Introduction

Popular scientific articles that follow will explain everything about asthma in children include:

1.

Definition
2.

Classification
3.

Etiology (cause)
4.

Epidemiology
5.

Risk Factors
6.

Clinical Manifestation
7.

Examination Support
8.

Diagnosis Banding
9.

Management
10.

Prevention

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Definition

According to National Asthma Guidelines for Children (PNAA) 2004, asthma is recurrent wheezing and / or persistent cough (settled) with the following characteristics:

*

occur in episodic,
*

tended at night / early morning (nocturnal),
*

seasonal,
*

after physical activity,
*

there is a history of asthma or other atopy in the patient and / or his family.

Classification

The division of asthma according to Global Initiative for Asthma (GINA, 2006) is as follows:

1.

Intermittent
2.

Persistent mild
3.

Persistent’s
4.

Persistent heavy

Meanwhile, the International Pediatric Consensus III (1998) divides the degree of asthma becomes:

1.

Rarely episodic asthma
2.

Frequent episodic asthma
3.

Persistent Asthma

Etiology (cause)

Genetic factors play an important role in asthma. Currently there are about 80 genes associated with asthma, one of which is ADAM-33 gene (a disintegrin and metalloprotease-33), genes found in 2002. In addition to genetic factors, causes of asthma is multi factor.

Epidemiology

Prevalence of asthma in the world’s total estimated 7.2% (6% in adults and 10% in children). Prevalence is highly variable. In Indonesia, the prevalence of asthma in children aged 6-7 years by 3% and for ages 13-14 years by 5.2% (Kartasasmita, 2002).

Based on reports the National Center for Health Statistics or NCHS (2003), the prevalence of asthma attacks in children aged 0-17 years was 57 per 1000 children (4.2 million the number of children), and in adults> 18 years, 38 per 1000 (number of adults 7.8 million). The number of women who experienced more attacks than men.

WHO estimates there are about 250,000 deaths due to asthma. Meanwhile, according to NCHS report (2000) there are 4487 deaths from asthma or 1.6 per 100 thousand population. Child deaths due to asthma are rare.

Risk Factors

Various factors that may affect the occurrence of asthma attacks, asthma incidence, severity of asthma, and deaths from asthma among others:

1.

Gender

The prevalence of asthma in boys more than girls.

1.

Age

Generally such as asthma symptoms first arose at a young age, ie in the first years of life.

1.

History of atopy (allergy)

Reports from England; 16-year-olds with a history of asthma or wheeze, wheezing attacks will happen more 2X if the child has experienced hay fever, allergic rhinitis, or eczema. Some reports also show that allergic sensitization to allergens inhalan, milk, eggs, or nuts in the first year of life, is a predictor of asthma incidence.

1.

Environment

Some allergens can increase asthma risk in children include: pet dander, house dust mites, mold, and cockroaches.

1.

Ras

Asthma prevalence and incidence of asthma attacks on black race is higher than whites (Steyer et al., 2003).

1.

Smoke

The prevalence of asthma in children exposed to cigarette smoke is higher than children who were not exposed to cigarette smoke.

1.

Outdoor water polution

Some small particles in the air such as dust on the highway, nitric dioxide, carbon monoxide, or SO2, thought to contribute to asthma symptoms, but have not found evidence agreed.

1.

Respiratory infections

RSV infection (respiratory syncytial virus) is a significant risk factor for the occurrence of wheezing at age 6 years. Meanwhile, recurrent viral infections that do not cause lower respiratory tract infections can give children protection against asthma.

Clinical Manifestation

* On a mild asthma attack:

- Children looked cramped as you walk.

- In infants: crying loudly.

- Position the child: to lie.

- Can speak with the sentence.

- Awareness: perhaps irritable.

- No cyanosis (bluish skin or mucous membranes).

- Wheezing was, often only at the end of expiration.

- Usually not using respiratory muscle aids.

- Intercostal retraction and shallow.

- Frequency of breath: fast (Tachypnoea).

- Frequency pulse: normal.

- No pulsus paradoksus (<10 mmHg)

- SaO2%> 95%.

- Pao2 normal, usually does not need to be examined.

- PaCO2 <45 mmHg

* In an asthma attack are:

- Children looked tight as she spoke.

- In infants: short and weak crying, difficult feeding / eating.

- Position the child: would prefer to sit.

- Can speak with the line severed / disconnected.

- Awareness: usually irritable.

- No cyanosis (bluish skin or mucous membranes).

