Rus Articles Journal

When to breathe unbearable. Bronchial asthma at the child of

Success of fight against bronchial asthma depends on many factors including from that, how diligently parents of the sick child implement recommendations which the doctor makes. What mother needs to remember to facilitate a course of disease at the kid?


For final establishment of the diagnosis “bronchial asthma“ (BA) of the child needs to be surveyed in the conditions of specialized allergologichesky office of children`s hospital or it is out-patient, but under supervision of the allergologist.

Poll of parents - an important point in diagnosis of asthma. Interests the doctor as pregnancy proceeded whether happened during it toxicosis, diseases, violations of a diet. Whether was complications at childbirth and problems with health at the newborn baby. What he was ill whether antibiotics were appointed to it and as he transferred them what was reaction to preventive inoculations. Whether there was it on breastfeeding whether food allergy was observed, and whether there are no reactions to hair of animals. It is also necessary to find out whether close relatives have allergic diseases (OH, pollinozy 1 , food and medicinal intolerance etc.). Also the doctor asks as at the child asthma attacks begin and proceed. Whether seasonality in their emergence is noted. Finds out probable occasions to start attacks (contact with an animal, walk in park, physical activity etc.) . What preparations were used and what their effect. All these data are necessary for the doctor in order that it is correct to examine the child, to establish the diagnosis and to appoint treatment. During consultation it is good to have at itself the polyclinic card of the child where there are records about the postponed diseases, results of blood tests, data of other diagnostic testings conducted earlier.

Identification prichinno - significant allergen is the following stage of diagnostics.

to Define

what allergen causes a disease, is possible by means of skin tests. The principle of their statement such is. On skin from the inside of forearms of the patient small scratches or injections are given, then on them the solution containing molecules of any allergen is dripped (there are special ready sets of food, pollen, household allergens). In the presence the child of hypersensibility to concrete allergen on skin has a blister. It occurs quickly enough, as a rule, within 20 minutes. Thus, it is possible to reveal the substance “guilty“ of allergic reaction of the patient.

Method rather simple. However statement of skin tests is possible only in an allergologichesky office and is made by specially trained nurse under supervision of the doctor. Besides, it has contraindications.

Test is not carried out by


allow to Reveal prichinno - significant allergens irrespective of a state of health of the child and his age laboratory methods. The most widespread of them - the immunofermental analysis (IFA) at which once take blood from a vein (not necessarily on an empty stomach) and determine by existence in serum of blood of specific protective proteins (antibodies) developed in response to repeated effect of allergen. Time in 2 - 3 years as the range of allergens can change over time is recommended to conduct such examination of the child.

to All children 5 years with suspicion on OH are more senior than

investigate function of external breath (FVD). This research of respiratory function of lungs. By means of the special device exhalation parameters are measured, and on the screen the graphic curve with the indication of the main indicators of work of respiratory system is displayed. At the same time the level of bronchial passability comes to light. Research allows to choose medicine for the specific patient also individually.

the Obstruction, i.e. narrowing of bronchial tubes, is most sharply expressed during an aggravation (the period of the repeating attacks), but it remains also after disappearance of clinical manifestations of an attack, though in a smaller measure. And at many patients it is observed also between the periods of aggravations, in particular at the heavy course of asthma. Important difference OH from other chronic pulmonary diseases - in reversibility of obstruction which has no steadily progressing current. Extent of narrowing of bronchial tubes can change at the same patient during the different periods of an illness and even within one day.

the Out-patient help If the diagnosis is OH established to


, the child needs supervision at the children`s allergist, for example in an allergologichesky office of children`s policlinic at the place of residence. Even in the absence of attacks it is necessary to show 1 time in 3 months the child to the allergologist.

the Children suffering from a severe form OH have the right for disability registration. In the large cities there are special improving centers for patients OH where along with the advisory help children can receive massage, be trained in respiratory gymnastics.

One more type of treatment practiced in the similar centers - use of a speleochamber. A speleochamber call the medical room, walls which floor and a ceiling are revetted with natural salt blocks which contain potassium have medical and bactericidal (killing bacteria) effect. The special microclimate supported here makes curative impact on lungs.

If necessary to the child at the place of residence provide to

the permit in sanatorium for children from a bronchial tube - pulmonary pathology.

at allergokabineta work as

At the present stage so-called asthma - schools . In them the children having asthma and their parents are trained. Besides an explanation of problems OH they get useful tips on treatment both in criminal, and in vnepristupny the periods, data on new preparations, and also are trained to use correctly auxiliary devices for the best delivery of drugs in bronchial tubes. Devices assistants

to Parents it is useful for p to know

that there are various ways of delivery of antiasthmatic drugs in an organism. Except tablets, syrups and mixtures which are applied oral (through a mouth) there are preparations for hypodermic, intramuscular and intravenous administration. They are used mainly in the conditions of a hospital. But there is also big group of medicines which are entered into an organism by means of inhalations. For example, the dosed aerosol inhalers (DAI) - portable barrels with medicine. Advantage of DAI consists that medicine moves is strictly dosed that allows to consider the received quantity of a preparation; besides, getting on mucous bronchial tubes in the form of an aerosol, it has fast and effective effect, removing a spasm.


to use an inhaler, it is necessary:

  • to remove a protective cap;
  • to stir up an inhaler;
  • smoothly to exhale
  • ;
  • to clasp a mouthpiece with lips;
  • pressing
  • a barrel, slowly and deeply to inhale;
  • to hold the breath approximately on 10 pages;
  • to wait for
  • 30 pages before the second inhalation.

