It fits in this chapter all therapeutic methods that go beyond the symptomatic treatment of acute asthma.

1. Protection

These drugs whose role is to protect the bronchi of asthmatics avoiding hypersensitivity reactions and obstruction.

a) Cromones and Allies disodium cromoglycate (Lomudal ®)

Without bronchodilator activity or anti-inflammatory, Lomudal ® is not a drug in asthma installed. It is a component of therapy.

Inhalation of this product before competition helps prevent asthma efforts.

If there is an associated food allergy, the product can be used orally (Nalcron).

In case of allergic rhinitis, the product exists as adjusted (Lomusol ®) and in cases of allergic conjunctivitis (eye drops Opticron ®).

Nedocromil (Tilade) is a product close Lomudal acting both on adult asthma than that of the child. The following acts Tilade allergic asthma and nonallergic. It can compensate in part corticosteroid sprays if it is not severe asthma.

b) ketotifen (Zaditen ®)

This product has properties antihistamines and anti-anaphylactic giving it a prominent place in the treatment of asthma. It is a nontoxic product with beneficial effects apparent after one month of treatment (decrease in frequency and intensity of crises).

2. The treatment causes

Allergens play a role in the initiation and maintenance of asthma even though their mechanism of action is unclear. The effectiveness of courses of desensitization is discussed but is useful when asthma is really linked to contact with the allergen. Often, the causes of asthma are varied and the allergen has a triggering role part, in which case the desensitization is illusory.

The specific desensitization (or hyposensitization or immunotherapy) is known since 1911.Currently, one can obtain results in allergic asthma to house dust mites, mold and pollen, provided that the indication has been given properly by a specialist allergist.

The physical treatment of asthma is a fundamental part of DMARD and is supported by the Social Security system.

During an asthma attack it allows the child to reduce inspiratory muscle work, promote the movement of the diaphragm to control the expiration and achieve good drainage of bronchial secretions including through the “clapping” and postural treatment. In addition, the reassuring presence near the child of a physiotherapist to help calm overcome its crisis. The principle of ventilation during crises is to teach the child to breathe slowly and calmly as possible by opening his mouth for air gushing easily. It blew the child 2 or 3 times and over again about every 5 minutes. This prevents the child from dying out by fast breaths and breathing short.

Apart from crises, physical therapy teaches the child to control the end to acquire the “mastery of breath. Exercises apnea increasingly extended to allow the child to stop anguished breathing difficulties when he knows that he can “live” without breathing for several tens of seconds …!

The “pulmonary toilet” is a technique that gives excellent results. Once the child is able to cough and blow (from 5 to 8 years), the physical therapist teaches him to exhale violently and thoroughly to loosen phlegm and make up in the throat. Very often, these efforts are forced expiration followed by cough and expectoration of phlegm. The child should repeat these maneuvers until the lungs become dry. He must practice this pulmonary toilet every night without exception.

Rehabilitation also aims at rehabilitation of daily life and sports activities and helps to recover some chest deformities.

Parents play an active role because they are the ones who can help the child in times of crisis and to apply the techniques learned.

The overall relaxation techniques (autogenic training Schultz “) seem very useful during international criticism for a general relaxation and perhaps even a decrease in airway resistance.

In children at risk (family history), we can try to avoid trigger asthma, delay its onset and minimize the symptoms.

When the ancestors of present history of allergies, the risk to the child is about 50%. When the two ancestors are themselves allergic, the child has 70% chance of being well. The IgE in the newborn or infant is a good yardstick of allergic risk if the rate rises during the first weeks.

Breastfeeding in strengthening the immune system of the child and avoiding the intake of allergenic proteins in cow’s milk is already a primordial prevention.

The first weeks of life will commit the future allergic infant comes into contact in the external environment with the predominant allergen in this time.

Prevention is then childhood risk factors to avoid allergens.

Each room in the house is likely to contain allergenic agents. The kitchen, especially if it is poorly ventilated, heated fats may contain (acrolein), aerosols, oven cleaners (ammonia, caustic soda …) or deodorants.

In the laundry, it will be wary of detergents (enzymes, bleaching agents releasing chlorine, dichloro-isocyanurate …).