- Send a loud, long expiration ± inspiration.

- Usually used aids respiratory muscles.

- Intercostal and suprasternal retraction, nature is.

- Frequency of breath: fast (Tachypnoea).

- Frequency pulse: fast (tachycardia).

- There pulsus paradoksus (10-20 mmHg)

- SaO2% of 91-95%.

- Pao2> 60 mmHg.

- PaCO2 <45 mmHg

* In severe asthma attacks without constant threat of breath:

- Children looked crowded while resting.

- In infants: do not want to drink / eat.

- Position the child: sit propped arm.

- Can speak the words.

- Awareness: usually irritable.

- There cyanosis (bluish skin or mucous membranes).

- Sent a very loud, sound, without a stethoscope during expiration and inspiration.

- Using a respirator muscles.

- Intercostal and suprasternal retraction, in nature, plus the nostril breath.

- Frequency of breath: fast (Tachypnoea).

- Frequency pulse: fast (tachycardia).

- There pulsus paradoksus (> 20 mmHg)

- SaO2% for <90%.

- Pao2 <60 mmHg.

- PaCO2> 45 mmHg

* In severe asthma attacks accompanied by the threat of stopping the breath:

- Awareness: confusion.

- True there is cyanosis (bluish skin or mucous membranes).

- Wheezing sound difficult or not.

- Use of respirator muscles: the paradox of movement torakoabdominal there.

- Shallow retraction / missing.

- Frequency of breath: slow (bradipnea).

- Frequency pulse: slow (bradikardi).

- No pulsus paradoksus; signs of muscle fatigue breath.

Guidelines for the raw value frequency conscious breathing in children:

Age of normal breathing frequency

<2 months <60 x / min

2 to 12 months <50 x / min

1 to 5 years <40 x / min

6 to 8 years <30 x / min

Guideline value of pulse frequency standard in children:

Age of normal pulse frequency

2 to 12 months <160 x / min

1 – 2 years <120 x / min

3 to 8 years <110 x / min

Examination Support

1.

Examination of lung function

Checks can be done using peak expiratory flow rate (PEFR) or peak expiratory flow (APE), pulse oxymetry, spirometri, muscle strength testing, the absolute lung volume, diffusion capacity.

In airway function tests, the most important thing is the forced expiratory maneuver to maximum. Measurements with this maneuver can be performed on children> 6 years old are forced expiratory volume in 1 second (FEV1) and vital capacity (VC) with a spirometer and the measurement of peak expiratory flow (PEF) or peak expiratory flow (APE) with a peak-flow meter .

In the National Guidelines for Asthma Children (PNAA) 2004, to support the diagnosis of asthma of children, use restrictions:

1.
1.

PEF or FEV1 variability> 15%,
2.

The increase in PEF or FEV1> 15% after the inhaled bronchodilators,
3.

Decrease in PEF or FEV1> 20% after bronchial provocation.

Variability assessment should be done by measuring for> 2 weeks.

1.

Hiperreaktivitas examination respiratory

Bronchial provocation test with histamine, metakolin, exercise or sports, and cold dry air, or with hypertonic saline is supporting a diagnosis of asthma in children.

1.

Measurement of respiratory tract inflammation indication of non-invasive

Can be done by examining eosinophils sputum (phlegm) and measured the levels of NO ekshalasi.

1.

Assessment of allergy status

This examination can help determine the risk factors or triggers of asthma.

In severe asthma attack, which required investigation is the analysis of blood gases (AGD) and chest X-ray projection images anterior-posterior (AP). Can be found on the AGD increased pCO2 and low Po2 (hipoksemia).

Diagnosis Banding

Asthma in children can be diagnosed appeal with:

1.

GER
2.

rinosinobronkitis
3.

OSAS
4.

cystic fibrosis
5.

primary cilliary dyskinesis
6.

foreign body
7.

vocal cord dysfunction

Management

A. Medical Therapy

*

On a mild asthma attack, was given medication (reliever) in the form of beta-agonists are inhaled / oral, or adrenaline 1 / 1000 subcutaneous 0.01 ml / kg body weight / time with a maximum dose of 0.3 ml / time.
*

In an asthma attack were given the drug as above plus the provision of oxygen, intravenous fluids, oral corticosteroids, and treated at the ODC (one day care) or a day care room.
*

In severe asthma attacks, in addition to the above drugs, conducted in the initial provision of aminophylline and maintenance. Corticosteroids may be given intravenously. Oral steroids at a dose of 1-2 mg / kg body weight / day divided by 3 is given for 3-5 days. Recommended steroids prednisone and prednisolon is.

