After eating, my belly button hurts. Pain after eating in the navel area

- it's chronic allergic disease respiratory tract, accompanied by inflammation and changes in bronchial reactivity, as well as bronchial obstruction arising against this background. Bronchial asthma in children occurs with symptoms of expiratory shortness of breath, wheezing, paroxysmal cough, and episodes of suffocation. The diagnosis of bronchial asthma in children is established taking into account allergy history; conducting spirometry, peak flowmetry, chest radiography, skin allergy tests; IgE determinations, gas composition blood, sputum examination. Treatment of bronchial asthma in children involves the elimination of allergens, the use of aerosol bronchodilators and anti-inflammatory drugs, antihistamines, carrying out specific immunotherapy.

Triggers of bronchial asthma in children can be viruses - the causative agents of parainfluenza, influenza, ARVI, as well as bacterial infection(streptococcus, staphylococcus, pneumococcus, Klebsiella, Neisseria), chlamydia, mycoplasma and other microorganisms that colonize the bronchial mucosa. In some children with bronchial asthma, sensitization can be caused by industrial allergens, taking medications (antibiotics, sulfonamides, vitamins, etc.).

Factors of exacerbation of bronchial asthma in children, provoking the development of bronchospasm, can be infections, cold air, weather sensitivity, tobacco smoke, physical activity, emotional stress.

Pathogenesis

The pathogenesis of bronchial asthma in children is divided into: immunological, immunochemical, pathophysiological and conditioned reflex phases. In the immunological stage, under the influence of the allergen, antibodies of the IgE class are produced, which are fixed on target cells (mainly mast cells of the bronchial mucosa). During the immunochemical stage, repeated contact with the allergen is accompanied by its binding to IgE on the surface of target cells. This process occurs with degranulation mast cells, activation of eosinophils and release of mediators that have a vasoactive and bronchospastic effect. During the pathophysiological stage of bronchial asthma in children, under the influence of mediators, swelling of the bronchial mucosa, bronchospasm, inflammation and hypersecretion of mucus occurs. Subsequently, attacks of bronchial asthma in children occur according to a conditioned reflex mechanism.

Symptoms

The course of bronchial asthma in children has a cyclical nature, in which periods of precursors, asthma attacks, post-attack and inter-attack periods are distinguished. During the warning period, children with bronchial asthma may experience anxiety, sleep disturbances, headache, itching of skin and eyes, nasal congestion, dry cough. The duration of the precursor period ranges from several minutes to several days.

The actual attack of suffocation is accompanied by a feeling of constriction in the chest and lack of air, and expiratory shortness of breath. Breathing becomes whistling, with the participation of auxiliary muscles; wheezing can be heard in the distance. During an attack of bronchial asthma, the child is frightened and takes orthopnea position, cannot speak, gasps for air. The skin of the face becomes pale with pronounced cyanosis of the nasolabial triangle and ears, covered in cold sweat. During an attack of bronchial asthma, children experience an unproductive cough with thick, viscous sputum that is difficult to separate.

Auscultation reveals harsh or weakened breathing with big amount dry wheezing; with percussion - a boxy sound. From the cardiovascular system, tachycardia, increased blood pressure, and muffled heart sounds are detected. If the duration of an attack of bronchial asthma is 6 hours or more, they speak of the development of status asthmaticus in children.

An attack of bronchial asthma in children ends with the discharge of thick sputum, which leads to easier breathing. Immediately after the attack, the child feels drowsy, general weakness; he is lethargic and lethargic. Tachycardia gives way to bradycardia, increased blood pressure gives way to arterial hypotension.

During interictal periods, children with bronchial asthma may feel almost normal. By severity clinical course There are 3 degrees of bronchial asthma in children (based on the frequency of attacks and respiratory function indicators). At mild degree bronchial asthma in children, attacks of suffocation are rare (less than once a month) and quickly stop. During interictal periods, general health is not affected, spirometry indicators correspond to the age norm.

Moderate bronchial asthma in children occurs with a frequency of exacerbations 3-4 times a month; spirometry speed indicators are 80-60% of normal. With severe bronchial asthma, asthma attacks in children occur 3-4 times a month; FVD indicators are less than 60% of the age norm.

Diagnostics

When diagnosing bronchial asthma in children, data from family and allergological history, physical, instrumental and laboratory examination. Diagnosis of bronchial asthma in children requires the participation of various specialists: pediatrician, pediatric pulmonologist, pediatric allergist-immunologist.

To the complex instrumental examination includes spirometry (children over 5 years old), tests with bronchodilators and physical activity (bicycle ergometry), peak flowmetry, radiography of the lungs and chest organs.

Laboratory research if bronchial asthma in children is suspected, include clinical analysis blood and urine, general sputum analysis, determination of general and specific IgE, study of blood gas composition. An important part of diagnosing bronchial asthma in children is performing allergy skin tests.

