Pediatric Bronchial Asthma
1. Dr. Osmonova Gulnaz Zhenishbaevna
2. Tamboliya Shyam Kanjibhai
3. Salman Ali
(1. Teacher, International Medical Faculty, Osh State University, Osh, Kyrgyz Republic.
2. Student, International Medical Faculty, Osh State University, Osh, Kyrgyz Republic.
3. Student, International Medical Faculty, Osh State University, Osh, Kyrgyz Republic.)
Abstract
Bronchial asthma (asthma) is a complex inflammatory airway disease affecting approximately 100 million children worldwide, imposing a heavy burden on society and families. Studies have shown that the gut microbiota plays a significant role in the occurrence and development of childhood asthma. This paper reviews the research progress on the relationship between gut microbiota and childhood asthma. potential value and application prospects of modulating gut microbiota as a new strategy for asthma treatment are discussed, providing a theoretical reference for in-depth research on the relationship between gut microbiota and the onset of childhood asthma and the development of new therapeutic approaches.
Bronchial asthma (hereinafter referred to as asthma) is a chronic inflammatory disease of the airways, pathologically characterized by widespread and reversible airflow limitation and airway hyperresponsiveness, and clinically manifested as paroxysmal shortness of breath, wheezing, and chest tightness. The pathogenesis of asthma is related to many factors such as genetic susceptibility, airway inflammation, and environmental factors. However, more and more studies have found that gut microbiota is closely related to asthma. Gut microbiota plays an important physiological role in the human body, including nutrition, digestion, protection, and immunity. Under normal circumstances, gut microbiota and the host coexist in a mutually beneficial symbiotic relationship and form a dynamic balance. If this balance is broken, it may lead to the occurrence and development of diseases. Taking asthma as an example, with the introduction of the concept of the "gut-lung axis" (the network of immune and inflammatory regulation between the lungs and the gut), the important role of gut microbiota in "gut-lung bidirectional regulation" has been further emphasized. Currently, bronchodilators and glucocorticoids remain the mainstays of asthma treatment. However, they only control asthma symptoms and cannot reverse the remodelling process. Low adherence to long-term medication use and adverse reactions also limit the effectiveness of these drugs, highlighting the urgent need to develop new treatment strategies. This article will explore the relationship between gut microbiota and asthma, as well as the role and mechanism of changes in gut microbiota composition and function in the development of asthma, providing a theoretical basis and new strategies for precision medicine in asthma.
Bronchial asthma is a heterogeneous disease characterized by chronic airway inflammation and airway hyperresponsiveness. Its main clinical manifestations are recurrent episodes of wheezing, coughing, shortness of breath, and chest tightness, which often occur or worsen at night or in the early morning.
In my country, the initial onset of bronchial asthma usually occurs between the ages of 1 and 6, with the most common occurrence in children under 3 years old. The incidence rate is 0.5% to 3.33%. Most children can experience relief with treatment or spontaneous remission, and some children's asthma may completely disappear during puberty. However, some children still experience persistent airway hyperresponsiveness and variable airflow obstruction. As the disease progresses, irreversible airway remodelling can occur, increasing the risk of developing COPD in adulthood.
Therefore, treatment for childhood asthma should begin as early as possible, adhering to the principles of long-term, continuous, standardized, and individualized treatment. Medications for asthma include controller medications and reliever medications. Controller medications are used long-term to suppress airway inflammation. Relief medications are those that quickly relieve bronchoconstriction and other accompanying acute symptoms, used during acute asthma attacks, and should be used as needed.
The most common sign of an asthma attack in children is expiratory wheezing. If the clinical manifestations are not obvious, a bronchial provocation test can be performed. A positive result indicates airway hyperresponsiveness, while a negative result is valuable in ruling out asthma. In addition, if the daily maximum expiratory flow variability is greater than 13%, or if the forced expiratory volume per second increases by 12% 15 minutes after inhaling a short-acting β2-receptor agonist, it will help improve the diagnosis rate of childhood asthma.
I. Triggering Factors
There are many factors that can trigger an attack of bronchial asthma in children, and eliminating these factors is key.
