After eating, the navel hurts. Pain after eating in the navel

- is chronic allergic disease respiratory tract, accompanied by inflammation and a change in the reactivity of the bronchi, as well as the bronchial obstruction that occurs against this background. Bronchial asthma in children occurs with symptoms of expiratory dyspnea, wheezing, paroxysmal cough, episodes of suffocation. The diagnosis of bronchial asthma in children is based on allergic history; spirometry, peak flowmetry, chest radiography, skin allergy tests; IgE definitions, 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, conducting specific immunotherapy.

The triggers of bronchial asthma in children can be viruses - the causative agents of parainfluenza, influenza, SARS, as well as bacterial infection(streptococcus, staphylococcus, pneumococcus, klebsiella, neisseria), chlamydia, mycoplasmas 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, may be infections, cold air, weather sensitivity , tobacco smoke, physical activity, emotional stress.

Pathogenesis

In the pathogenesis of bronchial asthma in children, there are: 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). In the immunochemical stage, repeated contact with the allergen is accompanied by its binding to IgE on the surface of target cells. This process proceeds with degranulation mast cells, activation of eosinophils and the release of mediators with a vasoactive and bronchospastic effect. In the pathophysiological stage of bronchial asthma in children, under the influence of mediators, swelling of the bronchial mucosa, bronchospasm, inflammation and mucus hypersecretion occur. In the future, attacks of bronchial asthma in children occur according to a conditioned reflex mechanism.

Symptoms

The course of bronchial asthma in children is cyclical, in which there are periods of precursors, asthma attacks, post-attack and interictal periods. During the warning period, children with asthma may experience anxiety, sleep disturbance, headache, itching of the skin and eyes, nasal congestion, dry cough. The duration of the precursor period is from several minutes to several days.

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

Auscultation reveals hard or weak breathing with large quantity dry wheezing wheezes; percussion - box sound. On the part of the cardiovascular system, tachycardia, increased blood pressure, muffled heart tones are detected. With a duration of an asthma attack of 6 hours or more, they talk about 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 drowsiness, general weakness; he is slow and lethargic. Tachycardia is replaced by bradycardia, increased blood pressure - arterial hypotension.

During interictal periods, children with 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 asthma attacks are rare (less than 1 time per month) and are quickly stopped. In the interictal periods, the general state of health is not disturbed, the spirometry indicators correspond to the age norm.

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

Diagnostics

When diagnosing bronchial asthma in children, the data of the family and allergological anamnesis, 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 (veloergometry), peak flowmetry, x-ray of the lungs and chest organs.

Laboratory research for suspected bronchial asthma in children, include clinical analysis blood and urine, general sputum analysis, determination of general and specific IgE, blood gas analysis. An important link in the diagnosis of bronchial asthma in children is the production of allergic skin tests.

In the process of diagnosis, it is required to exclude other diseases in children with bronchial obstruction: foreign bodies of the bronchi, 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 relief of asthma attacks, non-drug rehabilitation therapy.

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

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

With the development of an attack of bronchial asthma in children, repeated inhalations of bronchodilators, oxygen therapy, nebulizer therapy, parenteral administration glucocorticoids.

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

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

Over time, seizures occur less often and even completely stop. O signs and symptoms of development asthma in children will be discussed 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 backlash bronchi for a specific allergen.

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 the drugs used. The disease cannot be transmitted.

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 it will require compliance with many restrictions.

It is very difficult to eliminate the disease, but with the help of drugs it is possible to maintain remission for a long time.

Forms

The bronchial form is of the following forms:

Asthma non-allergic. This form is due to endocrine diseases, overloads of the nervous system or ingestion of microorganisms.
Mixed asthma. This pathology is characterized by all possible symptoms this disease.
allergic. This type of asthma manifests itself in the form of:

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

The course of the disease and possible complications

Asthma manifests 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 by taking medications.