However small children are not able to make a full-fledged breath of DAI independently. Therefore for fuller hit of a medicinal dose in an organism there are such devices as a speyser . This small easy device in the form of the hollow cylinder or a sphere supplied with a mask or a mouthpiece. Some kind of tank located between an inhaler and airways of the kid and facilitating drug intake. DAI is inserted into a special opening of a speyser into which cavity the preparation dose is injected, and directly inhalation of medicine happens through a mask (for children till 4 years) or through a mouthpiece (for children of 4 - 6 years). Thanks to a speyser efficiency of inhalation therapy increases.

Other device for delivery of drugs in a bronchial tree is the nebulizer (from armor. nebula - fog). The device consists of the compressor and a mouthpiece connected among themselves by a flexible hose. If inhalation is carried out to children of younger age, the mask is put on the device. Aerosol fog well gets into the lower departments of airways by means of compressed air or ultrasound. The nebulizer can be used as in the conditions of a hospital, and at home. However this device is too bulky to carry it with itself. Moreover, if the nebulizer is not equipped with the dosimeter, he does not allow to calculate a medicine dose precisely. And still the mask of the nebulizer is more convenient than a mask of a speyser for children of younger age. Besides, to children at whom heavy attacks OH are observed use of the nebulizer for removal of an attack is often vital.

the Main methods of treatment

the easiest, safe and effective ways of treatment and the prevention of aggravations OH are elimination of allergens and medicamentous therapy.

Having begun
in the childhood, asthma most often remains with the person and in mature years.

When prichinno - significant allergens are revealed, the doctor can make recommendations of their elimination (elimination) from an environment of the sick child. Often it renders very good effect and leads to recovery. For example, identification of pollen allergens allows to determine time of influence them on an organism. And knowing about existence of a cross allergy (for example, the allergy to pollen can be combined with an allergy to some foodstuff), it is possible to develop the diet allowing to avoid painful reactions. Quite often it is possible to warn an exacerbation of an illness, leaving in other climatic zone for blossoming of the plants capable to provoke an attack.

the Main objective of medicamentous therapy OH consists in achieving control over a disease, i.e. to make aggravations more rare, to weaken night attacks (ideally - to achieve their complete cessation), to normalize indicators of the function of external breath (FEB) and so forth. At the same time it is important to minimize side effects of the carried-out therapy. And also to eliminate restrictions of physical activity and to prevent possible disability.

Anti-inflammatory therapy

OH is the cornerstone of

a chronic inflammation therefore in treatment of this illness protivospalitelny therapy is key. It also call basic. It is appointed taking into account initial severity of a disease.

the inhalation way of introduction of preparations Is preferable

, to children 5 years are more senior control of FVD is obligatory (to the child till 5 years difficultly to cope with a task of the doctor and to make an exhalation in the special device). Basic therapy is carried out is long, and it is impossible to cancel it independently as it often causes an aggravation, and weight of a course of disease in a similar case can amplify. Regular supervision of the expert will help not only to warn an aggravation OH, but also to correct treatment and whenever possible to reduce the volume of the received preparations.

If at the child it is observed by easy or medium-weight a course of disease (1, 2, 3 steps OH), basic therapy is carried out with use of the dosed inhalation non-hormonal (nonsteroid) resolvents. Treat them KROMOGLIKAT of SODIUM (INTAL) and NEDOKROMIL of SODIUM (TAYLED) . These preparations slow down release of the specific substances participating in an inflammation of a mucous membrane of bronchial tubes and at regular long (not less than 2 months) application reduce the frequency of exacerbations of asthma, that is carry out a preventive role. To children of early age carry out preparation solution inhalations by means of the nebulizer by a mask way or through a speyser.

At a heavy current OH (the 4th step) or if treatment by other groups of preparations does not give effect, it is necessary to use the dosed inhalation hormonal means. It is of BEKLOMETAZON , of BUDESONID and of FLUTIKAZON . They possess the greatest anti-inflammatory action, reduce hypostasis of a mucous membrane of bronchial tubes and secretion of bronchial glands, that improving respiratory functions. Provide protection against a bronchospasm at contact with allergen, prevent changes of structure of bronchial tubes - at prolonged use the frequency of aggravations decreases. These preparations can be applied also by short courses (at treatment of aggravations), and is long, not less than 6 - 8 months (especially at a heavy current OH). Drugs can be injected in an organism by means of the nebulizer and through a speyser. In hard cases hormones in tablets and in the form of injections can be appointed. As a rule, such therapy is carried out in the conditions of a hospital.

