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),

The hepatitis C virus is a small RNA virus which has a special affinity for infecting liver cells. It is an infectious disease which, the majority of the time, is transmitted by exposure to blood contaminated with the virus.

In this post Dr. Juan Carlos Gavilan, from the Department of General Internal Medicine, explains about the new direct-acting antiviral treatments for chronic hepatitis C infection.

How is this virus transmitted?

In the past, before there was a blood test available to test blood donors, contaminated blood transfusion or the use of syringes and/or contaminated material in patients who were drug users was the most common method of transmission. Nowadays transmission through transfusion is highly unlikely. The risk of sexual transmission of the virus is low, although not impossible. However, a high percentage of patients who have the infection do not have any of the risk factors mentioned, therefore they very probably acquired it as a result of “unnoticed” exposure to blood or material contaminated with infected blood. 

How does the hepatitis C virus act?

Once in the body the virus multiplies leading to acute hepatitis, but in many cases the patient does not become jaundiced and the symptoms present as tiredness and weakness which are attributed to other factors, the infection passing unnoticed.

In approximately 20% of cases, the body’s defence system is able to effectively eliminate the infection, with it resolving spontaneously, but in 80% of cases this does not happen, and CHRONIC HEPATITIS develops. In other words it persists long term, causing continuous inflammation of the liver, which in a third of patients can lead to liver cirrhosis years later, and with it complications such as liver failure or liver cancer.

During the chronic phase, the infection presents few symptoms and frequently passes unnoticed until it is found incidentally on blood tests, or when donating blood. Spontaneous elimination during the chronic phase is very unlikely. Between 1 and 2% of the Spanish population may be affected, with a percentage of infected patients being unaware, precisely because of the lack of symptoms presented.

Possible treatment for hepatitis C

For years there was no effective treatment available to eliminate the virus; subsequently there were treatments such as interferon and ribavirin which had many side effects with low rates of recovery.

Nowadays however we have a wide range of direct-acting antiviral drugs, in tablet form. In more than 95% of cases these are capable of eliminating the infection with less than 12 weeks of treatment, and with few side effects.  Elimination of the virus during the chronic hepatitis phase, before the virus has caused significant damage to the structure of the liver, particularly in relation to the degree of fibrosis caused in the organ, makes the final prognosis after treatment excellent.

In cases where effective elimination of the virus takes place, but the liver already has a significant degree of fibrosis at the time of treatment, particularly if there is established cirrhosis, prognosis also improves. However elimination of the virus does not reduce possible future complications to zero as the liver can be affected by the consequences of cirrhosis, in these cases special monitoring is therefore recommended.

Detection of undiagnosed cases and their treatment will allow future eradication of the infection and of the complications which could result from the risk of progression to cirrhosis in many of these patients.

Bruxism refers to a biomechanical alteration of the temporomandibular joint that causes teeth grinding and jaw clenching. This alteration, although it may occur at any time, day or night, has a higher incidence during the night.

Dental pieces are usually the most subjected to this alteration, getting worn out due to the continuous movement of the upper teeth over the lower, in the form of compressing and grinding. Bruxism affects the teeth, but it also affects or may affect, other parts of the head.

Francisco Luis Garrido Luque, from the Physiotherapy Unit of the  Vithas Xanit Internacional Hospital, explains today the causes and symptoms of bruxism, offering some advice and recommendations on how to fight it.

Causes of Bruxism

Bruxism is a mechanical pathology with the psychological or emotional origin,in which stressis the leading cause. Other factors can exacerbate symptoms, such as poor eating habits, lack of rest, among other.

Symptoms of Bruxism

Many symptoms accompany bruxism. As we mentioned above, tooth wear is one of the main symptoms, but there are many others, which we will elaborate below:

• Pain and inflammation of the jaw joint.
• A headache: The permanent contraction of the muscles involved in chewing generates pain of referred character to the head area. Also, there are many nerve structures in that area that can be overstimulated.
• Ear pain, due to the relationship between the jaw joint and the auditory canal.

Exercises and tips to combat Bruxism and relax the mandibular joint

Meditation or relaxation

For a minute, we should focus on our breathing. To do this, we are going to lie down in a comfortable position, with arms and legs relaxed. Then we should close our eyes, and observe our breathing, and its two phases. The inspiratory phase, and the expiratory phase. During the observation stage, we will realise how many thoughts we have on our mind, which we will ignore, only focusing on our breathing, as if it were a roller coaster, going up and down. We observe its amplitude, symmetry. This exercise will clean our mind. As we have already mentioned, a good emotional state is essential to control bruxism and work on the same.

Massage of the muscles involved

Another technique that we can perform is massaging all the hypertonic muscles which relaxation will help their decompression. Besides, the massage will improve the entire circulation of the musculature.

Ear traction

Commonly known as “ear pull” is a technique used in cranial osteopathyfor decompression of the temporal bone, bone of vital importance in the constitution of the temporomandibular joint or jaw joint. Lying in a comfortable position, we press our earlobe with the thumbs and forefingers, and we will pull it gently towards the feet. When we notice a resistance, we should maintain the traction. Little by little, we will notice that the tissues relax.

Exercises for mobilisation and relaxation of the joint

We can also perform exercises to open and close the mouth, displacements of the lower jaw bone in both directions, right and left, in order to stretch the musculature.

Cervical stretching

We can also performcervical stretches, taking the ear to one shoulder and maintaining the tension for thirty seconds, in a smooth, slow and progressive way. We will perform stretching on both sides, in addition to combining them with breathing exercises, to achieve total relaxation of the tissues.

If after a period of following these recommendations we continue with Bruxism, it would be advisable to seek help from our GP or physiotherapist.