In the diagnostic process, it is necessary to exclude other diseases in children that occur with broncho-obstruction: bronchial foreign bodies, tracheo- and bronchomalacia, cystic fibrosis, bronchiolitis obliterans, obstructive bronchitis, bronchogenic cysts, etc.

Treatment of bronchial asthma in children

The main directions of treatment of bronchial asthma in children include: identification and elimination of allergens, rational drug therapy, aimed at reducing the number of exacerbations and stopping asthma attacks, non-drug restorative therapy.

When identifying bronchial asthma in children, first of all, it is necessary to exclude contact with factors that provoke exacerbation of the disease. For this purpose it may be recommended hypoallergenic diet, organization of hypoallergenic life, cancellation medicines, separation from pets, change of place of residence, etc. Long-term preventive use of antihistamines is indicated. If it is impossible to get rid of potential allergens, specific immunotherapy is carried out, which involves hyposensitization of the body by introducing (sublingual, oral or parenteral) gradually increasing doses of a causally significant allergen.

The basis drug therapy bronchial asthma in children consists of inhalation of mast cell membrane stabilizers (nedocromil, cromoglycic acid), glucocorticoids (beclomethasone, fluticasone, flunisolide, budesonide, etc.), bronchodilators (salbutamol, fenoterol), combination drugs. The selection of the treatment regimen, combination of drugs and dosage is carried out by the doctor. An indicator of the effectiveness of therapy for bronchial asthma in children is long-term remission and absence of disease progression.

When an attack of bronchial asthma develops in children, repeated inhalations of bronchodilators, oxygen therapy, nebulizer therapy, parenteral administration glucocorticoids.

During the interictal period, children with bronchial asthma are prescribed courses of physiotherapy (aeroionotherapy, ICD-10 code

Bronchial asthma in a child is no longer a disease that complicates the life of the child and parents. Adequate treatment will allow you to develop normally and lead a full life.

Over time, attacks occur less frequently and even stop completely. ABOUT signs and symptoms of development Let's talk about asthma in children further.

Read about the symptoms and treatment of anemia in a child in ours.

Features of the disease

How does asthma start? Bronchial asthma is negative reaction bronchi to a specific allergen.

The pathology is often hereditary and manifests itself at an early age.

Exacerbations are replaced by remission, and the duration of these periods depends on the characteristics of the child, living conditions, and medications used. The disease cannot be contracted.

When a child develops a cough after interacting with children who have the same symptoms, this indicates bronchial obstruction. It occurs due to the effect of the virus on the bronchi.

The diagnosis does not mean that the child will be disabled, but many restrictions will be required.

Eliminating the disease is very difficult, but with the help of medications you can maintain remission for a long time.

Forms

The bronchial form comes in the following forms:

Non-allergic asthma. This form occurs due to endocrine diseases, overload of the nervous system or ingress of microorganisms.
Mixed asthma. This pathology is characterized by all possible symptoms of this disease.
Allergic. This type of asthma manifests itself as:

Children of any age are at risk of developing asthma, but most often it develops in children under 5 years of age.

Course of the disease and possible complications

Asthma manifests itself differently at every age. Therefore, parents should pay attention to emerging symptoms.

This will allow you to quickly diagnose the disease and achieve long-term remission with the help of medications.

Manifestations up to one year:

constant sneezing, coughing and nasal discharge;
tonsils swell;
poor sleep;
problems with the gastrointestinal tract;
breath "sob."

Features of manifestation up to 6 years:

coughing in sleep;
a dry cough appears during outdoor games;
breathing through the mouth causes coughing.

In teenagers:

cough during sleep;
children are afraid of active movement;
the attack causes the child to sit up and lean forward.

At this age, the diagnosis has already been made, and the child knows the provoking factors. He must always carry an inhaler.

This disease is dangerous with complications. This is especially dangerous for the lungs, as it may cause:

Emphysema– the lungs become “airy”.
Atelectasis– blockage of the bronchus shuts off part of the lung.
Pneumothorax- V pleural cavity air penetrates.

Asthma also affects the heart. Heart failure with tissue swelling may occur.

Causes of pathology

The main cause of seizures is considered to be bronchial hyperactivity, which instantly respond to various stimuli.

The most common reasons:

Most often, asthma develops in boys, as they have features of the structure of the bronchi.
Children with overweight body also often suffer from asthma. The diaphragm occupies a high position and therefore insufficient ventilation of the lungs occurs.
Genetic predisposition plays important role in the development of this disease.
Some should be excluded: chocolate, nuts, fish.

Sometimes asthma is the final stage of allergic manifestations.

First, urticaria appears, then eczema with itching, and only then the body reacts to the irritant with an asthmatic attack.

Often attacks occur after bronchitis or after a respiratory disease.

How to treat adenoids in a child? you will find on our website.

Factors causing exacerbations

To avoid exacerbation of the disease, The following factors should be avoided:

tobacco smoke;
indoor fungal spores;
dust in the room;
plant pollen;
excess weight;
cold air;
animal fur.

All these factors aggravate the manifestation of asthma regardless of age.

