Pediatric Asthma: Recognizing Symptoms and Effective Attack Treatment

What is pediatric asthma and why does it matter?

Pediatric asthma is the most common chronic disease among children and represents a significant burden on the healthcare system [1, 2]. This is a condition that requires constant attention and adequate control to prevent deterioration in the child's quality of life and limitations in their daily activity [7]. Uncontrolled asthma can lead to frequent exacerbations, emergency department visits, and hospitalizations [1].

It is important to understand that with proper treatment and asthma control, children can lead a full lifestyle, including sports and active games, no different from their healthy peers [2].

How to recognize asthma symptoms in a child?

Pediatric asthma symptoms can vary, but often include characteristic manifestations, especially during or after physical activity. Up to 90% of children with asthma may experience symptoms precisely during this period [2].

• Cough: often dry, paroxysmal, especially at night or after exertion [2].
• Wheezing: a characteristic sound that occurs during exhalation due to narrowing of the airways [2].
• Shortness of breath: difficulty breathing, a feeling of air hunger [2].
• Chest tightness: discomfort or pressure in the chest [2].

In some cases, these symptoms, appearing during or after physical exertion, may be the only sign of asthma in a child [2]. Severe asthma attacks can lead to hypoxemic respiratory failure, when blood oxygen saturation levels drop to critically low values (e.g., down to 70%), requiring immediate hospitalization [3].

Certain factors can worsen asthma symptoms and make it harder to control:

• Overweight and obesity: can affect lung function and increase shortness of breath [2].
• Environmental triggers: exposure to respirable dust containing silica, heavy metals, and fungal spores, as shown in the case of a child after an earthquake, can provoke severe asthma [3]. Children are particularly vulnerable to disaster-related respiratory damage [3].

Diagnosis and monitoring of pediatric asthma

Despite the existence of pediatric asthma management guidelines, controversial issues regarding the best methods for managing the disease and preventing exacerbations still remain in primary healthcare [1].

Key aspects of diagnosis and monitoring include:

• Spirometry and peak flowmetry: these lung function measurement methods play an important role in disease management, although their optimal use in primary care remains a subject of debate [1].
• Assessment of attack severity: using standardized scales, such as the Pediatric Asthma Score (PAS), helps to quickly determine the severity of the child's condition and make decisions on treatment tactics [6].
• Written asthma action plans: their use is one of the controversial points, but they can be a useful tool for parents and doctors in daily disease management [1].

Effective treatment of asthma attacks

The main goal of asthma treatment is to achieve symptom control and prevent any limitations in the child's physical activity [2]. Timely and adequate treatment of attacks is critical.

In the emergency setting, the implementation of quality improvement protocols (QI interventions) has significantly improved treatment outcomes. For example, such measures have led to a reduction in time to the first documentation of PAS score assessment, as well as faster administration of bronchodilators and steroids [6]. This, in turn, reduced the length of stay in the emergency department and decreased hospitalization rates for children with moderate and severe asthma [6].

Important treatment aspects:

• Treatment adherence: low adherence to treatment by patients and their caregivers is one of the main causes of uncontrolled asthma [7]. The role of parents and caregivers in this process is extremely important [7].
• Educational and motivational programs: aimed at parents can significantly improve their understanding of the disease and treatment adherence, which contributes to successful asthma management in children [7].
• The role of long-acting beta-agonists: their use is one of the discussed issues in pediatric practice [1].

The role of lifestyle and complementary approaches

In addition to medical treatment, lifestyle and certain complementary methods play an important role in managing pediatric asthma.

• Physical activity: despite parental fears, physical activity is not only possible but also beneficial for children with asthma. With controlled asthma, the physical performance of children does not differ from healthy peers, so any restrictions in sports are unacceptable [2].
• Weight management: overweight and obesity can worsen asthma symptoms and shortness of breath, so maintaining a healthy weight is an important part of comprehensive treatment [2].
• Alternative methods: some studies show that the application of acupoint patches, based on the principles of traditional Chinese medicine, can be effective as complementary therapy. Meta-analysis showed improved lung function parameters (FEV1) and a reduction in wheezing resolution time in children with asthma [4]. However, these methods should be considered as an addition to the main treatment and discussed with the attending physician.

Sources

1. Controversies in Pediatric Asthma. https://pubmed.ncbi.nlm.nih.gov/30874821/
2. Asthma, exercise and metabolic dysregulation in paediatrics. https://pubmed.ncbi.nlm.nih.gov/30789156/
3. Case Report: Severe asthma following earthquake-related inhalational exposure in a child. https://pubmed.ncbi.nlm.nih.gov/42707524/
4. Traditional Chinese Medicine Based Acupoint Application for Asthma Treatment in Children: A Meta-Analysis and Systematic Review. https://pubmed.ncbi.nlm.nih.gov/38500520/
5. Effects of a QI intervention on pediatric asthma treatment using patient outcomes and workflow in an emergency department. https://pubmed.ncbi.nlm.nih.gov/36562525/
6. Caregiver's sense of coherence and adherence to paediatric asthma treatment. https://pubmed.ncbi.nlm.nih.gov/36842951/

The information provided in this article is for reference purposes only and cannot replace professional medical advice. Always consult with your healthcare provider for the diagnosis and treatment of any medical conditions.