Childhood cough or asthma
Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics | Posted on 28-02-2018
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Asthma is a chronic condition of the respiratory tract which is characterised by a group of symptoms and a series of positive diagnostic tests. Generally these tests cannot be performed correctly until the age of 6 or 7, therefore the term “recurrent wheeze” is recommended when talking about children younger than this, or a nitric oxide test can be performed from the age of 4 if the patient is able to cooperate.
Today Dr Carlos Hermosos Torregrosa, Paediatric Respiratory Physician at Vithas Xanit International Hospital, answers some of our questions relating to this condition, which tends to be more complicated during the colder months.
. What respiratory difficulties occur with asthma?
Clinically a cough and shortness of breath are typical in the asthma process. It is often episodic, and in some cases it is shown to be related to a lung allergen, always occurring at the same time of year.
When correctly controlled in children, it will appear on rare occasions throughout the year (once or twice), manifesting as a cough when exercising and at rest, usually becoming worse at night.
. What signs should parents look out for?
A cough is the main sign that parents should look out for to predict the onset of an asthma attack. Other signs such as indrawing of the abdomen (subcostal retraction) or increased breathing rate appear when the attack is already quite advanced.
. How is asthma diagnosed?
One of the most common and well-known tests used in the diagnosis of asthma, also used when assessing the level of control, is spirometry with the bronchodilator reversibility test. This helps to determine lung function, however sometimes use of this technique alone is not sufficient to diagnose the condition. In the last few years there has been a rise in use of the fractional exhaled nitric oxide (FeNO) test. This has the advantage that it can be performed at an earlier age than spirometry, from the age of 4 in selected patients. This test determines the nitric oxide exhaled at a proximal level (in the bronchi), as well as at a distal or alveolar level.
- How is asthma treated? Which treatments are most effective?
There are many asthma treatments, however it is important to differentiate between the two main types: treatments focused on an acute attack, and maintenance treatments which are prescribed to correctly control the asthma and minimise the number of attacks.
The most effective treatments for asthma attacks, approved in national and international asthma guidelines, are INHALED, never oral, short acting β2-adrenergic bronchodilators: salbutamol and terbutaline.
There are also studies which show that adding corticosteroids, such as budesonide, to inhaled β2-adrenergic bronchodilators, increases their effectiveness by reducing the bronchial inflammatory component which always accompanies an acute asthma attack. When an attack is serious, these inhaled treatments are accompanied by oral corticosteroids.
With regard to maintenance treatment, there are also many options such as leukotriene receptor antagonists (montelukast), inhaled corticosteroids (budesonide/fluticasone), or combined inhaled corticosteroids and long-acting β2-adrenergic bronchodilators (formoterol/budesonide, salmeterol/fluticasone) which are prescribed depending on the patient’s clinical history.
Additionally there are some vaccines which are particularly recommended for asthmatic patients due to their higher risk of suffering from serious infections and increased risk of complications due to certain pathogens. With this in mind, it is important that providing there are no contraindications, these patients, and those they live with, have yearly flu vaccinations, preferably with a quadrivalent vaccine. As well as the flu, it is essential to vaccinate correctly against pneumococcus.
- Can asthma be prevented?
No. If an individual is genetically predisposed to developing asthma, currently there is no way of preventing it.
However, it is possible to prevent exacerbations of asthma and improve control of the disease. This is achieved through individual, specialist outpatient monitoring and control, where the necessary tests and required maintenance treatment is prescribed for each child, with the aim of achieving better control of the disease with as little medication possible.
The tests required for diagnosis of the condition are the respiratory function tests already discussed, using spirometry with the bronchodilator reversibility test, and FeNO tests which should be performed in all children when an allergic component is suspected.
Furthermore, both spirometry and FeNO are used for monitoring of the condition, FeNO has the advantage that it can be performed in younger children (from age 4) predicting attacks in children who are apparently well controlled.
- Should a child with asthma change their lifestyle? (Sports, games….)
A child with asthma can lead a normal life. There are many examples of elite athletes who take part in their sport without any limitations due to their asthma.
- Are children of parents with allergies more likely to suffer from asthma?
It is a subject still under discussion today, but it appears that children with a history of a first degree relative with asthma, or with a strong allergic component, are more likely to suffer from asthma in the future.
A detailed clinical history during a specialist consultation gives the asthma predictive index (API), which is a very useful tool in determining the type of treatment and monitoring which the patient is going to require.
What is clear today is that a child under the age of 3 who starts with repeated bronchial episodes, and who has a family history of asthma, must be observed and strictly monitored until the age that the necessary tests to diagnose asthma can be performed.
Dr. Carlos Hermoso Torregrosa (Paediatric Respiratory Physician),