PEDIATRIC ASTHMA 13
Asthmais a respiratory disease associated with chronic inflammation in theairways. The disorder involves frequent, but reversible respiratorypath barrier. The inflammation of the airways causes airwayhyperactivity that in turn makes the airways constrict because of theeffect of different stimuli such as cold air, allergens, andexercise. Pediatric asthma refers to a disorder that occurs when theairways and lungs become inflamed due to exposure to asthmatictriggers like airborne pollen. However, childhood asthma can escalatein case of respiratory infection or exposure to cold. The diseaseoften causes troublesome daily symptoms that can meddle withchildren’s sleep, sports, school, and playing activities. Thedisease requires effective management in children to prevent severeattacks that may put the lives of children at risk. Althoughpediatric asthma is not much different from adult asthma, kidsexperience distinct challenges. A significant share of emergencydepartment visits involving children is associated with asthmacomplications. Nonetheless, the disease is incurable, so the symptomsoften extend to adulthood. Fortunately, advanced research has yieldedeffective medication that can help in suppressing the symptoms andpossible lung damage to the developing lungs. According to Sharma(2014), Asthma in adolescents and children aged between five andseventeen years leads to a loss of up to ten million days per year.In addition, the caretakers of sick children spend $726.1 millionannually due to work absence. Asthma is generally breathingcomplication that result when the airways are obstructed by excessmucous, inflammation of constriction of the muscles. The disorder isone of the chronic human diseases since the medical fraternity is yetto invent suitable cure for the disease. The following paper is acomprehensive research and analysis of the major issues regardingpediatric asthma
Asthmais a common disease worldwide, although it tends to be higher amongthe lower income nations than higher income countries. In 2011,statistics indicated showed that 250,000 people die every year fromthe disorder. However, 80% of the deceased patients are normally fromlower to middle-income countries. The death rates of childrenresulting from asthma vary significantly from one country to another,but it averages between one and eighteen percent. The prevalence ishigher in the developed countries than in the developing nations(Sharma, 2014). This implies that asthma prevalence in Africa, Asia,and Eastern Europe is lower than in regions such as North America andWestern Europe. Other asthma facts are that it is common amongchildren from affluent families in the developing countries whilechildren from the economically disadvantaged families are the mostvulnerable to the disease in the developed countries. Presently, thecause for the differences above is yet to be established. Anothertrend about asthma is the fact that its prevalence rate is about 50%higher in boys than in girls, but the occurrence of severe conditionsis relatively equal. In addition, there are more young peoplesuffering from asthma than adults. This means that some childrensuffering from minor asthmatic symptoms in the early years fullyrecover from the disease prior to becoming adults (Cantani, 2008).
Thefrequency of child asthma has increased significantly from 1960 to2008. However, the disease was classified as a key public healthconcern in 1970s. In 2001, 9% of all children in the United Stateswere suffering from the disease, which was a drastic increase from3.6% in 1980s (Subbarao et al., 2009).
NormalPhysiology of the lungs and air ducts
Asthmais a respiratory disease that complicates the breathing. The lungsare composed of two big and soft organs with consistency thatresembles that of a sponge. The organ is situated inside the chest.The lung lobes surround the heart except around the sternum(breastbone). The heart is located within a strong, but a versatilecage formed by ribs. The ribs are curved bones attached to thevertebrae (backbone) and the breastbone via cartilage. The inhalationand exhalation process changes the shape and size of the chestconsistently (Healey, 2008).
Boththe lungs and other compositions of the abdomen are detached fromabdomen contents by a sturdy dome-shaped muscle known as thediaphragm. During inhalation, the diaphragm moves downwards whileduring exhalation it moves upwards. The key role of the lungs issupplying the lungs with adequate oxygen, as well as extractingcarbon dioxide from the blood system. The exchange process of thesegases is facilitated by unobstructed air passages found on the lungsurface (Subbarao et al., 2009). The air gets into the human bodythrough both the mouth and nose, and then moves down the trachea(windpipe) until it reaches the bronchi and bronchioles. These aresmaller airways that interlink the larger airways to the smaller airunits. The bronchioles are the smallest, and they end in microscopicairways that are characterized by tiny air sacs known as alveoli. Atypical lung structure contains above 300 million of the minuteballoon-like bags. A semi-permeable membrane containing very smallblood vessels known as capillaries surrounds the air sacs. Since theair sacs and the capillaries’ walls are thin, they allow exchangeof gases between the blood and the airway system (Johnston, 2007).
Thelungs accumulate a high volume of oxygen during inhalation, which thecapillaries and air sacs extract for enriching the blood. At the sametime, the lungs expel carbon dioxide that has been extracted from theblood via the lungs. In situations when overproduction of secretions,mucous, and airway inflammation causes tightening and swelling of themuscles surrounding the smooth airways, air transportation within theorgan is obstructed, and the regular tasks conducted by lungs becomeseither harder or impossible (Wood & Casella, 2010).