Typical symptoms

It is quite difficult to detect asthma in a child. This is explained by the fact that the symptoms of bronchial asthma are similar to those of a common cold or viral disease. Therefore, parents often do not even realize that a serious pathology is developing.

It should be noted that in case of bronchial asthma no increase in temperature. A few days before the main symptoms of asthma, warning signs appear. At this time, children are irritated, sleep poorly and are excited.

Manifestations of harbingers:

In the morning, your baby has mucus running from his nose and sneezes frequently.
After a couple of hours, a dry cough appears.
In the middle of the day the cough intensifies and becomes wet.
After a maximum of two days, the cough becomes paroxysmal.

Then the warning signs stop and the main symptoms of the disease appear.

Manifestations of the main signs:

A severe coughing attack occurs before going to bed or after waking up.
The upright position reduces coughing.
Before an attack, the child begins to cry and be capricious, as his nose is blocked.
Shortness of breath occurs.
Breathing is intermittent and accompanied by whistling.
There are atypical manifestations– itching and rashes on the skin.

If asthma has taken severe form, then attacks begin to occur at any time.

Diagnostics

It is imperative to collect all the information about the child’s life. Often, after a conversation with parents, you can guess the type of allergen, causing asthma . Then certain tests are taken to precise definition allergen.

The traditional way to identify a provocateur is a skin test.

Various irritants are applied to the forearm. Then install degree of dysfunction of the respiratory system. The procedure is called spirometry, which measures the volume of breathing.

Unfortunately, asthma is detected too late. It is often mistaken for obstructive bronchitis. Doctors do not risk putting terrible diagnosis and they prescribe the wrong drugs.

Providing first aid during an attack

Parents are required to sense the onset of an asthma attack in a timely manner and be able to quickly eliminate it.

Attention should be paid on breathing and appearance child:

The breathing rate should be no more than 20 breaths per minute.
When breathing, the child's shoulders should not rise. The rest of the muscles should not be used either.
Before an attack, the child’s nostrils begin to dilate.
A bad sign is hoarse breathing.
A dry cough may also indicate the development of asthma.
You should monitor your child's skin. If you have asthma, the body spends a lot of effort to restore breathing, and this leads to the fact that the skin becomes sticky and pale.
At severe attack the skin in the nose area takes on a bluish tint. This indicates a lack of oxygen. The condition is very dangerous, so you should always have inhalers at home.

The attack occurs suddenly and without any reason. In this case emergency help needed.

In such a situation, when inflammation has occurred in the respiratory tract (edema, bronchospasm), the choking child needs to ease breathing with a strong bronchodilator.

Most effective method– inhaler, allowing the drug particles to instantly reach the affected area of the bronchi.

A good and proven drug for providing immediate assistance is an aerosol Salbutamol. It is prescribed by a doctor, and the parents of a sick child are required to know how to use the device.

Children under 5 years old do not yet know how to inhale correctly. Therefore, for such babies there are special inhalers - nebulizers. It is often necessary to use spacers. The inhaler itself is inserted into such a device.

At acute attack The child is given certain doses of the drug. The inhalation process is carried out every 10 minutes and continues until breathing normalizes. If there is no improvement, then hospitalization required.

You should not be afraid of the inhaler, as there is no danger of overdose.

What is absolutely forbidden to do?

Asthma attacks don't always end well. With this disease, there are deaths. Unfortunately, it is often not the disease itself that is to blame for the death of children, but the unreasonable actions of the parents.

This happens if inadequate medications have been used. To kid, when he has an asthma attack, you can not give:

sedatives drugs. Such tools hinder deep breathing, and this is unacceptable with a severe asthma attack;
expectorants drugs. Mucolytics activate the formation of mucus, and it is already in excess in asthma;
antibiotics. These drugs are the most useless in asthma. They can only be used for complications (pneumonia).

Drug treatment

Medical treatment can be divided into two types:

symptomatic treatment, that is, elimination of the attack;
basic therapy.

Only the doctor chooses the treatment tactics. Self-medication is absolutely excluded, since improper use of medications will aggravate the disease and can lead to respiratory failure.

Symptomatic treatment consists of the use of bronchodilators: Salbutamol, Ventolin. In severe cases, corticosteroid drugs are used. The main route of administration is inhalation.

Unfortunately, all drugs of this type of treatment have a temporary effect. And uncontrolled use of such drugs will lead to the fact that the bronchi will stop responding to the medicine. Therefore, the dose of the drug should be strictly controlled.

Basic therapy is selected individually, taking into account the severity of asthma and the characteristics of the child.

The following drugs are used:

Antihistamines means – Suprastin, Tavegil, Claritin.
Antiallergic– Intal, Ketotifen.
Antibiotics– sanitize foci of infection.

Sometimes prescribed hormonal drugs, preventing exacerbations of the disease. Leukotriene inhibitors are often used, which reduce sensitivity to allergens.

Treatment is canceled if remission is observed for two years. In case of relapse, treatment should be started again.