Manifestations up to a year:

persistent sneezing, coughing and nasal discharge;
swollen tonsils;
bad sleep;
problems with the gastrointestinal tract;
breath "sobbing".

Features of manifestation up to 6 years:

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

For teenagers:

cough during sleep;
children are afraid of active movement;
the seizure 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 fraught with the lungs, as it may occur:

Emphysema- the lungs become "airy".
Atelectasis- blockage of the bronchus disables part of the lung.
Pneumothorax- in pleural cavity air penetrates.

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

Causes of pathology

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

The most common reasons:

Most often, asthma develops in boys, as they have structural features of the bronchi.
Children with overweight body also often suffer from asthma. The diaphragm occupies a high position and therefore there is insufficient ventilation of the lungs.
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 exacerbate the manifestation of asthma. regardless of age.

Typical Symptoms

Diagnosing asthma in a child can be difficult. 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 know about the development of a serious pathology.

It should be noted that in bronchial asthma no temperature rise. A few days before the main symptoms of asthma, precursors appear. At this time, children are irritated, do not sleep well and are excited.

Manifestations of harbingers:

In the morning, the baby has mucus from the nose, and he often sneezes.
After a couple of hours, a dry cough appears.
In the middle of the day the cough gets worse and becomes wet.
After a maximum of two days, the cough becomes paroxysmal.

Then the precursors stop and the main symptoms of the disease appear.

Manifestations of the main signs:

An attack of severe cough occurs before going to bed or after waking up.
Upright position reduces coughing.
Before an attack, the child begins to cry and act up, as his nose is blocked.
There is shortness of breath.
Breathing is irregular and accompanied by whistling.
There are atypical manifestations- itching and rashes on the skin.

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

Diagnostics

It is necessary to collect all the information about the life of the child. Often, after talking with parents, you can guess the type of allergen, causing asthma . Then certain analyzes are given for exact definition allergen.

The traditional way to determine the provocateur is a skin test.

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

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

Providing first aid during an attack

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

Attention should be paid for breathing and appearance child:

The respiratory rate should be no more than 20 breaths per minute.
When breathing, the child should not raise his shoulders. The rest of the muscles should also not be involved.
Before an attack, the child's nostrils begin to expand.
A bad sign is hoarse breathing.
A dry cough can also indicate the development of asthma.
You should take care of your baby's skin. In the presence of asthma, the body spends a lot of energy to restore breathing, and this leads to the fact that the skin becomes sticky and turns pale.
At severe attack the skin in the nose becomes bluish. This indicates a lack of oxygen. The condition is very dangerous, so there should always be inhalers at home.

The attack happens suddenly and for no reason. In this case urgent help needed.

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

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

A good and proven drug to provide immediate help is an aerosol Salbutamol. It is prescribed by a doctor, and the parents of a sick child must be able to use the device.

Children under the age of 5 do not yet know how to inhale properly. Therefore, for such crumbs, 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 an inhaler, as there is no danger of an overdose.

What absolutely cannot be done?

Asthma attacks don't always end well. With this disease, there are deaths. Unfortunately, it is not the disease itself that is often 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).

Medical treatment

Medical treatment can be divided into two types:

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

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

Symptomatic treatment consists in 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 the 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 preparations preventing exacerbations of the disease. Often used leukotriene inhibitors, which reduce sensitivity to allergens.

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

Non-drug therapy

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

medical gymnastics;
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 needed preventive measures . They must be taken if there is a predisposition of the child 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:

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Bronchial asthma is a severe and often "insidious" disease that is not always quickly and correctly diagnosed. How do doctors diagnose bronchial asthma? Often, bronchial asthma is disguised as other diseases of the respiratory system or pathology.

Therefore, without collecting a complete patient history and, if necessary, prescribing additional tests and studies, it can be difficult to diagnose a patient, especially on initial period bronchial inflammation.

