Asthma and Age
Age is one of the most significant criteria that determine the phenotype of asthma.
The clinical picture of asthma in different age groups has a number of characteristics, and therefore the choice of diagnostic methods and treatment strategies should be based on age.
In practice, for these purposes, the following age groups are distinguished:
- children from 0 to 2 years;
- preschool children from 3 to 5 years;
- schoolchildren from 6 to 12 years;
Studies show an undeniable connection between “child” and “adult” bronchial asthma, but the data on the transition of the disease to persistent remission are quite contradictory.
It was found that bronchial asthma disappears in 30-50% of children (especially males) in the puberty period, but often reappears in adulthood.
It is known that asthma, which began in childhood, in 60-80% of cases continues in patients who have reached adulthood.
The evolution of the disease at school age is of great interest. This is the period when there is intensive growth, the hormonal background sharply changes.
Pubertal age in many patients is a turning point in the course of allergic diseases, the further development of the disease is determined by the successes of prevention and treatment.
The adequacy and systematic nature of the treatment are essential for the outcomes of asthma in children.
We will discuss the characteristics of asthma in children and its phenotypes in the next post. So far, we will review these aspects shortly.
In childhood, asthma preserves all features of an allergic, hereditary-conditioned disease.
In connection with the anatomophysiological features of small children (narrow lumen of the bronchial tree, poorly developed muscular layer, significant development of the blood and lymphatic vessels), for a long time, this diagnosis is hidden under the mask “ORI with bronchial obstructive syndrome”, “recurrent obstructive bronchitis.” Asthma at an early age is often not recognized, and patients are treated not rationally.
The clinical symptoms of asthma change during the day, so complaints and auscultative picture can also change due to the fact that obstruction is reversible (spontaneously or against the background of treatment).
The entire set of symptoms should be discussed over the past 3-4 months, paying special attention to those who have been harassed for the previous 2 weeks.
In addition to the symptoms characteristic of asthma, it can even be a decrease in activity: the child runs, plays and laughs with less intensity than other children; quickly gets tired when walking.
Whistling breathing should be confirmed by a doctor since parents may misinterpret the sounds their child makes when breathing, especially if they try to listen to the child themselves.
Teenagers should be alerted to the bronchospasm arising during physical exertion.
In adulthood, the diagnosis of asthma is also purely clinical and is established on the basis of complaints, anamnesis, an auscultatory picture.
Spirometry with bronchodilator test is mandatory for suspected asthma. Spirometry should be performed during each visit to a specialist. With a favorable course of asthma and good control, spirometry should be conducted at least once every 6-12 months.
Definition of a specific allergological examination (skin tests with allergens and / or determination of specific IgE in serum). Thus, we determine the type of asthma: allergic, not allergic, mixed.
In adult patients with a high probability of bronchial asthma, trial treatment is prescribed immediately!
If the treatment does not work, doctors evaluate compliance (the patient’s adherence to treatment), the correct technique for using inhalers, and … And the question is: is it really asthma?
A diagnostic search is being conducted to determine a more alternative diagnosis (upper respiratory tract diseases: rhinitis, vocal cord dysfunction syndrome, gastroesophageal reflux disease, heart disease, pulmonary fibrosis, chronic obstructive pulmonary disease, etc. There will also be discussed in a separate article.