What is asthma?
Bronchial asthma is a chronic inflammatory disease characterized by reversible airway obstruction due to narrowing of the bronchi and bronchioles, resulting in episodes of coughing, shortness of breath, wheezing and chest tightness.
Usually, childhood asthma is of atopic etiology; which means it occurs because of allergy to certain triggers like pollens, pet hair, mould spores or house dust mite. Atopic asthma in children usually runs in the family with positive family history for coughing and sneezing on exposure to certain allergens. Adult asthma often results from particulate matter irritants (PM2.5 or PM10) like mould spores, pollens, smoking, chest infection, stress or drugs.
How childhood asthma happens?
Allergy or hypersensitivity occurs when our bodies abnormally view some non-harmful substances (allergens) as harmful, and start reacting against them by releasing "harmful" chemicals that lead to inflammation and asthma. On exposure to allergy, plasma cells (the immune-cells that secrete antibodies) start to produce a specific type of antibody called immunoglobulin E "IgE", which in turn causes production of large amounts of a chemical substances called "Histamine" (Figure 1). Histamine and other chemical mediators released during asthma attacks are responsible for the usual symptoms, as they act on the bronchi leading to narrowing of their diameters, dilatation of their blood vessels and secretion of viscid mucous (causing more narrowing).
Epidemiology of asthma
Statistics show that:
- Asthma affects approximately 10% of the population worldwide.
- About one fourth of all children suffer from wheezing at some point of their childhood.
- Childhood asthma is twice more common in boys than girls.
- Adulthood asthma is more common in females than males.
- Poor indoor air quality and exposure to water damaged buildings increases chances for worsening of asthma.
- Asthma is one of the most common causes for ER visits.
Triggers for childhood asthma
- Cold: Respiratory infection by a virus is the most common trigger for asthma episodes especially in young children. Infection causes edema in the inner mucosal layer of the bronchi, bronchoconstriction and increased mucous secretion, which leads to narrowing of bronchial diameter, predisposing the person to asthma attacks.
- Passive smoking/Vaping: Smoking is the most common cause of chronic obstructive pulmonary diseases (COPDs) in adults, also passive smoking worsens asthma in children. Vaping also releases hazardous and toxic levels of PM2.5 particulate matter into the airspace and should not be considered a safer alternative to traditional (combustion) cigarettes due to the particle clouds that are created when vaping indoors.
- Pollen, pet hair, house dust mites and moulds (spores and cell wall fragments): To control your child's exposure to the above allergens, you should keep a dry, clean condition of the home, wash all bedding weekly, use mite-proof covers followed by HEPA (high efficiency particulate air) vacuum cleaning of carpets, mattresses and furniture. Proactively addressing and maintaining good indoor air quality is critical to control your child's atopic asthma.
Different medications for childhood asthma
Some of these drugs are used during the attach to relief the symptoms, others are used in between to decrease the likelihood of attach occurrence.
- Short & Long acting Beta-2 agonist inhalers. They cause bronchodilatation.
- Non-selective Beta-adrenergic stimulants [Epinephrine : Adrenaline]. Causes mast cell stabilization (prevents release of histamine)
- Anticholinergic drugs [e.g.: Atrovent]. Prevent bronchoconstriction (prevent asthma).
- Inhaled, oral, and injected corticosteroids. Cause bronchodilatation, ↓ histamine release, ↓ mucous secretion. They are very powerful anti-inflammatory drugs.
- Supplement oxygen.
- Antibiotics for infections.
Main symptoms of childhood asthma
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