The statement of a medical opinion 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 correct diagnosis is the key to successful fight with attacks of bronchial asthma. The clinical symptoms of the disease include the following:

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

Features of the detection of the disease

To answer the question of how specialists diagnose bronchial asthma, one 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 (up to 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. The main symptoms are episodically manifested sudden attacks choking, cough with a small amount of viscous sputum. To bet correct diagnosis, the doctor should evaluate the patient's history, the results of allergy tests, clinical and immunological blood tests, and some others additional research bronchi.

Is the result of intolerance acetylsalicylic acid or certain other non-steroidal anti-inflammatory drugs. If a this species asthma is left untreated, then in the future attacks of coughing and suffocation may occur not only in connection with the intake of these medicines. A complete history of the patient and testing for aspirin and others helps to make the correct diagnosis. pharmacological preparations non-steroidal origin.

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 system, most frequent period manifestations are transitional and cold seasons.

The division of these forms is conditional, any long course disease forms 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 often situations 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 to make a more definite diagnosis.

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

Depending on the symptoms identified, the therapist directs the patient to a narrow-profile one. The disease always proceeds with various symptoms and arises due to individual circumstances. In order to make the correct diagnosis, and also depending on the path of the disease, other specialists may be involved in the treatment, for example, a gastroenterologist, an allergist or a cardiologist.

Further, the pulmonologist finds out the presence of other chronic diseases, such as: skin pathologies, urticaria, angioedema. How often a person has previously had bronchitis, SARS, pneumonia. Does the patient suffer from a heart disease, what diseases of the cardiovascular system have he been diagnosed with.

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

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

Along the way, these samples find out what comorbidities the patient has. As shows medical practice diseases such as atopic dermatitis and eczema further intensify severe course bronchial asthma and require immediate treatment.

Other diagnostic methods that allow the diagnosis of AD

One of the main methods for diagnosing bronchial asthma is spirometry procedures. The technique allows you to track the dynamics of changes in activities respiratory organs. The disease is characterized by such a phenomenon as the narrowing of the gaps 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 the appropriate treatment. But the main thing that shows for a pulmonologist is:

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

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

Percussion (tapping) of the chest has importance in the diagnosis of bronchial asthma. A pulmonologist, when tapped, hears high-pitched sounds characteristic of asthmatics, which appear if a person's lungs are full of air. Various wheezes are also well heard during breathing, which experienced specialist classified by sound.

Bronchial X-ray. When the doctor has a discrepancy between the results of the tests and the methods being carried out, he can prescribe a chest x-ray, which accurately determines all anomalies and pathologies in the bronchi and lungs. Sometimes doctors manage only by prescribing fluorography.

A blood test helps make the diagnosis. If the results of the study revealed the presence of IgE antibodies, then this is a confirmation of the preliminary conclusion.
Also, if asthma is suspected, patients usually take tests of urine and sputum released when coughing.

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

The human body is a single interconnected system, therefore, such difficult process staging a medical report is a little time-consuming, but the most faithful and correct. All additional studies and analyzes that are carried out after the examination and history of the patient should 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 asthma increases the chances of patients to recover.

How Asthma Develops

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

During an attack of bronchial obstruction, a narrowing of the lumen of both small and larger bronchi occurs.

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

No less important is the second provision - about the presence of bronchial hyperreactivity in patients with asthma, that is, increased irritability of the bronchi, which respond with spasm even to insignificant amounts of irritating substances in the inhaled air. This makes it necessary to create a healthy air environment for these patients.

"Not all asthma that whistles"

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 a remission (light intervals), which distinguishes them from asthma.

But in childhood There is a group of diseases very similar to asthma associated with a viral infection. They have nothing to do with asthma. And an asthmatic infant, and his peer without signs of allergy can give an episode of obstruction against the background of SARS. The only difference is that asthma attacks will recur, and not only with SARS, 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 similar episodes will stop. It is this fact that creates difficulties in the above "relationships" with the diagnosis of "asthma" in 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 SARS and asthma? For some viral infections at infants there is inflammation of the bronchial mucosa, which thickens, and mucus production increases. This leads to constriction of the very narrow childhood bronchi, which is accompanied, as in asthma, by difficulty in exiting. This picture can be repeated 1-2 times, but with the growth of the child and an increase in the diameter of his bronchi new infection, although it causes bronchitis, does not cause a significant violation of bronchial patency.