In the bathroom, we will think of the hair powder (persulfates) and multiple products in aerosol cans (hairspray, deodorant antiseptic etc. …).

In the living room is especially tobacco smoke is the irritant.

The bedroom should be the subject of tough measures to disperse the dust of his guest house and formidable mite “Dermatophagoides pteronyssinus .”…

The room is often too hot, the means of heating are inadequate (by land or forced air), the atmosphere is too dry. The decoration must banish carpets, curtains, drapes, furs, lint etc. …

The feather pillows and comforters should not go into the bedroom of the asthmatic. It is a foam mattress wrapped in plastic. The vacuum must be spent every day and sheets, covers etc. … should be spread regularly and treated with an aerosol (spray) acaricide (Paragerm AK ®, etc. …). Acardust ®

Insecticides are frequently allergenic (pyrethrum, organophosphate, organochlorine, paradichlorobenzene …) and it is best not to put in the room. Screens on windows are equally effective and less allergenic.

The diagnosis is indisputable that for a first attack of asthma in a child previously spared by this disease.

Faced with respiratory symptoms suggestive, physicians should:

• A family history of allergy, asthma, eczema …
• The existence and duration of breastfeeding;
• Digestive disorders during withdrawal and the introduction of cow’s milk;
• Infectious episodes ENT repeatedly resulting in antibiotic prescriptions, of paracentesis and removal of adenoids;
• The repetition of respiratory episodes in a stereotyped;
• The occurrence of seizures when exposed to allergens;
• The improvement of symptoms by active drugs: steroids, beta-agonists;
• The limited effectiveness of antibiotics and cough suppressants;
• Signs suggestive of allergy: the crease below, folliculosis, conjunctivitis edematous, pale nasal mucosa, reddening of the pharynx, ear mucosa, dry skin, etc. accentuation of the palmar creases.

1. Examinations and further tests

The chest radiograph shows a hyper-ventilation of the lungs and eliminates complications (secondary infection, pneumothorax, etc …) or inhalation of a foreign body.

The blood count may reveal a hyper-eosinophilia.

Allergy skin tests are not common practice especially in children before 3 years although very painful, they are often feared by them, technically difficult to perform and their interpretation is delicate. The allergist in practice initially a very close examination to delineate the most probable allergens.

Skin tests involve introducing into the dermis a small amount of suspected allergen. If the child is sensitized to the allergen, it has 1GE type antibodies fixed on his skin mast cells, its mast and its bronchial blood basophils. The introduction of the allergen into the dermis has resulted in the rapid degranulation of mast cells, within minutes, releasing various chemical mediators, including histamine. These substances determine about the point of introduction of the allergen induration or papule surrounded by erythema.

Three types of tests can be used:

• The skin test;
• The skin prick test (multitest, Morrow Brown needle);
• The patch tests (patch tests by stamps).

Spa treatments and conditions:

France has several spas (Le Mont-Dore, the Bourboule Allevard Saint-Honore, Amelie-les-Bains, Enghien etc …) specialized in the treatment of respiratory diseases.

Spa treatments are medical treatment about three weeks. They consist of mineral waters to act either by bath or drink, or by aerosols or sprays on asthmatic children. The thermal waters have a local action on the airways but also the “field” and the psyche of patients.

But especially the climate of altitude (Font-Romeu, Briancon, Villars-de-Lans, Lans-en-Vercors Saint-Gervais-le Fayet, Lozère Sommail etc …) that attracts children with asthma . Marine climate stations are located in Arcachon and Grasse while in plain Dieulefit in the Drôme is a renowned resort. Treatments may be short (holidays) or long-term through schools altitude.

The prolonged treatments are required only in very severe cases resistant to any treatment for the psychological consequences of family separation are unpredictable. The Social Security system can support the costs of medical treatment.

The results are generally good but at the end of the treatment of altitude, the symptoms may recur if no action has been taken to facilitate the return home: action on environmental allergen, initiation of specific hyposensitization, learning techniques chest physiotherapy, rehabilitation efforts, eradication of outbreaks etc. ….

In a few hours or days, several successive phases: a runny nose and cough, and paroxysmal nocturnal wheezing finally appear. Within days, the cough becomes “fat”. Dyspnea is very moderate or absent. The sputum is often swallowed by the infant and released during vomiting.

