Asthma of the child over 7 years

This is the most typical form of intermittent asthma with paroxysmal dyspnea in which the allergic component is predominant.

Asthma of the preschool child.

The crisis is characterized by episodes of dyspnea (difficulty breathing) sibilant (wheezing) occurring readily in the evening, or in the second half of the night but also the day. This nocturnal predominance can be explained by the weather conditions of the environment, circadian rhythms (nocturnal hypoactivity of the adrenals) and the anxiogenic role of night. Also, in bed, the child is in contact with the feathers of the pillow, wool blankets, plush toys and dust from the ambient air.

This is typically an "expiratory bradypnea", and the expiration is difficult, slow and prolonged. The child finds it difficult to exhale the air he inspires.

Between attacks, the asthmatic child breathes normally. The auscultation is perfect. Only specialized tests (EFR or respiratory functional tests) allow crises to detect bronchial hypersensitivity characteristic of asthma.

Sometimes the crisis is preceded by prodromes (general malaise, irritability, conjunctivitis, digestive disorders, sneezing, runny nose ...) and evolves in two phases.

The dry phase is characterized by an expiratory bradypnea which awakens the child brutally by a feeling of choking. In the beginning, a spasm of the bronchial musculature is created, edema of the mucosa and a secretion of a thick and adherent mucus that accumulates in the lumen of the bronchus. This causes airway obstruction. All the inspired air can no longer be exhaled and remains in the alveoli producing "obstructive emphysema". The child, soaked in sweat, anxious and agitated must sit in bed, which facilitates his breathing. The chest is blocked in inspiration.

The catarrhal wet phase is the second step.

When the hypersecretion of the mucous glands has been discharged into the bronchi of small caliber, the sibilances appear. These are expiratory whistles often perceived spontaneously by the patient and the entourage, better understood at the auscultation by the doctor. They are the primary symptom of asthma. Parents say the child "whistles".

Fits of coughing lead to mucous sputum (sputum), scanty, compared to grains of cooked tapioca or gray pearls. The veins in the neck become distended but there is no cyanosis. The temperature is normal at the beginning but a moderate fever often appears secondary even in the absence of superinfection. The doctor notes a tachycardia but a normal blood pressure.

Sometimes they are associated with: obstructive rhinitis, sinusitis, conjunctivitis, eczema etc.

The threshold at which the asthmatic child complains of respiratory discomfort varies greatly from one child to another. Some children panic and claim their medications for very small bronchial obstructions while others tolerate without complaining much larger obstructions. Caution should therefore be exercised in assessing the severity of an asthma attack.

During the crisis, there is little need for further testing.

A chest x-ray would show thoracic distension and confirm the absence of complications. The blood count would show hyper-eosinophilia. The study of bronchial flows would indicate their reduction.

After a certain time, spontaneously or under the effect of treatment, the crisis ceases but the sibilances persist for a few hours.

Several factors can trigger these attacks: massive allergic contact, bacterial or viral infectious episode, climatic factor, psychological influences, etc.

Infant asthma (asthma bronchitis, bronchiolitis, bronchoalveolitis, dyspneising bronchitis, etc.)

The crisis often occurs in a context of viral infection such as a banal rhino-pharyngitis. The infant suddenly begins to breathe quickly. The cough is not constant but it is embarrassed to breathe. He loses his appetite and fever rises. The examination reveals signs of respiratory distress: supra and sub-sternal, intercostal, flapping of the wings of the nose. Auscultation is the sound of "frying", a mixture of sibilance, ronchus and subcrepitant.

In severe forms, cyanosis appears with disturbing polypnea and right heart failure.

In moderate attacks, the symptoms regress in 2 or 3 days but there is still sibilance and rhino-bronchial congestion. Paroxysmal worsening may occur during exposure to cold or during a meal.

In a few hours or days, several phases follow: nasal discharge then dry cough and nocturnal quinteuse, finally appearance of sibilances. In a few days, the cough becomes "greasy". Dyspnea is very moderate or absent. The expectoration is often swallowed by the small child and then rejected during vomiting.

Auscultation finds disseminated ronchus. The throat is red, the fever is high and the diagnosis of rhino-bronchitis is often carried. Two elements must evoke the asthma before this table evoking common bronchitis

One particular form is very frequent: children who present a cough, isolated, recurrent, nocturnal occurring either spontaneously or during an effort (running, excitement during games, laughter, crying , Cries etc.), exposure to cold. These are asthmatic equivalents. Some children can cause asthma attacks just by breathing quickly and amply.

The repetition of these seizures, their stereotyped character, the existence of a family history of allergies or eczema makes it possible to suspect the asthmatic disease.

Stress asthma ("exercise-induced asthma" or A.I.E.)

A.I.E. Is sometimes the only apparent manifestation of asthma. Other times, the crisis occurs in a known asthmatic child whose seizures are also allergic.

A.I.E. Often starts after stopping exercise, recovery and spontaneously gives in a few minutes. The child is dyspneic, his breathing is wheezing and there are sibilances. This table should be differentiated from the common breathlessness to the effort imposing its stop. It should be noted that patients may suffer from A.I.E. Without knowing it: they believe they just get out of breath quickly.

The causes of bronchospasm are multiple: hyperventilation, release of chemical mediators during ample respiratory movements, buccal breathing of a cooler and drier air than that inspired by nasal breathing etc ...

The extent of bronchospasm depends on the type, intensity and duration of exercise. Mid-distance running (800 meters), foot-ball, rugby, cross country in cold weather in steep and hilly terrain are more often involved than walking or swimming.

Diagnosis can only be confirmed by respiratory functional tests (stress tests). Treatment is preventive.

The recurring and stereotyped character of crises, and the existence of sibilants at the auscultation associated with the ronchus.