Childhood asthma today
Childhood asthma is a major public health problem.
It is recorded as the most common chronic disease in children, is one of the most common reasons for their visit to the Emergency Department and remains a frequent reason for admission to the Hospital. The social and economic cost of the disease has been estimated and found to be particularly high, while epidemiological indicators show a continuous increase or a tendency to stabilize in Western societies.
During the last decades, significant progress has been made in the field of understanding the pathogenesis of the disease, the way to manage the chronic phase and exacerbations, as well as the prevention of the disease. However, there are still gaps in the full understanding of the mechanism by which the disease manifests, the choice of the simplest but safest diagnosis and, finally, the optimal treatment.
The clinical pattern of childhood asthma is recurrent episodes of wheezing, coughing, shortness of breath and chest tightness, which may vary in severity and duration.
The main disorder that leads to the above symptoms is intermittent airway obstruction due to spasm of the muscle fibers of the bronchial wall and inflammation in the mucosa that cause narrowing of the lumen and, ultimately, restriction of airflow. Sensitivity (bronchial hyperresponsiveness) to various stimuli that trigger the onset of the episode usually coexists. Such stimuli are viral respiratory infections, allergies, exercise, inhalation of irritants and others.
For each patient, the characteristic symptoms of the disease (phenotype) vary. Thus, for some children, persistent or intermittent wheezing may predominate, others may exhibit rapid deterioration with severe respiratory distress, and others may have a chronic cough. The variety of clinical phenotypes becomes more evident when factors such as age, allergy (inhaled perennial or seasonal allergens) and co-existence of other diseases (e.g. obesity) are included.
Various criteria are used to classify the disease.
Depending on the criterion, an appropriate adjective is prefixed to the word asthma. Common criteria include age (e.g. infantile, pediatric), severity (e.g. intermittent, persistent), level of control (e.g. fully, partially controlled, uncontrolled), the factor that triggers the manifestation of symptoms (e.g. allergic, infectious, after exercise), etc.
The aggressive designation bronchial that is often prefixed to the word asthma is a residual term, from when it was needed to contrast it with cardiac asthma. Today, when it is known that it is by definition a disease of the airways, it is obviously redundant.
Childhood asthma is often outgrown with advancing age. Especially that caused by infections. In order to reduce the days that young patients experience symptoms, avoid or reduce their number of hospital admissions, and improve the quality of life of patients, it is necessary to have appropriate monitoring, take the prescribed treatment, and pursue physical activity.
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