01. Respiratory tract infections (especially viral and mycoplasma infections)
02. Inhaled allergens (pollen, dust mites, animal dander and excrement, cockroaches, fungi, etc.)
03. Ingestion of allergens (milk, fish, shrimp, eggs, peanuts, etc.)
04. Strong emotional changes
05. Exercise and hyperventilation, cold air
06. Dust and gases, etc.
II. Treatment during the acute phase
Acute asthma attacks in children are mainly characterized by a sudden onset or worsening of cough and wheezing, with expiratory wheezing audible in the lungs. The primary goal of treatment during an acute asthma attack is to relieve airway spasm, reduce airway inflammation, and rapidly control the condition. Therefore, non-pharmacological treatments include oxygen therapy and mechanical ventilation, while pharmacological treatments mainly include inhaled short-acting β2-receptor agonists, inhaled anticholinergic drugs, glucocorticoids, and theophylline.
01. Non-pharmacological treatment
Oxygen therapy: Oxygen. For patients with hypoxemia, maintain blood oxygen saturation at 0.94-0.98. Mechanical ventilation: Oxygen and air. If symptoms continue to worsen and signs of respiratory failure appear despite appropriate combined treatment, mechanical ventilation should be used promptly. Sedatives should not be used before treatment.
02. Drug treatment
1. Inhaled selective short-acting β2 receptor agonists: Salbutamol and terbutaline are the first-line drugs of choice for acute attacks.
2. Inhaled short-acting anticholinergic drugs: Ipratropium bromide is a combination therapy for acute attacks. When used in combination with inhaled selective short-acting β2-receptor agonists, it can increase the bronchodilator effect.
3. Glucocorticoids: Early use of high-dose inhaled glucocorticoids such as budesonide, beclomethasone dipropionate, and fluticasone propionate can help control acute attacks and can be used for a short period. However, they cannot replace systemic glucocorticoid therapy in severe cases, where systemic glucocorticoids such as prednisone, methylprednisolone, and hydrocortisone are used.
4. Other treatments: Magnesium sulphate helps relieve symptoms of severe asthma; aminophylline is not routinely used, but may be used if asthma attacks cannot be effectively controlled by the above-mentioned medications.
III. Long-term treatment plan for childhood asthma
Controlling asthma requires the joint efforts of doctors and patients, and long-term treatment is essential for its effectiveness. Long-term treatment plans for asthma in children ≥6 years old (5 levels) and children <6 years old (4 levels) are based on a comprehensive assessment of the child's asthma symptom control level, the frequency and severity of acute attacks, and consideration of timely escalation or de-escalation of treatment.
01. Inhaled corticosteroids
Inhaled corticosteroids are the preferred medication for controlling childhood asthma, but long-term use should be monitored for potential adverse reactions. For children under 6 years old, if low-dose inhaled corticosteroids are used and good control is maintained for 3-6 months, discontinuation of the medication may be considered
02. Leukotriene receptor antagonists
Such drugs, such as montelukast sodium, can effectively inhibit cysteine leukotrienes and improve respiratory inflammation, making them a first-line alternative for the control and treatment of childhood asthma. They can be used as monotherapy for the control and treatment of mild childhood asthma, or in combination with inhaled corticosteroids for the treatment of moderate to severe childhood asthma.
03. Inhaled corticosteroids + long-acting β2 receptor agonists
For children aged 6 years and older who are unwilling or unable to continue using inhaled corticosteroids for treatment, inhaled corticosteroids combined with long-acting β2 receptor agonists (such as budesonide and formoterol) can be considered as needed, which can help reduce the dosage of inhaled corticosteroids.
04. Other
For refractory and severe asthma, anti-IgE monoclonal antibodies such as omalizumab and long-acting anticholinergic drugs such as tiotropium bromide can be used as adjunctive therapy to the aforementioned control medications, but cannot be used alone. Anti-interleukin-5 antibodies such as mepolizumab have been approved in other countries for use in children aged 6 years and older with severe eosinophilic asthma.
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