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

Among children of the first three years who have obstructive diseases, the risk group for bronchial asthma are:

Children with an allergic predisposition (allergies from parents who have allergic skin manifestations, positive skin 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 to diagnose bronchial asthma in almost all children with obstructive manifestations, 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. This division of asthma into forms is not limited.

Many children have asthma without pronounced 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 an asthma attack that is persistent. nocturnal cough without severe shortness of breath - this is also a form of asthma, which over time can turn into a typical form.

Some children experience shortness of breath and difficulty breathing in response to exercise - 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 speak of mental mechanism asthma, but there is no doubt that in any form of this disease, excitement, especially associated with the inability of the child to cope with a particular problem, can cause an attack - there is no doubt. Therefore, in a family where there is a child with asthma, a healthy psychological climate is very important.

How does asthma progress?

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

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

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

Asthma treatment

When I watch a child with asthma, the first thing I tell his parents is that there is no cure for asthma. known means. It may be cruel, but why am I saying this? Because many parents, in search of a miracle cure, try the most different methods, most of which not only do not benefit, but also harm the patient.

If you do not count on a cure, then what is the point of treatment? Its meaning is to reduce the severity of asthma, to learn how to prevent attacks, at least make them rarer, to quickly relieve an attack if it occurs. In short, to make the child's life full - like a healthy child.

And with regard to the possibility of a cure, I always "lighten the soul" of the parents - in a very a large percentage cases of asthma in a child goes away on their own.

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

How to prevent an attack? Seizure prevention is key basic treatment. But to this must be added measures to possible warning contact with allergens, in the first place - with house dust. It is better to remove carpets and upholstered furniture, at least in the room where the child sleeps. I often joke - the ideal bedroom for a child is a prison cell, where, apart from a bed, a table and a stool, there is nothing. It is important to close books in glass shelves, use a vacuum cleaner more often for cleaning, and moisturizing is better. To reduce the contact of the patient with the dermatophagoides mite, 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 or foam rubber ones.

It is very difficult to part with pets, but it is necessary if the child's sensitivity to their hair is revealed. The room should not have fresh flowers - not only their smells and pollen can be dangerous for the patient, but also the aspergilus fungus, which often starts in flower pots. In small patients with asthma, it is not uncommon for an attack to be associated with food allergens.

It is hardly necessary to talk about the dangers of smoking in an apartment where there is a patient with asthma. For him, first of all, it is necessary to create conditions that ensure maximum stay in the fresh air. Yes, and all other allergy prevention measures must be fully observed.

It is very important to temper the child - this will reduce the 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 do 1-2 inhalations of a beta-mietic 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's why Physical Culture, increasing physical endurance is included in the arsenal medicinal products with asthma. Moreover, physical training increases the self-esteem of the patient, contributes to the development of his self-confidence and reduces dependence on adults. Very helpful breathing exercises, patients with asthma in the process of training learn to breathe properly.

Many parents ask if a child with asthma can travel 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 them 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, what about the treatment of 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 have heard or read about miracle cures- acupuncture, special breathing techniques, miracle drugs, psychics, supposedly curing asthma. Yes indeed, mild seizure can be removed with breath holding or acupuncture, but I could never figure out what acupuncture is better inhalation. Moreover, even with moderate asthma, holding your breath can be very dangerous.

I don't know of a single solid study that has proven that asthma can be cured using these methods, and reports like "we were treated by a psychic - and the asthma went away" are completely unconvincing: after all, most children have asthma sooner or later!