Asdescribed previously, lungs contain two sections. One section islocated on the right-hand side of the cavity while the other lung issituated on the left side of the chest cavity. The right organ iscomposed of the right lower lobe (RLL), right upper lobe (RUL), andthe right middle lobe (RML). The lobes are then subdivided intosegments (Mayo Clinic., 2011).
PATHOPHYSIOLOGYOF THE PEDIATRIC ASTHMA
Pediatricasthma occurs when airflow in the lung airways become obstructed bycomplications such as airway thickening associated with inflammationand scarring, oversized mucus glands, slimming of the airways locatedin the lungs, as a result, of surrounding smooth muscles becomingtighter, and bronchoconstriction. Bronchial inflammation may alsoresult from narrowing caused swelling associated immune responses toallergy causing elements and edema (Subbarao et al., 2009).
Asthmaticchildren have “hypersensitive” airways to certain “stimuli”,also called triggers. In case the bronchi (large airways) are exposedto the triggers, and they begin contracting into spasms, which areknown as “asthma attack”. The airways soon develop aninflammation that triggers excessive mucous production as well asnarrowing of the airways that cause extreme coughing and otherbreathing problems. The bronchospasm sometimes resolves automaticallyafter one to two hour`s period. However, 50% of the children whooften heal automatically might experience additional inflammation andbronchoconstriction about three to four hours afterward. This makesit essential for parents to consider seeking professional medicalassistance every time a child suffers from an asthmatic condition.This helps in preventing the condition from manifesting once moreafter some time (Barnes, 2009).
Thenormal functioning of the bronchus is often sustained throughbalanced working of the systems that both function reflexively. Theparasympathetic reflex loop contains afferent nerve endings thatemanate from beneath bronchus’ inner lining. Every time theafferent nerve endings become stimulated (by triggers such as fumes,cold air, or dust), impulses are immediately sent to the brain-stemvagal center. The impulse is then propelled down the vagal efferentpathway until it gets to the small bronchial airways (Barnes, 2009).
Theefferent nerve endings are responsible for releasing acetylcholine.The acetylcholine causes extreme synthesis of various inositol forms,including inositol 1-,4-, and 5- trisphosphate (IP3) inside smoothmuscle cells located in the bronchial. IP3 causes muscle shortening,as well as triggering bronchoconstriction (Wood & Casella, 2010).
Bronchialinflammation is an asthmatic condition caused by allergic reaction.The allergens often get into the body through inhalation so manychildren suffer from this condition. In both children suffering fromasthma, as well as the ones who are not suffering from the disorder,the inhaled allergens are combines with antigen-presenting cells(APCs) that are located in the inner airways of all human respiratorysystems. The APCs then “introduce” some components of theallergen in rest of the immune system cells. To non-asthmaticpersons, the other immune cells (THO cells) “scrutinizes” theallergy causing molecules but does not react towards them in any way.However, in asthmatic patients, the cells change into distinct (TH2)cell varieties for reasons that doctors are yet to evaluate (Barnes,2009).
Theensuing TH2 cells trigger a crucial form of the immune system calledthe humoral immune system. The inhaled allergens make the humoralimmune system to synthesize antibodies. If a child later inhales thesame type of the asthma causing allergen, the antibodies “identify”it and release a hormonal response. This causes inflammation. Theinflammation results when the airway walls releases chemicals thattriggers the thickening of the airway walls, whose cells increasesscaring effect, as well as enhancing further “airway remodeling.”In addition, homoral response makes the mucus synthesizing cells tobecome bigger and generate thicker and larger amount of mucus. Thecell-connected immune system arm also becomes activated by thehumoral response. In normal circumstances, inflamed airways arehighly hyperactive, as well as vunerable to bronchospasm (Wood &Casella, 2010).
Accordingto the “hygiene hypothesis”, regulation imbalance of the TH cellvarieties in children may cause a long-term cell domination of cellsassociated with allergic responses and over the cell varieties thatcombat infection. The logic behind the hypothesis is that exposure tomicrobes during childhood, consuming limited antibiotics, staying ina big family, and growing up in the rural areas triggers TH1reactionand decrease the potential of suffering from asthma (Catrambone,2013).
THECLINICAL MANIFESTATIONS & ASSESSMENTS PEDIATRIC ASTHMA
Childhoodasthma can be noted through the following signs and symptoms.Frequent coughing spells that may happen at night, during the day, orwhile laughing and it is crucial to know that coughing can be theonly symptom available. Less energy when a child is playing, with theneed for frequent rest time to catch a breath. Other less serioussymptoms include Chest hurting or tightness, rapid breathing,whistling sound when a child is breathing out, frequent headaches,loss of breath, chest muscles, tightened neck, feelings of tirednessor weakness, loss of appetite, and dark circles under eyes. However,it is important to notice that not all children have similar asthmasymptoms, and symptoms can differ from one asthma incident to anotherin the same child (Sockrider, 2002).
