs ( for affected children and their
parents in asthma schools)parents in asthma schools)
• Health promotion programs for decreasing ARDHealth promotion programs for decreasing ARD
morbiditymorbidity
• Co-morbidities sanitations like allergic rhinitis, etc.Co-morbidities sanitations like allergic rhinitis, etc.
A lot of additional arrangementsA lot of additional arrangements
are useful :are useful :

54. Key statements of BA treatment
• The most efficient BA treatment is causative allergenThe most efficient BA treatment is causative allergen
eliminationelimination
• Asthma can be controlled but not cured of completelyAsthma can be controlled but not cured of completely
• Late diagnostics and improper treatment are the mainLate diagnostics and improper treatment are the main
reasons of severe BA course and lethal outcomereasons of severe BA course and lethal outcome
• BA treatment choice according to course severity anyBA treatment choice according to course severity any
case must be individual taking into account allcase must be individual taking into account all
personal peculiaritiespersonal peculiarities
• BA treatment is performed by step therapy approachBA treatment is performed by step therapy approach
• It can be proposed some non-drug means of treatmentIt can be proposed some non-drug means of treatment