Abstract: Respiratory disease is one of the most common causes of suffering in children and major cause of death in paediatric age group. Among them bronchial asthma is one among the chronic airway disease, which requires immediate intervention. It can affect the day to day life activity and can progress into the adulthood. Even though it is concerned with an individual’s genetic predisposition.It is identified as a major seasonal lung problem also. Development had taken in the system of treatment, but which is still have limitation to control such type of condition. Here the gifted medical world of homoeopathy makes a challenge for the better prognosis. Treat a child; build our world with a healthy citizen in the future.
Respiratory disease is one of the most common causes of suffering in children and major cause of death in paediatric age group. Among them bronchial asthma is one among the chronic airway disease, which requires immediate intervention.The incidence has steadily increased in both developed & developing countries from 1970 to 2000. WHO recognizes asthma as a disease of major public health importance.In India, estimate indicates a prevalence of between 10% & 15% in 5-11 year old children.
Asthma is a chronic inflammatory disease of airways characterised by hyper responsiveness if the trachea bronchial tree to various stimuli and manifested by a widespread narrowing of the airways that changes in severity either spontaneously or as a result of therapy clinically manifested by wheeze, tightness of chest, cough and breathlessness.
Other names: reversible obstruction of airway disease, allergic bronchitis, asthmatic bronchitis ,wheezy bronchitis, chronic desquamative eosinophilic bronchitis.
Age of onset
Asthma may have its onset at any age; 26.3 percent of patients are symptomatic by one year of age,51.4 percent by 1-5 years of age and 22.3 percent after five years of age. Childhood asthma among children 13-14 years of age was lower than the younger children(6-7 years of age).The male to female ratio is 1.8:1 on par with various other studies.
Evidence suggests that an individual with an asthmatic predisposition will only present with this disease after exposure to an environmental trigger. These trigger includes:
- Allergens: Indoor allergens, Pollens, house-dust mite, mould spores and animal dander.
- Viral Upper respiratory tract infections: Respiratory syncytial virus & rhinoviruses are the predominant viruses.
- Season: Incidence during monsoon, followed by winter & less common in summer.
- Irritants:These include air pollution, tobacco smoke, dust, strong odours.
- Pets: The saliva, urine & dander are the cause for allergy sensitization.
Bronchial asthma is a complex genetic disorder influenced by environment. The current knowledge is, it is inherited as an autosomal dominant trait. The abnormal loci is on chromosome 11, & for total IgE (atopy) it is on chromosome 5 for specific IgE, it is on chromosome 7.
Prenatal risk factors for developing childhood bronchial asthma includes, maternal smoking, use of antibiotics & also maternal stress during gestation. Exposure to tobacco smoking in children under 5yrs of age increases the risk.If the child has already allergic rhinitis, eczema, food allergy, inhalant allergen/ food allergen sensitization, severe lower respiratory tract infection they are at high risk to develop bronchial asthma.Also if the child gives history of environmental tobacco smoke exposure, use ofParacetamol, reduced lung function at birth, they are also at high chance to present with bronchial asthma in future.
Bronchial asthma is a common chronic disease causing considerable morbidity. In 2007, 9.6 million children (13.1%) had been diagnosed with asthma in their lifetime. Approximately 80% of all asthmatic patients report disease onset prior to 6 years of age.The male to female ratio is 1.8:1 on par with various other studies.
Various stimuli can initiate the asthmatic symptoms. When a person gets exposed to allergens, immunologic IgE mediated type I hypersensitivity reaction occurs. The non-immunologic stimuli which acts by increasing the exposure of airway to cool dry air & activates the cells and stimulates autonomic nervous system, which releases bronchoactive& vasoactive mediators like histamine, eosinophilic chemotactic factor& platelet activating factor.
Three major pathologic events contribute to airway obstruction.
