Asthma is a respiratory disease that can appear at any age but is more common in children (affecting more than 10%) and in people with a personal or family history of allergies.
Its presentation varies from person to person and may change in the same patient throughout his or her life, but it is characterized by symptoms such as coughing, shortness of breath (shortness of breath), chest tightness or tightness, and wheezing ( wheezing). in the chest.
“Like many other chronic diseases, asthma cannot be cured, but optimal control can be achieved, which is the key to a good quality of life. People with asthma can lead normal lives even in the most severe cases, so it will always be important to have an adequate diagnosis that also takes into account the origin of the asthma, precipitating factors and severity of the condition, in addition to adherence to the treatment regimen set by the treating physician,” explained Dr. Jorge Maspero, specialist in allergology and clinical immunology, medical director of Fundación CIDEA.
The following are factors to consider in order to fully understand if you are experiencing asthma and determine how it manifests in each patient in order to prevent complications and better control the disease.
- Symptoms and severity of episodes: it is necessary to establish the method of their occurrence, both at the beginning and in development, duration, intensity, hourly variability and regularity (permanent or seasonal); frequency, attendance on duty, hospitalizations, need for and response to medications.
“One of the main goals of treating asthma, especially in severe cases, is to prevent flare-ups that require medical attention, often an emergency.
Early recognition of the onset of symptoms and their worsening by the patient and their family will allow for early therapeutic intervention, prevent the progression of the crisis and reduce the likelihood of hospitalizations, ”said Dr. Veronica Jubergia, pediatric pulmonologist at Garrahan Hospital.
- Disease development: This is due to age of onset, progressive or not, previous and current diagnoses and treatments.
“The diagnosis of asthma is fundamentally clinical and confirmed by spirometry and a bronchodilation test.
In young children (preschoolers), diagnosis is more difficult, as it is more difficult to perform a lung function test, such as spirometry. However, in children over the age of 6, this is usually achieved in the same way as in adults,” explained Dr. Jubergia.
There are children with asthma who reach adulthood without a diagnosis, although in many cases symptoms suggestive of asthma appear in the first years of life. About 4 out of 10 children with respiratory infections will eventually be diagnosed with asthma in later years. On the other hand, determining the severity of asthma in each patient is critical. Long-term follow-up of children with asthma between the ages of 7 and 10 years seems to confirm that the severity of their condition persists over time: those who develop severe asthma in early school age tend to have severe asthma in adulthood. age. .
“Severe asthma, by definition, is one that cannot be controlled despite adherence to adequate therapy at maximum doses, or that, even if it can be controlled, worsens when treatment is reduced at high doses; it affects 5 to 10% of cases,” Dr. Maspero described.
- Provoking or aggravating factors: Whether the episodes are associated with respiratory infections, exposure to environmental allergens (mites, animal skin, fungal spores or pollen) or environmental pollutants (tobacco smoke or other pollutants), association with environmental changes (travel, other place of residence), emotional factors (crying, laughing), food and supplements, medications (aspirin), gastroesophageal reflux, and factors such as cold air, exercise, or weather changes.
It is also relevant if the dwelling is urban or rural, house or apartment; geographic location and heating. Description of the bedroom (type of mattress, pillows, rugs, soft toys, books). Pets (cat, dog, etc.). Family smoking (number of smokers, frequency if smoking indoors).
Dr. Maspero pointed out: “There are various etiological agents, such as indoor allergens, mites, animal epithelium, fungi or pollen, that affect exacerbations. It is necessary to assess the patient’s allergic sensitization and the influence of the environment, which in many cases are modifiable, which should be agreed with the specialist.
- Disease impact: The pathology can cause difficulties for the patient, such as absenteeism from school, unwillingness to participate in games and sports, disturbances in sleep, development, growth and behavior, as well as affect the family with changes in daily routine, loss of work time and economic costs. That’s why it’s also important to understand what periods without seizures are like, whether you also have symptoms, exercise tolerance, occasional or frequent need for medication, etc.
“It is necessary to consider the impact on a child’s life when he cannot run or play with his peers; how much it affects the child and his entire family when he does not rest at night due to the symptoms and the fear that the difficulty in breathing will worsen and they will have to go to the emergency room. That is why it is so important to find ways to achieve the best control over the disease, to cope with its impact on various lifestyles, ”admitted Dr. Jubergia.
- Education: Involving the family and the patient in informing about the disease, its chronic course, establishing and monitoring an asthma control plan, together with a healthcare professional, which also includes the proper prescription of medications, is key. advice on how to act in a crisis situation.
“Those children who cannot control their disease with conventional therapies will be at risk for more crises, hospitalization and repeated courses of systemic corticosteroids, the sum of which can pose long-term health risks,” the specialist said. . . .
Good news about treatment
As far as treatment is concerned, the news is encouraging. Medicine increasingly has better therapeutic options that improve the health and quality of life of patients and their families. For example, at an event for health professionals today, an indication was presented that the biological dupilumab (present in our country since 2019) was received a few months ago for children aged 6 to 11 years as an additional maintenance treatment for asthma. y severe, caused by type 2 inflammation when standard treatment fails to control it.
In one year of treatment, this drug has been shown to reduce the frequency of exacerbations by 65% in children aged 6 to 11 years with uncontrolled moderate to severe asthma and cause a rapid, sustained and clinically significant improvement in lung function after only 15 days of treatment. .
“For a population that has had limited therapeutic options, the availability of innovative therapies that better control the pathophysiology of severe asthma, as well as a better safety profile, is a significant advance. It is good news that the science continues to advance and we can look forward to this type of therapeutic innovation in the country,” concluded Dr. Maspero.
