Pediatric Asthma

Excerpt

Pediatric asthma is characterized by variable expiratory airway limitation and persistent respiratory symptoms, including wheezing, coughing, shortness of breath, and chest tightness. Asthma often starts in childhood, with nearly half of all infants wheezing in their first year, and most developing persistent asthma by age 6. A complex interplay between genetic predisposition and environmental factors underscores its prevalence and severity. Additionally, patients commonly experience airway hyperresponsiveness and inflammation. The severity ranges from intermittent symptoms to potentially life-threatening airway compromise, necessitating a comprehensive diagnostic approach.

Generally, 2 groups of children exhibit wheezing and asthma-like symptoms at a young age. One group experiences sporadic symptoms, usually triggered by viral infections, and tends to overcome these episodes as they age. The other group tends to develop symptoms at a later age, often in combination with atopy, a family history of asthma, and an elevated risk of developing persistent asthma in the future. Researchers have attempted to predict which children are prone to long-term asthma by categorizing epidemiologic phenotypes, identifying genetic risk factors, and creating predictive tools. However, the clinical utility of these measures is currently limited.

Evaluation with spirometry, complemented by postbronchodilator response, is pivotal for establishing a definitive diagnosis. Spirometry aids in identifying various respiratory issues in children, including airway obstruction, restrictive lung disease, chest wall and respiratory muscle defects, diffusion defects, and respiratory muscle weakness. Although airborne agents typically dominate discussions of asthma triggers, a diverse range of stimuli, such as respiratory infections, allergen exposure, environmental irritants, physical activity, hormonal fluctuations, medications, and psychosocial factors, can precipitate or worsen symptoms. Treatment strategies revolve around educating patients and caregivers, regularly monitoring symptoms, and ensuring access to both fast-acting bronchodilators and appropriate controller medications tailored to disease severity.