Parents often ask

why they to the child appoint medicines if attacks already stopped.

The matter is that treatment is OH directed to removing an allergic inflammation, and it occurs only at prolonged use of drugs. Besides, basic therapy allows to achieve remission (lack of external displays of an illness). If remission was not interrupted within 5 years, medical supervision over the child can be stopped. However it is impossible to forget that the child had asthma. Unfortunately, attacks can renew at any age.

as additional measures are appointed by bronchial spasmolytics - the inhalation preparations expanding bronchial tubes. At insufficient effect of basic anti-inflammatory therapy, and also for the prevention of attacks OH, especially night, to children 4 years in a complex of treatment are more senior add preparations of long action - the prolonged bronchial spasmolytics. Treat them of SALMETEROL and of FORMOTEROL . They weaken smooth muscles of bronchial tubes and reduce their sensitivity to allergen, block release of the substances supporting an inflammation.

also combined preparations containing hormones and the prolonged bronchial spasmolytics ( SERETID the MULTIDISK , etc.) Exist which are also used for basic therapy.

For fast elimination of lungs and moderately expressed symptoms of asthma are appointed by the inhalation dosed preparations - bronchial spasmolytics of short action: SALBUTAMOL , of VENTOLIN , of ATPOBEHT , of FENOTEROL . Duration of their action - 3 - 5 hours. They quickly remove a spasm of bronchial tubes, eliminate the whistling rattles and cough.


as additional therapy also such preparations weakening smooth muscles of bronchial tubes as of AMIIOFILLIN , of EUFILLIN in tablets or injections can be used.

If control over a disease is established to

and is supported during certain time, the doctor, as a rule, corrects a treatment technique, trying to reduce the volume of the carried-out therapy. In case of resistant results severity of a disease has to be reconsidered also towards reduction. However all decisions concerning treatment are accepted only by the doctor since not only positive dynamics, but also weighting of course of an illness is possible.

the Preparation of the emergency help

Parents of the child suffering OH always have to have at themselves the dosed aerosol inhaler - Salbutamol which quickly eliminates asthma attack, or other preparation which effectively fights against attacks, and a small bottle with non-carbonated drinking water (liquid will reduce viscosity of a phlegm).

do not give to the small child an inhaler for independent use. It can lead to overdose of a preparation and serious consequences.


Identification of allergens (house dust, pollen of plants and so forth) causing OH, allows to carry out further to children an allergenspetsifichesky immunotherapy (ASIT) . The essence of a method consists in introduction to the child`s organism with a certain frequency of the increasing doses of “guilty“ allergen that leads to development of special antibodies which will be able to prevent attacks OH at contact with the allergen which was earlier causing an exacerbation of an illness. ASIT allows to prevent transition of easy forms of a disease to heavy, reduces (or even completely eliminates) need for medicines. By means of this therapy it is possible to achieve long-term remission.

of ASIT it is appointed the allergologist and it is carried out by him according to specially developed schemes. The hypodermic method of introduction is most widely used. Now use of specially developed allergens which can be entered sublingual (under language) or orally is begun (through a mouth). These new methods, certainly, it is more preferable, especially to children. However the range of such allergens is still small.

Most often the initial stage of course ASIT, especially at younger children (of 3 years), is carried out in a hospital during remission according to the special scheme: 2 - 3 injections of allergen daily within 2 - 3 weeks. Then the course proceeds under supervision of the doctor allergolo - a gichesky office in policlinic: 1 - 2 injections a week within 1 - 2 months. During ASIT aggravations OH are possible. Achievement of good effect, as a rule, requires carrying out not one course ASIT, but two - three. In cases of a heavy course of disease of ASIT do not carry out.

the Forecast

at OH should belong To the concept “recovery“ carefully as it represents in essence only long remission which can be broken under the influence of various reasons. Having begun in the childhood, asthma most often (in 60 - 80% of cases) remains with the person and in mature years.

How favorable will be a forecast, depends on many factors, main of which - disease severity. At patients with easy liberation from attacks of the complicated breath is OH possible. At OH average weight and at its heavy current in most cases it is possible to achieve improvement, however the total disappearance of attacks is observed seldom with age.

Besides severity, the outcome of an illness is influenced by presence at the sick kid of other allergic manifestations (a food and medicinal allergy, a pollinoz). At treatment of asthma at children adequacy and systematicity of the appointed procedures, timely statement of the diagnosis, early identification and removal of allergens is very important. All this allows to achieve improvement of a condition of the sick child. And parents have to remember what OH is a chronic disease therefore the child suffering from it needs continuous supervision and treatment.