Type 2 inflammation, the mechanism behind most cases of childhood asthma (Gettyimages)

“My son coughs all night, many nights, several times a year.” “The girl is excited for no reason, whistling is heard when breathing.” “The teachers tell me that he sits down during recess, that he doesn’t play with his classmates because he immediately gets short of breath.” In these sentences, parents may or may not have in mind asthma picturesbut – in the conditions of viruses and respiratory infections – it is important to identify this pathology, since it chronic illness the treatment of which is different: it requires education and determined medical activities.

Although asthma is a respiratory disease that can occur at any age, more common in children (affects one in ten in Argentina) and in people with a personal or family history of allergies. “Like many other chronic diseases, asthma is not curablebut you can get optimal control, which is the key to a good quality of life,” said the doctor. Jorge Masperospecialist in allergology and clinical immunology, medical director of the CIDEA Foundation.

In this sense, the expert pointed out that “people with asthma can lead normal lives even in the most severe casestherefore, it will always be important to have an adequate diagnosis that also takes into account the origin of asthma, the precipitating factors and severity of the condition, as well as adherence to the treatment prescribed by the attending physician.”

Diagnosis and follow-up of asthma in childhood, a complex path to well-being and quality of life (Getty)

manifestations of asthma They vary from person to person and may change in the same patient throughout life, but symptoms such as cough, shortness of breath (shortness of breath), feeling of a closed or tight chest, and wheezing in the chest are characteristic.

Experts say in a statement, “… main mechanism is type 2 inflammationan inflammatory process present in 85% of cases of childhood asthma.

There are a number of factors to consider in order to “comprehensively understand whether you are dealing with an asthma picture and determine how it presents in each patient in order to prevent complications and better control the disease,” they stressed in a statement. .

Asthma affects the quality of life of children and families in Argentina (Getty)

1. Symptoms and severity of episodes: “One of the important goals of treating asthma, especially in severe cases, is to exacerbation prevention, which images require medical attention, often urgent, ”said the doctor Veronica Dzhubergiapediatric pulmonologist at Garrahan Hospital.

As he explained, it is necessary to establish the way they occur, both in inception and development, duration, intensity, hourly fluctuations and patterns (permanent or seasonal); frequency, attendance on duty, hospitalizations, need for and response to medications.

Early recognition of the onset of symptoms by the patient and family will allow for early therapeutic intervention.c, prevent the progression of the crisis and reduce the likelihood of hospitalizations,” the expert added

Tools and technologies for administering asthma medications needed for effective treatment (Illustrative image by Infobae)

2. Development of the disease: “He diagnosis asthma in general clinical and confirmed spirometry and one bronchodilator 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 from 6 years old, this is usually achieved in the same way as in adults, ”Dzhubergia emphasized, emphasizing that this pathology,

According to experts, the development of the disease is associated with the age of onset, progressive nature or not, previous and current diagnoses and treatment methods. The fact is that there are children with asthma who reach adulthood without a diagnosis, although in many cases the symptoms indicating 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.

Except, 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. .

It is for this reason that Maspero pointed out: severe asthmaby definition, it is one that can’t be controlled despite adherence to adequate therapy at maximum doses, or even with controlled deterioration when treatment is reduced with high doses; affects 5 to 10% of cases“.

Asthma Education and Family Involvement, Key Factors for Successful Asthma Management (iStock)

3. Triggering or aggravating factors: “There are various etiological agents, such as indoor allergens, mites, animal epithelium, fungi or pollen, that affect exacerbations. Assess the patient’s allergic sensitization and environmental influenceswhich in many cases can be changed, which must be agreed with the specialist,” Maspero emphasized.

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).

Environmental Control and Allergen Prevention, Vital Steps in Treating and Controlling Asthma in Children (Getty)

4. Influence of disease: “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’s why it’s so it is necessary to look for ways to achieve the best control over the disease, to cope with its impact on different orders of lifeDzhubergiya admitted.

According to experts, this pathology can create difficulties for the patient, such as school absences, unwillingness to play games and sports, sleep, developmental, growth and behavioral disorders, as well as affect the family by changing the daily routine, loss of working time. and economic costs. That’s why it’s also important to understand what seizure-free periods are like, whether they have symptoms or not, exercise tolerance, occasional or frequent need for medication, among other things.

Phase 3 clinical trial of new asthma drug, including dupilumab, targets severe asthma in children aged 6 years and older (iStock)

5. Training: “Those children who cannot control their disease with conventional therapies will be at risk for more crises, may require hospitalization and repeated courses of systemic corticosteroids, the sum of which can ensure long-term health,” Giubergia said. risks.”

Thus, the experts pointed out that involvement of the family and the patient himself in the knowledge of the disease is keyits chronic course, the creation and follow-up of an asthma control plan together with a healthcare professional, which also includes the proper administration of medications and specific recommendations on how to act in a crisis.

As for the treatment, experts noted that there is encouraging news. “In medicine, there are increasingly better therapeutic options that improve the health and quality of life of patients and their families. For example, in an event for health professionals, an indication that biological dupilumab (present in our country since 2019) received a few months ago for children from 6 to 11 years old as adjunctive supportive care for severe asthma caused by type 2 inflammation when it is not controlled with standard treatment; due to the fact that phase 3 clinical trials of this new therapy were conducted in 11 medical institutions in Argentina and Chile,” they wrote in the letter.

As they stated, “This drug has been shown to reduce the frequency of exacerbations by 65% ​​in children aged 6 to 11 years with moderate to severe asthma in one year of treatment. uncontrolled and led to a rapid, sustained and clinically significant improvement in lung function after 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 that we can look forward to this type of therapeutic innovation in the country,” concluded Maspero.

Keep reading:

Asthma: When Difficulty Breathing May Be a Doctor Seek or Alarm

Asthma in Argentina: Half of patients don’t know they have it

World Asthma Day: symptoms and treatments for a terminal illness that can be controlled

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