B. Supportive Therapy

Supportive treatment necessary in an asthma attack. In certain circumstances, such as complications of dehydration, metabolic acidosis, or atelectasis, necessary actions to overcome them. In special circumstances, such as a psychological disorder, then the role of a child psychologist or psychiatrist is needed because the stress is one trigger asthma attacks.

C. Surgical Therapy

Surgery is usually not necessary unless complications arise in the form of pneumothorax. In the circumstances required pungsi pneumothorax and if necessary the installation done WSD (water seal drainage) to remove the air from the pleura (the membrane or the membranes covering the lungs).

Following steroid preparations can be used for an asthma attack, but before you use it you should consult with your doctor or the nearest pediatrician.

A. Oral steroids

1.

Prednisolon (generic name)

Trade name: medrol, medixon, lameson, urbason.

Dosage: 4 mg tablets.

Dose: 1-2 mg / kg body weight / day every 6 hours.

1.

Prednisone (generic name)

Trade names: hostacortin, pehacort, dellacorta.

Dosage: 5 mg tablets.

Dose: 1-2 mg / kg body weight / day every 6 hours.

1.

Triamsinolon (generic name)

Trade name: kenacort.

Dosage: 4 mg tablets.

Dose: 1-2 mg / kg body weight / day every 6 hours.

B. Steroid injections (injections)

1.

M. Prednisolon succinate (generic name)

Trade name, dosage, dose, route:

1.
1.

Solu-Medrol, vial of 125 mg, 30 mg / kgBB in 30 minutes (high dose) every 6 hours, IV / IM.
2.

Medixon, vial of 500 mg, 30 mg / kgBB within 30 minutes (high dose) every 6 hours, IV / IM.

1.

Hydrocortisone succinate (generic name)

Trade name, dosage, dose, route:

1.
1.

Solu-Cortef, vial of 100 mg, 4 mg / kgBB / times every 6 hours, IV / IM.
2.

Silacort, vial of 100 mg, 4 mg / kgBB / times every 6 hours, IV / IM.

1.

Dexamethasone (generic name)

Trade name, dosage, dose, route:

1.
1.

Oradexon, 5 mg vials, 0,5-1 mg / kgBB bolus, followed 1 mg / kgBB / day given every 6-8 hours, IV / IM.
2.

Kalmetason, 4 mg vials, 0,5-1 mg / kgBB bolus, followed 1 mg / kgBB / day given every 6-8 hours, IV / IM.
3.

Fortecortin, 4 mg vials, 0,5-1 mg / kgBB bolus, followed 1 mg / kgBB / day given every 6-8 hours, IV / IM.
4.

Corsona, 5 mg vials, 0,5-1 mg / kgBB bolus, followed 1 mg / kgBB / day given every 6-8 hours, IV / IM.

1.

Betamethasone (generic name)

Trade name, dosage, dose, route:

Celestone, 4 mg vials, 0,05-0,1 mg / kgBB every 6 hours, IV / IM.

Prevention

Environmental control, exclusive breastfeeding at least 6 months, potentially alergenik food avoidance, reduction of exposure to house dust mites and animal fur , has been shown to reduce the incidence of food allergy and atopic dermatitis, especially in infants.

In addition, every family who has a child with asthma should make environmental controls, among other things: prevent children from cigarette smoke; no furry pets such as dogs, birds, cats; improve ventilation of the room; reduce humidity room for children who are sensitive to house dust and mites.

Another preventive step is the prevention of primary, secondary, and tertiary. Primary prevention (prenatal) performed on pregnant women who have a history of atopy (allergy) to himself, family, children before, or the husband. Primary prevention aims to prevent the occurrence of sensitization in the fetus intrauterin (while in the womb) and performed when the fetus is still in the womb and breast. Pregnant women and nursing mothers should avoid the trigger factors (inducer) such as cigarette smoke or food alergenik.

Secondary prevention aims to prevent the occurrence of inflammation (inflammation) in infants or children who have sensitisasi. Target are babies or children who have parents with a history of atopy. Antihistamines administered over 18 months in children with atopy dermatitis and history of atopy in older people.

Tertiary prevention aims to prevent the occurrence of asthma attacks in children who already suffer from asthma. Prevention of avoidance of triggers and medication delivery controller (controller)