And the harm from all these methods is the same - 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 drugs during an attack (you have to hear from parents that they were recommended broncholithin, no-shpu, papaverine, solutan and even antibiotics) is unacceptable, since they, as a rule, do not alleviate the suffering of the child.

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 decrease.

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, about 470,000 hospitalizations and more than 5,000 asthma-related deaths are recorded annually. The incidence among women and men is approximately the same.

The mechanism of the onset of the disease is to establish bronchial hypersensitivity 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 infection of the respiratory tract, 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 glands that secrete mucus, etc. Of the allergens most often causing bronchial asthma, one can name house dust accumulating in carpets and pillows, particles of the chitinous membrane of micromites and cockroaches, pet hair (cats), plant pollen. Genetic predisposition causes an increased sensitivity of the bronchi to the factors described above. Asthma attacks can be triggered by inhalation of cold or hot air, physical effort, stressful situations by inhaling 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" asthma caused by chronic aspirin use.

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

Methods for diagnosing bronchial asthma

Diagnosis of bronchial asthma it is a complex and multi-step process. The initial stage of diagnosis is the collection of anamnestic data (patient survey) and clinical examination patients, 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 features every patient.

On the 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 bronchial muscle tone in the morning (3-4 am). 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 note some individual symptoms the upcoming attack: runny nose, sore throat, itching of the skin, etc. Then comes progressive difficulty breathing. At first, the patient notes only difficulty in exhaling. There is a dry cough and a feeling of tightness in the chest. Respiratory disorders force the patient to sit down with his hands leaning in order to facilitate breathing by the work of the auxiliary muscles of the shoulder girdle. The increase in suffocation is accompanied by the appearance of wheezing, which at first can be detected only by auscultation of the patient, but then become audible at a distance from the patient. For an attack of suffocation in bronchial asthma, the so-called "musical wheezing" is characteristic - consisting of sounds of different heights. Further development an attack is characterized by difficulty in breathing due to the installation respiratory muscles pregnant deep breath(bronchospasm prevents air from being expelled from the lungs during expiration and leads to the accumulation of large amounts of air in the lungs).

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

Most characteristics are detected when examining a patient with an asthma attack. As a rule, the patient seeks to take sitting position and rests his hands on a chair. Breathing is elongated, intense, participation of auxiliary muscles in the act of breathing is noticeable. jugular veins on the neck swell on exhalation and subside on inhalation.

When percussion (tapping) of the chest, a high (box) sound is detected, indicating the accumulation of a large amount of air in the lungs - it plays an important role in diagnosis. Lower bounds lungs are lowered and inactive. On auscultation of the lungs, a large number of wheezing different intensity and heights.

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

Especially serious condition is asthmatic status - in which progressive suffocation endangers the life of the patient. At status asthmaticus, all clinical symptoms more pronounced than with 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 heart rhythm disturbances.

Additional methods for diagnosing bronchial asthma

Carrying out a preliminary diagnosis of bronchial asthma is possible on the basis of clinical data collected using the methods described above. Determination of a specific form of bronchial asthma, as well as the establishment of pathogenetic aspects of the disease requires the use of additional research methods.

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

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

There are special devices that allow patients to determine the volume of forced exhalation at home. The control of 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). The determination of FEV is carried out in the morning before taking a bronchodilator and in the afternoon after taking the medication. A difference of more than 20% between the two values indicates the presence of bronchospasm and the need to modify treatment. Decreased FEV below 200 ml. reveals severe bronchospasm.

Chest radiography – additional method diagnosis 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 infectious-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- is to define hypersensitivity organism in relation to some allergens. Identification of the relevant allergen and its exclusion from the environment of the patient, in some cases, allows you to completely cure allergic asthma. To determine the allergic status, an antibody test is carried out type IgE in blood. Antibodies of this type determine the development immediate symptoms with 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 general idea about the patient's condition and prescribe appropriate 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 for diagnosis and treatment, Volgograd, 1998