Treating Asthma In Children
Asthma is one of the most frequent chronic diseases in childhood. It is a public health problem that has increased in recent years and leads to the consumption of large amounts of medication. So, in this article, we’re going to delve into the treatment of asthma in children.
What is asthma?
Asthma, according to the III International Pediatric Consensus, is a disorder characterized by “recurrent wheezing and permanent coughing in a situation in which asthma is possible and other less frequent diseases have been ruled out”.
The most common symptoms of an asthmatic episode are as follows:
- Wheezing.
- Dyspnea.
- Cough.
- Thoracic oppression.
- Airway obstruction.
- Bronchial hyperreactivity.
- Airway Inflammation.
Asthma Treatment in Children
Asthma treatment is usually divided into two big blocks. On the one hand, we have the treatment of acute crises and, on the other, the chronic maintenance treatment. The main goals of treating asthma in children are:
- Reduce and try to eliminate chronic symptoms.
- Prevent the appearance of acute attacks.
- Avoid, as much as possible, the use of medications and their side effects.
The main drugs used to treat asthma in children are:
- Bronchodilators for symptom relief.
- Anti-inflammatory drugs to control the disease.
Treatment of an acute asthma attack
When we are faced with an acute crisis, the goals of treatment change and the most important thing is to treat hypoxemia, which is a decrease in the pressure of oxygen in the blood. In fact, this is the first assessment that is usually done on a child who presents with an asthma attack.
The assessment of partial pressure of oxygen in arterial blood is done with a pulse oximeter that measures oxygen saturation. Thus, depending on the result obtained, the crisis can be classified according to its severity :
- Light : O2 saturation greater than 94%.
- Moderate : O2 saturation between 91 and 94%.
- Severe : O2 saturation less than 91%.
Hypoxemia is considered when the partial pressure of oxygen in the arterial blood decreases to less than 91%, or 60 mmHg. In these cases, the child must be sent to the hospital urgently. In addition, also when there is a risk of complications, a history of high risk or a lack of response to treatment.
In an acute crisis, the treatment used as the first option is the administration by inhalation of beta-2-adrenergic drugs. They are administered with a pressurized chambered inhaler system or with a nebulizer.
The most used drug is salbutamol. Other options may be ipratropium bromide or corticosteroids.
In all patients with an oxygen saturation of less than 94%, oxygen administration is required. Therefore, they must be referred to a hospital for further evaluation and follow-up.
Maintenance Treatment of Asthma in Children
When we talk about chronic maintenance treatment, we must especially take into account the age of the children. Generally, in addition to pharmacological treatment, the option of immunotherapy is evaluated and special emphasis is placed on education in the management of illnesses and crises.
In the treatment of asthma in children, as we said before, we should avoid, as much as possible, the chronic consumption of medications. It should start with a basic treatment which, if necessary, can be increased gradually.
The medications most used as maintenance treatment for asthma are inhaled corticosteroids, such as budesonide or fluticasone.
It is important to control corticosteroid doses to avoid unwanted side effects. If it becomes necessary to increase the dose, it is often preferable to combine them with bronchodilators.
It should be borne in mind that, in children under 3 years of age, most asthma episodes occur because of viral infections and symptoms resolve regardless of treatment. Therefore, one should not abuse unnecessary drugs that can cause more harm than good.
