Although asthma is a respiratory disease that can appear at any age, it is more common in children (it affects one in ten in Argentina) and in people with a personal or family history of allergies.
“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,” said Dr. Jorge Maspero, Allergy and Clinical Immunology Specialist, Director of the Cidea Foundation.
In this sense, the expert noted that “People with asthma can lead a normal life 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 asthma, trigger factors and severity of the condition, in addition to adherence to treatment determined by the treating person. medical worker.”
The manifestations of asthma vary from person to person and may change in the same patient throughout life, but it is characterized by symptoms such as coughing, shortness of breath (dyspnea), feeling of tightness or constriction in the chest, and wheezing (wheezing). ) in the chest chest.
As stated in the experts’ statement, “The underlying mechanism is type 2 inflammation, an inflammatory process present in 85% 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. .
1. Symptoms and severity of attacks: “One of the main goals of asthma management, especially in severe cases, is to prevent exacerbations that require medical attention, often emergency,” said Dr. Veronica Giubergia. pediatric pulmonologist at Garrahan Hospital.
As he explained, it is necessary to establish how they arise, both in their beginning and in their development, duration, intensity, hourly variations and character (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 his family will allow for early therapeutic intervention, prevent the progression of the crisis and reduce the likelihood of hospitalizations,” the expert added.
2. Development of the disease: “The diagnosis of bronchial asthma is mainly clinical and is confirmed by spirometry and bronchodilatory test. In young children (preschoolers), the diagnosis is more difficult because lung function tests such as spirometry are more difficult to perform. 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.
In addition, determining the severity of asthma in each patient is crucial. 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 asthma is, by definition, one that cannot be controlled despite adherence to adequate therapy at maximum doses, or which, even if it can be controlled, worsens when treatment with high doses is reduced; It affects 5 to 10% of cases.”
3. Trigger or aggravating factors: “There are various etiological agents, such as indoor allergens, mites, animal epithelium, fungi or pollen, that affect the aggravation. It is necessary to evaluate the patient’s allergic sensitization and the influence of the environment, which 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).
4. Impact of illness: “It is necessary to consider the impact on a child’s life when he cannot run or play with 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 necessary to find ways to achieve the best control over the disease, to cope with its impact on different orders of life, ”admitted Dzhubergia.
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.
5. Education: According to Jubergia, “those children who fail to control their disease with conventional therapies will be at risk for more crises, may require hospitalization, and repeat courses of systemic corticosteroids, the sum of which can pose health risks in long term.
Thus, the experts indicated that involving the family and the patient himself in knowledge of the disease, its chronicity, the development 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 situations.
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, an event for healthcare professionals provided an indication that the biological dupilumab (present in our country since 2019) had been obtained a few months earlier for children aged 6 to 11 years as an additional maintenance treatment for severe asthma. . caused by type 2 inflammation when standard treatment fails to control it; 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.
They stated: “Over one year of treatment, this medication 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 rapid, sustained and clinically significant improvement in lung condition. function from the 15th day 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.