Drug-free therapy

There are also such ways to treat bronchial asthma. They mean:

therapeutic exercises;
physiotherapy;
massage;
hardening;
breathing techniques;
visiting salt caves.

Phytotherapy complements traditional treatment and contributes to an increase in the period of remission. Decoctions are used medicinal herbs. Prepare daily and take them for a long time. Doses must be agreed with the doctor.

Bronchial asthma sometimes disappears on its own adolescence but this happens infrequently.

Prevention

To reduce asthma attacks to a minimum other than direct treatment necessary preventive measures . They must be taken if the child is predisposed to this disease.

How to prevent this pathology:

Books should be kept in closed cabinets.
No need to store clothes in the child's room.
Do not buy soft toys.
It is advisable to wash bed linen with hypoallergenic powders.
The presence of animals in the apartment is undesirable.
During the cleaning period, the child should be removed from the room.
Linoleum should be replaced with another coating.

Previously, asthmatics adjusted their lives to the disease. Much was under the strictest prohibition. Children especially suffered from this - neither to have a puppy, nor to jump.

But today everything has changed. Advances in medicine have allowed children live full life on par with other people.

Dr. Komarovsky about asthma in this video:

We kindly ask you not to self-medicate. Make an appointment with a doctor!

Bronchial asthma is a serious and often “insidious” disease that cannot always be quickly and correctly diagnosed. How do doctors diagnose bronchial asthma? Often, bronchial asthma is disguised as other diseases of the respiratory system or as pathologies.

Therefore, without collecting a complete medical history of the patient and, if necessary, prescribing additional tests and studies, it can be difficult to diagnose the patient, especially at initial period inflammation of the bronchi.

The formulation of a medical report on the disease is based on the following data:

when a complete clinical picture corresponding to this disease is revealed;
if there are aggravating circumstances, in particular family predisposition or
an allergic component, which is also often hereditary;
helps to make a diagnosis - objective results of examinations.

A correctly identified diagnosis is the main thing in successful fight with attacks of bronchial asthma. Clinical symptoms of the disease include the following:

IMPORTANT! Any alarming or strange symptoms associated with the human respiratory system, suspicious coughing attacks, weakness or shortness of breath are serious reasons to consult a doctor about diagnosing the disease.

Features of identifying the disease

To answer the question of how experts diagnose “bronchial asthma,” you should understand what forms of bronchial damage exist.

There are three main forms of bronchial asthma - atopic, aspirin and. Atopic asthma most often develops in childhood (under 5 years) and adolescence. This is a chronic non-infectious allergic inflammation of the respiratory tract, which develops under the influence of external allergic components.

The decisive factor is the genetically determined tendency to atopy. Main symptoms - occasionally manifested sudden attacks choking, cough with a small amount of viscous sputum. To bet correct diagnosis, the doctor must evaluate the patient’s medical history, allergy test results, clinical and immunological blood tests and some others additional research bronchi.

Is a consequence of intolerance acetylsalicylic acid or some other non-steroidal anti-inflammatory drugs. If this type If asthma is not treated, then later attacks of coughing and choking may occur not only in connection with taking these medications. A complete medical history of the patient and testing for aspirin and other drugs helps to make a correct diagnosis. pharmacological preparations non-steroidal origin.

An infection-dependent form of the disease occurs in humans different ages. Most often it is diagnosed in adults against the background of chronic inflammatory processes in the respiratory organs, most frequent period manifestations are transitional and cold seasons.

The division of these forms is conditional; any long course diseases form combined types bronchial asthma.

Diagnosis of the disease

Regardless of the form of bronchial asthma, the diagnostic process takes place in several stages. In most cases, at the first stage of diagnosis, the doctor can issue a preliminary conclusion. But situations often arise when all the symptoms suddenly disappear before a visit to the doctor. In such cases, doctors must prescribe the patient to undergo additional tests and studies, the results of which help make a more definitive diagnosis.

When a person first contacts a medical institution, the therapist conducts a full survey the sick person: his diet, the presence of animals in the house, working conditions, and also finds out the symptoms that most worry the person. All identified circumstances help to identify the extent of damage to the respiratory system, its localization, speed up diagnosis and set treatment goals.

Depending on the identified symptoms, the therapist refers the patient to a specialist. The disease always occurs with various symptoms and arises due to individual circumstances. To make the correct diagnosis, and depending on the path of development of the disease, other specialists may be involved in treatment, for example, a gastroenterologist, an allergist or a cardiologist.

Next, the pulmonologist finds out the presence of other chronic diseases, such as: skin pathologies, urticaria, Quincke's edema. How often has a person previously suffered from bronchitis, acute respiratory viral infections, and pneumonia? Does the patient suffer from heart disease, what diseases of the cardiovascular system have he been diagnosed with?

IMPORTANT! Many symptoms of bronchial asthma are similar to those of heart disease, so consultation with a cardiologist in such cases is extremely important.

If experts believe that bronchial asthma is caused by allergic components from the patient's everyday environment, such as house dust, coat animals, medicines or the flowering of certain plants, they prescribe allergy tests for all potential irritants. Samples will help accurately identify allergic pests.

