Asthma in children

Abstract

Asthma is a chronic and heterogeneous disease that affects more than 250 million people around the world. In children, it has a prevalence of 13.7%. It has a multifactorial origin with a genetic base, and its clinical expression will depend on the predisposing and triggering factors that result in a specific phenotype. Allergic phenotype is most common in children, and has an earlier onset. Diagnosis is suspected by the clinical triad of cough, wheezing and distressed breathing which can be triggered by an allergen, exercise or infection, and vary in time and intensity. In children 6 years and older confirmation can be obtained by pulmonary function tests, which will reveal reversible airway obstruction. In younger children the diagnosis might not be as easy due to the many factors that can trigger cough and wheezing other than asthma (for example virus-induced wheezing). Tools (mAPI) have been developed to help differentiate between asthma and other causes of wheezing. Treatment is based on inhaled steroids, and the aim of the physician must be to find the minimum necessary dose to maintain control of symptoms. Treatment can be escalated or lowered according to the “treatment ladder”, and second medications (LABA) can be added if needed. Inhaler technique is as important as the medication itself to achieve control, and must be checked frequently. If control is lost, an asthma crisis might occur. Caregiver´s knowledge on identifying and treating the crisis is essential to prevent complications.