Auscultation finds of scattered rhonchi. The throat is red, high fever and the diagnosis of rhino-bronchitis is often worn. Two elements should evoke asthma before this picture suggestive of bronchitis banal:

• The relapsing and stereotyped crises;
• And the existence of wheeze on auscultation associated with rhonchi.

A particular form is very common: it is about children who have a hacking cough, isolated, recurrent, late occurring either spontaneously or in connection with an effort (running, excitement at the games, laughter, tears , cries etc..) exposure. This is equivalent asthma.Some children can cause asthma attacks just by breathing rapidly and widely.

The repetition of such crises, their formulaic character, the existence of family history of allergies or eczema to suspect asthma.

The exercise-induced asthma (exercise-induced asthma “or IEA)

The A. I.e. is sometimes the only apparent manifestation of asthma. At other times, the crisis occurs in an asthmatic child whose seizures are known also allergic.

The A. I.e. often begins after cessation of exercise, recovery and yield spontaneously within a few minutes. The child was dyspneic, his breathing is wheezy and there are wheezing. This table should be differentiated from ordinary breath on exertion requiring discontinuation. It should be noted that patients may suffer from IEA Unknowingly, they simply believe falter quickly.

The causes are multiple bronchospasm: hyperventilation, the release of chemical mediators in respiratory movements, loose mouth breathing an air cooler and drier than that inspired by nasal breathing etc. …

The importance of bronchospasm depends on the type, intensity and duration of exercise.Running middle distance (800 meters), football, rugby, cross-country running in cold weather and rugged steep terrain are more often involved than walking or swimming.

The diagnosis can be confirmed by lung function tests (stress tests). The treatment is preventive.

1. Theophylline is more widely used

Parents should be aware of signs of overdose that require medical consultation: anorexia, nausea, vomiting, sweating, palpitations, headache, irritability, insomnia.

2. ß-sympathomimetics or beta-2 agonists (salbutamol or Ventolin ®, Bricanyl ® or terbutaline, isoprenaline or Aleudrine Isuprel ® and ®, Alupent ® or orciprenaline, fenoterol or Berotec ®, Maxair pirbuterol or …).

Overall, the impression of fast relief and well-being, reducing the number and length of crisis, are the best indicators of the effectiveness of the drug. Where there is no improvement or when the efficiency decreases, it should discontinue treatment.

3. Ventolin ®

Spray two inhalations crisis, followed by two others, after the first 15 minutes in case of inefficiency. Never exceed the dose of 2 inhalations 4 times a day. Usually a gust of 100 micrograms a quiet crisis average 2-5 minutes.

4. The synthetic atropine (anticholinergic vagolytic)

Ipratropium bromide (Atrovent, Tersigat) are excellent bronchodilators: 2 puffs 3 times per day.

There are associations and beta-2 vagolytic (Berodual, Bronchodual). The bronchodilating action is superior to that of each product separately. This combination allows for a savings of beta-2 adrenergic receptors and decreases the number of drug compliance (2 puffs 3 times per day)

5. The Gluco-corticosteroids (prednisone or Cortancyl ®, Solupred ® prednisolone, betamethasone or Célestène ® etc …)

6. Corticosteroid therapy of acute crisis

The asthma attack is not simple in principle an indication of glucocorticoids because of their slow action. The ß2-sympathomimetics is more effective.

By cons, if a severe crisis from the outset or whether ß2-sympathomimetics have been used, it uses fast-acting steroids intravenously:

• Solumedrol ® or Dépomédrol ® (methylprednisolone);
• ® Hydrocortisone hemisuccinate (hydrocortisone hemisuccinate);
• Soludécadron ® (dexamethasone = methylated and fluorinated derivative of hydrocortisone);
• Célestène Betnésol ® or ® or Diprostène ® (betamethasone = methylated and fluorinated derivative of Δ-cortisol).

The improvement is apparent only after long delays of about 4 to 8 hours.