Along the way, these tests find out what concomitant pathologies the patient has. As shown medical practice, diseases such as atopic dermatitis and eczema further intensifies severe course bronchial asthma and require immediate treatment.

Other diagnostic methods that allow you to diagnose asthma

One of the main methods for making a diagnosis of “bronchial asthma” is spirometry procedures. The technique allows you to track the dynamics of changes in activities respiratory organs. The disease is characterized by the phenomenon of narrowing of the lumens in the bronchi, which significantly impairs the functioning of the lungs.

The results of the spirometry procedure demonstrate many important parameters that allow the doctor to make a diagnosis and prescribe appropriate treatment. But the main thing that shows for a pulmonologist is:

patient's forced expiratory volume;
forced vital capacity of the patient's lungs.

Thanks to the results obtained, the doctor can track the person’s response to treatment, monitor or adjust the course of therapy. At home, patients often use a simplified version of this method, called. A person can independently keep a table of indications to determine the next bronchospasm.

Percussion (tapping) of the chest has important in the diagnosis of bronchial asthma. When tapping, the pulmonologist hears high-pitched sounds characteristic of asthmatics, which occur if a person’s lungs are full of air. Various wheezing sounds when breathing are also clearly audible, which experienced specialist classifies by sound.

X-ray of the bronchi. When a doctor has a discrepancy between the results of tests and the methods used, he can prescribe a chest x-ray, which accurately identifies all anomalies and pathologies in the bronchi and lungs. Sometimes doctors get by with just prescribing fluorography.

A blood test helps make a diagnosis. If the study results reveal the presence of IgE antibodies, this confirms the preliminary conclusion.
Also, if asthma is suspected, patients usually undergo tests of urine and sputum produced when coughing.

IMPORTANT! Before taking blood, urine, and sputum tests, the patient should not drink alcohol, smoke, or take medications, otherwise the results will be distorted. final results research, which will prevent the specialist from making the correct diagnosis.

The human body is a single interconnected system, therefore difficult process making a medical report is a little labor-intensive, but the most accurate and correct. All additional studies and tests that are carried out after the examination and medical history of the patient must be carried out within one day or with the most minimal interruption, otherwise the picture of the disease may be distorted. Careful and immediate diagnosis of bronchial asthma increases patients' chances of recovery.

How does asthma develop?

Asthma is defined by doctors as a disease characterized by episodes of bronchial obstruction (bronchial obstruction), which are fully or partially reversible. It is based on inflammation of the bronchial mucosa and bronchial hyperreactivity.

During an attack of bronchial obstruction, the lumen of both small and larger bronchi narrows.

All patients with asthma, when there is no attack, nevertheless show signs of inflammatory process in the bronchial mucosa. This fact raises the question of treating the inflammatory process - and not only during an asthma attack. There are such drugs, so persistent long-term treatment should become the basis of the fight against asthma.

No less important is the second point - about the presence in patients with asthma of bronchial hyperreactivity, that is, increased irritability of the bronchi, responding with spasm even to insignificant amounts of irritating substances in the inhaled air. This forces us to create a healthy air environment for these patients.

"Not all asthma is whistling"

Bronchial obstruction is observed not only in asthma, but also in a number of other diseases. In most of them, especially in adults, the disease does not have remission (light intervals), which distinguishes them from asthma.

But in childhood There is a group of diseases very similar to asthma that are associated with a viral infection. They have nothing to do with asthma. And an asthmatic infant, and his peer without signs of allergies can give an episode of obstruction against the background of ARVI. The only difference is that an asthmatic will have repeated attacks of the disease, not only with ARVI, but also in response to one or another non-infectious allergen, while a child without allergies will get sick obstructive bronchitis and will most likely “outgrow”, so bronchial obstruction after 1-2 such episodes it will stop. It is this fact that creates difficulties in the above-mentioned “relationship” with the diagnosis of asthma for many parents, as well as the incomplete acceptance of the definition of asthma by pediatricians.

What is the difference between obstructive bronchitis against the background of ARVI and asthma? For some viral infections at infants inflammation of the bronchial mucosa is observed, which thickens and mucus production increases. This leads to a narrowing of the very narrow children's bronchi, which is accompanied, as with asthma, by difficulty in exiting. This picture can be repeated 1-2 times, but as the child grows and the diameter of his bronchi increases new infection, although it causes bronchitis, it does not cause significant disruption of bronchial obstruction.

The same thing happens in an allergic child, but over time, due to the persistence of bronchial hyperreactivity, almost every new infection will be accompanied by bronchospasm. Moreover, such a child may have attacks of obstruction in response to inhalation of aeroallergens - and this is bronchial asthma.

Among children of the first three years of age with obstructive diseases, the risk group for bronchial asthma is:

Children with an allergic predisposition (allergy in parents with skin allergic manifestations, positive skin allergy tests or high level immunoglobulin E);

Children whose obstructive disease develops without fever (which indicates the role of a non-infectious allergen);

Children with more than 3 obstructive episodes.