Asthmais often hard to assess during infancy. However, in older childrenasthma can be diagnosed based on child medical history, physicalexam, as well as symptoms. Symptom description and medical historyare main issues that doctors look after. For instance, doctors areinterested in history of child breathing problem, history of anasthma problem in family, skin condition called eczema, allergies, orlung diseases. It is crucial for a parent to explain child’ssymptoms to the doctor. During the physical examination, doctorslisten to child’s lungs and heart. Pulmonary function test andchest X-ray test are conducted on many children and the tests measureamount of air in lungs as well as how fast it may be exhaled. Theoutcome helps doctor to know how severe the asthma condition is. Inmost cases, children under the age of five years are unable to gothrough pulmonary function tests. Therefore, doctors depend onsymptoms, history, and examination (Sharma, 2014).
DIAGNOSTICTESTING OF CHILDHOOD ASTHMA
Generally,pediatric asthma is diagnosed based on the presence of specificsymptoms, medical and family history of the patient, physical exams,as well as lung tests results. The level of asthma severity can besevere, mild, intermittent, or moderate, and should be figured out bythe primary care doctor. The initial step used by doctors whendiagnosing asthma is to obtain details of medical history of apatient where they have to answer questions regarding any familyhistory of allergies and asthma. On the other hand, physical examsused by doctors when diagnosing asthma include examination of theupper respiratory tract that is the throat, nose and upper airways(Mayo Clinic., 2011). In this process, the doctor will measure thefunctioning of the lungs using a stethoscope, in order to determinethe amount of air that moves and out when one is breathing. Thecommon type of lung function tests are methacholine challenge andspirometry tests (Thomson et al., 1998). A spirometry test is simpleand mostly used to find out the amount of airflow interference orobstruction. On the other hand, the methacholine challenge test isused to evaluate suspected asthma, especially when the spirometrytest does not establish asthma diagnosis. The main sign of asthma inan individual is wheezing which is the removal of high-pitchedwhistling sounds when breathing. In addition, allergic conditions onthe skin such as eczema and hives are other signs to look for whendiagnosing asthma. In children, asthma signs include louder andfaster breathing than normal rate. Frequent coughing and limitedengaging in physical activities. Most of the children who developasthma begin showing the symptoms before the age of five years (MayoClinic, 2011).
Alternatively,diagnosis of occupational asthma is established if an individualworks in a business such as paint spray, chemicals, baking andpastry, as well as timber factory, where one can easily get thecondition. Furthermore, doctors can carry out tests to determine ifone is allergic or sensitive to the specific substances that areknown to cause occupational asthma. As a result, trial of treatmentis prescribed when testing for asthma diagnosis. If a patientresponds to a given treatment, then this is used to establish asthmacondition. Therefore, it is easier for the doctor to manage asthma ifproper diagnosis is carried out (Mayo Clinic, 2011).
CLINICALMANAGEMENT OF CHILDHOOD ASTHMA AND THE EFFECT ON THE PATHOPHYSIOLOGY
Asthmamanagement is a process that is complex since it exhibitsheterogeneity, in regards to its clinical presentation, naturalhistory, severity, and response to therapy. Asthma care requirescoordination alongside communication between health care providersand patients. Therefore, a single management approach may not workfor all patients, and consequently each patient requires atailored-made therapy. Generally, the quality of Asthma management isgreatly improved when trained doctors and nurses are involved. Thisis for the main reason that well trained doctors can improvediagnosis, monitoring and prescribing of quality care based on thegiven guidelines. To achieve maximum benefit, asthma clinic use astructured and planned approach, which can also include a writtenasthma plan (Mayo Clinic., 2011).
Initialmanagement of Asthma involves providing an educational overview tothe patients on the types of asthma, diagnosis, severity, triggersand options for treatment. Environmental control is another clinicalmanagement where patients are advised on how to avoid triggers andexposures recognized to worsen asthma. In this process, all riskfactors are reduced, and this includes occupational exposures andair pollutants. Medical therapy is also determined based on theseverity, responsiveness, control and type of asthma (Mayo Clinic.,2011). To achieve short-term control reliever medication areadministered to the patients. For long-term control, medicationstaken daily include Leukotriene modifiers, long-acting beta2-agonistsand inhaled corticosteroids which reduce inflammation, and improvethe symptoms and lung functioning. It is crucial that patientsunderstand why they were prescribed to certain medications, and havealso reasonable expectations concerning their effects. Inhaledcorticosteroids have proved as the most effective treatment forcontrol of asthma in both adults and children (Thomson, Rodger, &Barnes, 1998).
Anotherclinical management is the development of a medication plan (AsthmaAction Plan) to all patients suffering from asthma. This AsthmaAction Plan is a written plan partnership with the patient, and oftenaddresses the current medical therapy, medications for control,signs, and symptoms, peak expiratory flow rate, and when to contactthe medical provider. Prevention is also used as an initial clinicalmanagement where all adults with asthma get a pneumococcal vaccine,while patients aged 6 months and above receive a flu vaccine.Management of asthma is crucial and help to prevent exacerbations andprovide early treatment to individuals diagnosed. As a matter offact, under-diagnosis and wrong treatment are suggested by experts asa major contributing factor to morbidity and mortality linked toasthma (Barnes, 2009).
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