- Spasm of airway smooth muscles
- Edema of mucous membranes
- Excess mucous production
Bronchial asthma can be classified based on Etiological factors, depends upon the Intensity and also based on the Frequency
These are 2 main types of childhood asthma:
- Recurrent wheezing in early childhood
- Chronic asthma (persistent wheeze)
Bronchial asthma presents with a group of signs & symptoms. The features are
- Episodic dyspnoea
- Chest tightness
All asthmatic do not present with wheeze. Cough is the pre dominant symptom for asthma. Cough which persists after an episode of upper respiratory infection lasting more than 10 days should be considered. The cough is usually more at night or early morning. They can also present with vomiting, abdominal pain & chest pain.
- During asthma exacerbations, expiratory wheezing & a prolonged expiratory phase can usually be appreciated by auscultation.
- Decreased breath sounds in some of the lung fields, commonly the right lower posterior lobe.
- Crackles (or rales) & rhonchi can sometimes be heard
In severe exacerbation.
- Labored breathing
- Inspiratory & expiratory wheezing
- Increased prolongation of exhalation.
- Suprasternal & intercostal retractions
- Nasal flaring
- Accessory respiratory muscle use.
Signs considered life-threatening in acute severe asthma.
- Silent chest
No investigation is routinely indicated in the treatment of asthma. Some of the investigations that can be used.
- Hemogram – Mild Eosinophilia
- Chest X-ray – It is done only to rule out pneumonia or any other pathology.
- Peak expiratory flow rate – It is measured using a very economical & portable meter called peak flow meter in children aged more than 5 years of age
- Spirometry – Expiratory spirometry can be done when the child is older than 6-7 years. It is the objective measurement of lung function.
- Diagnosis of bronchial asthma is by clinical features & by auscultatory findings.
- Peripheral blood smear shows eosinophilia, totalIgE is elevated in atopic children.
- Improvement of peak expiratory flow rate after therapy is highly suggestive of bronchial asthma.
- Vascular ring
While there is no certain way to prevent asthma, experts continue to look at things that may reduce a child’s chance of getting asthma.
- Avoid exposure to tobacco smoke and other allergens and irritants.
- Keep the child inside the house when air pollution levels are high.
- Use of an air filter machine in the house to reduce the amount of dust & other pollutants.
- Adequate rest.
- Prevent the relapse of attacks to prevent school absenteeism, encourage participating in sports and attaining good growth & development.
- Education of the patients, parents, grandparents about the disease.3
Although asthma can be a fatal disease, the long-term prognosis is good in children.
ANTIMONIUM TART: Great rattling of mucous, but very little is expectorated.Rapid, short difficult breathing, must sit up.Coughing& gasping continuously. Dyspnoea better by eructation. Dyspnoea better by lying on right side.
ARALIA RACEMOSA: Dry cough coming on after first sleep, about middle of night. Asthma onlying down at night with spasmodic cough;worse after first sleep.
ARSENICUM ALBUM: Unable to lie down, fears suffocation. Air passages constricted, Asthma worse midnight, cough worse after midnight, worse lying on back.Wheezing respiration, Dry cough as from sulphur fumes, after drinking.
NATRUM SULPHURICUM: Dyspnoea, during damp weather, must hold chest when coughing. Humid asthma, rattling in chest, at 4 & 5 am. Cough with thick ropy greenish expectoration. Every fresh cold thing on attack of asthma.
KALI CARB: Dry, hard cough about 3 am, Expectoration scanty and tenacious, but increasing in morning & after eating.Wheezing, Asthma relieved by rocking.
PULSATILLA: Dry cough in the evening and at night;must sit up in bed to get relief;and loose cough in the morning.Pressure upon the chest and soreness. Urine emitted with cough.Short breath when lying on left side.
Respiratory disease is one of the most common causes of suffering in children and major cause of death in paediatric age group. Homoeopathic system can treat asthma in children fast and easy way with no side effects. Just giving medicine not cure the case of asthma, where parents have to identify the triggering factor and make sure that the child comes in contact with the same not frequently(If the cause is avoidable one).Treat a child with homoeopathy,and earn happiness.
Guide: Dr. JYOSHNA SHIVAPRASAD, MD
PROFESSOR & HOD OF PAEDIATRICS, FMHMC, MANGALORE
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