After the age of 3 years, it is appropriate for almost all children with obstructive manifestations to be diagnosed with bronchial asthma, however, in many of them the disease stops after 1-3 years.

Forms of bronchial asthma

Above we mentioned two forms of asthma - allergic and non-allergic. The division of asthma into forms is not limited to this.

Many children have asthma without severe attacks; during an exacerbation they develop bronchitis with clear signs obstruction, which we usually call asthmatic bronchitis, which should not reassure parents: asthmatic bronchitis is a form of bronchial asthma.

Some children have persistent asthma attacks night cough without severe shortness of breath - this is also a form of asthma, which over time can turn into a typical form.

A number of children experience shortness of breath and difficulty breathing in response to physical activity - this is asthma physical tension, and an attack develops as a result of bronchial hyperreactivity stimulated by muscle efforts.

Many parents notice that an asthma attack occurs when strong excitement child, sometimes they even talk about “mental asthma”. There is hardly any reason to talk about psychic mechanism asthma, but there is no doubt that in any form of this disease, worries, especially those associated with the child’s inability to cope with a particular problem, can cause an attack. Therefore, in a family where there is a child with asthma, a healthy psychological climate is very important.

How does asthma occur?

A “normal” attack develops suddenly, breathing quickens, exhalation becomes difficult, the child takes a sitting position and breathes shallowly. Often wheezing can be heard from a distance, sometimes it is felt only when the child's ear is raised to the child's mouth. Difficulty in exhaling leads to air retention in the chest; it usually swells; if you put your hands on it, you feel a trembling at the exit.

An attack can last from several minutes to many hours, and often ends spontaneously. However, waiting for it to pass or using dubious means (there are a lot of them) is unacceptable: suffocation is a very painful phenomenon, so every minute of delay with effective treatment increases the child’s suffering, frightens him, which in itself can increase bronchospasm. In more severe cases, intensive care is required.

Patients also differ in character interictal period. In some patients, no changes can be detected, while in others, even in the interictal period, there are significant restrictions on the respiratory function.

Asthma treatment

When I see a child with asthma, the first thing I tell his parents is that asthma cannot be cured by any known means. This may be cruel, but why am I talking about this? Because many parents, in search of a miracle remedy, try the most different methods, most of which not only do not bring benefit, but also harm the patient.

If you don’t expect a cure, then what is the point of treatment? Its meaning is to reduce the severity of asthma, learn to prevent attacks, at least make them less frequent, and quickly relieve an attack if it occurs. In short, to make the child’s life complete - like a healthy child.

And regarding the possibility of a cure, I always “lighten the souls” of parents - very a large percentage In most cases, a child’s asthma goes away on its own.

Well, how to properly treat asthma? It is necessary to clearly distinguish between therapeutic measures that help get rid of an attack that has already occurred, and means that mitigate the course of the disease.

How to prevent an attack? Seizure prevention is the main goal basic treatment. But to this should be added measures to possible warning contact with allergens, primarily house dust. It is better to remove carpets and upholstered furniture, at least in the room where the child sleeps. I often joke that the ideal bedroom for a child is a prison cell, where there is nothing but a bed, a table and a stool. It is important to close books in glass shelves, use a vacuum cleaner for cleaning more often, and preferably a moisturizing one. To reduce the patient’s contact with the dermatophagoides mite, you should cover the child’s mattress with plastic wrap and put 2 pillowcases on the pillows. Taking into account the allergenic properties of bird feathers, feather pillows should be replaced with cotton wool or foam rubber.

It is very difficult to part with pets, but it is necessary if a child is sensitive to their fur. You should not have fresh flowers in the room - not only their smells and pollen can be dangerous for the patient, but also the aspergillus fungus, which often grows in flower pots. In young patients with asthma, an attack can often be associated with food allergens.

There is hardly any need to talk about the dangers of smoking in an apartment where there is an asthma patient. For him, first of all, conditions should be created that ensure maximum stay in the fresh air. And all other allergy prevention measures must be fully observed.

It is very important to temper the child - this will reduce purity respiratory infections, which often cause an attack and contribute to increased bronchial hyperreactivity.

Many children with asthma do not tolerate physical activity well - after 5-7 minutes from the start of running or outdoor games, they experience bronchospasm, causing shortness of breath, or even an asthma attack. To prevent this, you should take 1-2 inhalations of a beta-myetic or take aminophylline powder, after which bronchospasm will not develop, and after 20-30 minutes, under the influence of physical activity, the bronchi, on the contrary, will expand, which is very useful for the patient.

That is why Physical Culture, increasing physical endurance is included in the arsenal medicinal products for asthma. Moreover, physical training increases the patient’s self-esteem, helps him develop self-confidence and reduces dependence on adults. Very useful breathing exercises, asthma patients learn proper breathing during exercise.