Asthma results from a combination of two kinds of factors:

• Predisposing factors, congenital, which constitute the “field”;
• And factors predisposing immuno-allergic, psychological or related to the environment;

Also known as allergic asthma (atopic or extrinsic) where the major cause is allergic and nonallergic asthma (intrinsic or entangled) when other factors including infectious appear to predominate.

1. The field of allergic asthma

The influence of the “field” allergic, that is to say, of heredity, is very important before puberty, especially in young children. There is family history of allergies in 49-75% of cases. There are links between allergic manifestations and HLA (major histocompatibility complex). There is a hereditary predisposition to produce IgE against allergens surrounding the bronchial hyperreactivity, abnormal vis-à-vis chemical mediators and the autonomic nervous system.

From birth, the baby may develop an allergy.

Children fed breast milk have fewer allergic symptoms than those fed cow’s milk. Breast milk provides immunological defense components and avoids the newborn to raise awareness vis-à-vis the cow’s milk proteins considered “foreign” by the body of the child. Breastfeeding is strongly recommended when there is family history of allergies.

Atopic eczema is often associated with asthma. Often, the child suffers from eczema during the first two years and then the skin disease disappear being replaced by the respiratory disease.The reasons for this relationship are poorly understood.

2. Environment

If genetic factors are important in the allergic mechanism, factors related to the environment are essential to the onset of clinical symptoms.

3. The first weeks of life

Avoid newborn contact with domestic animals and particularly in allergic families, taking care to eliminate house dust and smoke tobacco.

Asthma and respiratory allergies are more common in children who suffered in the neonatal period. Attacks such as hospitalization, infection, surgery and anesthesia promote the early development of allergy.

A few years ago, patients with mild asthma could not practice any sport. Nowadays, available treatments allow most people with asthma to exercise and even compete in competitions.

Among the Olympic athletes who have thrilled you, some asthmatics. However, before imitating them and get involved in a sport intensely, it is necessary to establish a schedule of training.With the guidance of regular peak expiratory flow (PEF), your doctor may tell you a tailored preventive treatment.

The association recommends formally ASTHMA sport for asthmatic children including competition. The child will learn very quickly to regulate their effort and especially to prepare.

1. Choose a sport suited

Some sports are particularly recommended:

• Swimming pool if you do not
• eczema or warm water;
• Sea Sports unless the dive;
• Walking, hiking, climbing, cross country skiing;
• Ball sports, cycling, gymnastics, skating, surfing, sailing;
• Combat sports;
• Running slow, indoors or in warm weather: Beware of intense cold, the exertion (sprints, middle distance).

In contrast, other sports are to be avoided:

• Horseback riding, because of allergy to animal hair;
• The scuba diving.

2. What to do in practice?

While it is recommended that sports activities, observe the following guidelines:

• Warm up time, consider the weather, learn how to adjust your efforts based on your respiratory condition;
• Wear a balaclava and an over-garment if it is cold;

True, the child with asthma will be better if he played sports. Above all, do not deprive yourself, instead, push it to the sport of their choice.

If sport is good for health in general, for children with asthma it is even more beneficial. Moreover, many athletes have asthma, and even gold medalists in the Olympics.

The asthmatic children treated properly and regularly takes his treatment, leads a normal life, like all his friends, many of whom play sports. One exception, however, scuba diving with bottles is prohibited.

1. Do not forbid him to play sports

An asthmatic child who does not sport can have an asthma attack or shortness of breath for a little effort. In this case, a lot of good advise parents then logically their beloved child not to make too much effort.

In reality, these good parents are misinformed. Instead, with regular sports, asthmatic children learn to make efforts without any problem.

For many children, the sport regularly improves asthma, which has resulted in the reduction of medication. The sport has many benefits: the child, better control their breathing (the muscles used in breathing), breathing better and more efficiently. Also, playing sports helps limit excess weight and feel better about yourself.

If an asthma attack occurs during exercise, is that asthma is poorly treated. So you should consult your doctor.

2. Focus overheating

Sometimes, for children as for adults, asthma occurs after 5-10 minutes of effort. This form of asthma is called exercise-induced asthma or asthma post-exercise. To avoid this, just long enough to warm up before exercise and take an inhaled asthma medication (called a bronchodilator), evidently prescribed by your doctor. For this reason we should keep constantly in his pocket during training.