Many parents ask whether a child with asthma can go south to the sea. Experience shows that such a change in climate usually provokes an asthma attack, so you need to be prepared for this. But then the children usually feel good and get a lot of benefits from being at sea - after all sea air very clean, breathing it reduces bronchial hyperreactivity. Upon returning home, many patients again have asthma attacks, and one must also be prepared for this. In general, the benefits of such a trip will be tangible if you stay in the south for a month and a half or two, no less.

Another frequently asked question- about climate change. In most cases, it is not possible to "pick up" the climate, so I usually do not advise parents to embark on this very difficult undertaking. If asthma is clearly associated with the flowering of a particular plant, for this period it is sometimes possible to take the child to another region, but most often it is not possible to completely get rid of asthma in this way. The same applies to trips to the mountains, where there are very few allergens at an altitude of 1500-2000 meters: this is useful (including in terms of physical training), but it is still not possible to completely get rid of asthma.

Well, how should you feel about treating asthma in salt mines? There are no allergens in the air, and this helps to reduce bronchial hyperreactivity. But you can’t spend your whole life in a mine, so you can’t count on a cure. But staying in a halochamber (a room whose walls are covered with salt) seems to me at least doubtful.

Alternative Treatments

Many people have heard or read about miracle cures- acupuncture, special breathing techniques, miracle drugs, psychics who supposedly cure asthma. Yes indeed, mild attack can be relieved by holding your breath or acupuncture, but I could never figure out why acupuncture better than inhalation. Moreover, holding your breath even with moderate asthma can be very dangerous.

I don’t know of a single solid study that would prove the cure of asthma using these methods, and information like “we were treated by a psychic and the asthma went away” is completely unconvincing: after all, in most children, asthma goes away sooner or later!

But the harm from all these methods is the same - by resorting to them, parents are distracted from those measures that really help with asthma, in particular, they do not carry out basic treatment. And the use of other medications during an attack (you hear from parents that they were recommended broncholitin, no-shpu, papaverine, solutan and even antibiotics) is unacceptable, since they, as a rule, do not alleviate the child’s suffering.

What is the future of asthma patients? At proper treatment, as a rule, it is possible to stabilize the child’s condition, and if the attacks do not stop completely, then their frequency and severity decreases.

And do not forget that very often asthma goes away.

>> bronchial asthma

Bronchial asthma(from Greek asthma - hard breath, suffocation) is chronic illness human respiratory system. The incidence of bronchial asthma is approximately 5% of the total population of the planet. In the United States, there are approximately 470,000 hospitalizations and more than 5,000 asthma-related deaths annually. The incidence among women and men is approximately the same.

The mechanism of occurrence of the disease is the establishment of hypersensitivity of the bronchi against the background of a chronic inflammatory process localized at the level of the respiratory tract. The development of bronchial asthma can be caused by various factors: persistent respiratory tract infection, inhalation of allergens, genetic predisposition. Prolonged inflammation of the airways (eg. chronic bronchitis) leads to structural and functional changes in the bronchi - thickening of the muscular membrane, increased activity of the glands that secrete mucus, etc. Among the allergens that most often cause bronchial asthma, we can name house dust that accumulates in carpets and pillows, particles of the chitinous membrane of micromites and cockroaches, the hair of domestic animals (cats), and plant pollen. Genetic predisposition causes increased sensitivity of the bronchi to the factors described above. Attacks of bronchial asthma can be triggered by inhaling cold or hot air, physical exertion, stressful situations, inhalation of allergens.

From the point of view of pathogenesis, we distinguish two main types of bronchial asthma: infectious-allergic asthma and atopic asthma. Also, some rare forms of asthma are described: asthma caused by physical activity, “aspirin-induced” asthma caused by chronic use of aspirin.

At allergic asthma, we distinguish two types of response to inhalation of an allergen: immediate response ( clinical picture bronchial asthma develops a few minutes after the allergen penetrates the bronchi) and a late response, in which asthma symptoms develop 4-6 hours after the allergen is inhaled.

Methods for diagnosing bronchial asthma

Diagnosis of bronchial asthma this is a complex and multi-step process. The initial stage of diagnosis is the collection of anamnestic data (questioning the patient) and clinical examination patient, allowing in most cases to make a preliminary diagnosis of bronchial asthma. Taking an anamnesis involves clarifying the patient’s complaints and identifying the evolution of the disease over time. Symptoms of bronchial asthma are very diverse and vary depending on the stage of the disease and individual characteristics every patient.

On initial stages development (pre-asthma), bronchial asthma is manifested by bouts of cough, which can be dry or with a small amount of sputum. Cough occurs mainly at night or in the morning, which is associated with physiological increase tone of the bronchial muscles in the morning (3 – 4 am). A cough may appear after a respiratory tract infection. Coughing attacks in the initial stages of the disease are not accompanied by difficulty in breathing. Auscultation (listening to the patient) may reveal scattered dry rales. Latent (hidden) bronchospasm is detected using special methods studies: with the introduction of beta-agonists (drugs that cause relaxation of the muscles of the bronchi), an increase in the fraction of exhaled air (sirometry) is observed.

At later stages of development, asthma attacks become the main symptom of bronchial asthma.

The development of an asthma attack is preceded by the impact of one of the provoking factors (see above), or the attacks develop spontaneously. At the beginning, patients may notice some individual symptoms of the oncoming attack: runny nose, sore throat, itchy skin, etc. Then comes progressive difficulty breathing. At first, the patient notes only difficulty in exhaling. A dry cough and a feeling of tension in the chest appear. Breathing disorders force the patient to sit with his arms supported in order to facilitate breathing by working the auxiliary muscles of the shoulder girdle. The increase in suffocation is accompanied by the appearance of wheezing, which at first can only be detected by auscultation of the patient, but then becomes audible at a distance from the patient. An attack of suffocation in bronchial asthma is characterized by so-called “musical wheezing” - consisting of sounds of varying pitches. Further development attack is characterized by difficulty inhaling due to installation respiratory muscles pregnant take a deep breath(bronchospasm prevents the removal of air from the lungs during exhalation and leads to the accumulation of large amounts of air in the lungs).

Examination of the patient for diagnosis at the pre-asthma stage does not reveal any characteristic features. In patients with allergic asthma, nasal polyps, eczema, and atopic dermatitis may be found.

Most characteristic features are detected during examination of a patient with an attack of suffocation. As a rule, the patient seeks to take sitting position and leans his hands on the chair. Breathing is elongated, tense, and the participation of auxiliary muscles in the act of breathing is noticeable. jugular veins on the neck swell as you exhale and collapse as you inhale.

When percussing (tapping) the chest, a high-pitched (boxed) sound is detected, indicating the accumulation of a large amount of air in the lungs - plays an important role in diagnosis. Lower limits the lungs are lowered and inactive. When listening to the lungs, it is revealed a large number of wheezing varying intensity and heights.

The duration of the attack can vary - from several minutes to several hours. Resolution of the attack is accompanied by a tense cough with the release of a small amount of clear sputum.

Especially serious condition is status asthmaticus - in which progressive suffocation endangers the patient's life. At status asthmaticus, All clinical symptoms more pronounced than during a normal asthma attack. In addition to them, symptoms of progressive suffocation develop: cyanosis (cyanosis) skin, tachycardia (increased heart rate), heart rhythm disturbances (extrasystoles), apathy and drowsiness (inhibition of the function of the central nervous system). With status asthmaticus, the patient may die from respiratory arrest or cardiac arrhythmias.

Additional methods for diagnosing bronchial asthma

Preliminary diagnosis of bronchial asthma is possible on the basis of clinical data collected using the methods described above. Determining the specific form of bronchial asthma, as well as establishing the pathogenetic aspects of the disease requires the use of additional research methods.

Research and diagnosis of function external respiration(FVD, spirometry) for bronchial asthma, they help determine the degree of bronchial obstruction and their response to provocation by histamine, acetylcholine (substances that cause bronchospasm), and physical activity.

In particular, forced expiratory volume in one second (FEV1) and vital capacity of the lungs (VC) are determined. The ratio of these values (Tiffno index) allows one to judge the degree of bronchial patency.

There are special devices that allow patients to determine the volume of forced expiration at home. Monitoring this indicator is important for adequate treatment of bronchial asthma, as well as for preventing the development of attacks (the development of an attack is preceded by a progressive decrease in FEV). FEV is determined in the morning before taking a bronchodilator and in the afternoon after taking the medicine. A difference of more than 20% between the two values indicates the presence of bronchospasm and the need to modify treatment. Decrease in FEV below 200 ml. reveals pronounced bronchospasm.

Chest radiography – additional method diagnostics allows you to identify signs of emphysema (increased transparency of the lungs) or pneumosclerosis (growth in the lungs connective tissue). The presence of pneumosclerosis is more typical for infection-dependent asthma. In allergic asthma, radiological changes in the lungs (outside of asthma attacks) may be absent for a long time.

Diagnosis of allergic asthma– lies in defining hypersensitivity body in relation to some allergens. Identification of the corresponding allergen and its exclusion from the patient’s environment, in some cases, makes it possible to completely cure allergic asthma. Antibodies are determined to determine allergic status. type IgE in blood. Antibodies of this type determine the development immediate symptoms for allergic asthma. An increase in the level of these antibodies in the blood indicates an increased reactivity of the body. Also, asthma is characterized by an increase in the number of eosinophils in the blood and in sputum in particular.

Diagnostics concomitant diseases respiratory system (rhinitis, sinusitis, bronchitis) helps to compose general idea about the patient’s condition and prescribe adequate treatment.

Bibliography:

Eds. L. Allegra et al. Methods in asthmology, Berlin etc. : Springer, 1993
Fedoseev G.B. Bronchial asthma, St. Petersburg. : Medical information agency, 1996
Petrov V.I. Bronchial asthma in children: Modern approaches to diagnosis and treatment, Volgograd, 1998