Therapy of bronchial asthma in children: age-related aspects

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Abstract

Bronchial asthma (BA) is a disease that is one of the most frequent chronic diseases of childhood. Characteristic clinical symptoms of BA are wheezing, cough, difficulty in breathing, shortness of breath and, of course, recurrent episodes of bronchial obstruction. They require mandatory clarification of family and individual allergoanamnesis, assessment of symptoms, differential diagnosis with other diseases that may occur with BA. The Global Initiative for the Treatment and Prevention of Bronchial Asthma (GINA 2020–2021) preserves and develops the ageappropriate approach to verification of diagnosis and therapy selection, which is supported in the Russian National Program "Bronchial Asthma in Children" and in the Russian clinical guidelines "Bronchial Asthma 2021 When the diagnosis of BA is made, therapy should be started as early as possible. Administration of low-dose inhaled glucocorticosteroids (IGCS) immediately after the diagnosis allows not only to control the inflammatory process, which is the basis of BA, but also to reduce the severity of exacerbations. IGCS are the most effective drugs for children of any age, they ensure control of the disease and reduce the risk of AD exacerbations.

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Natalia A. Geppe

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: geppe@mail.ru
ORCID iD: 0000-0003-0547-3686

D. Sci. (Med.), Prof., Sechenov First Moscow State Medical University (Sechenov University)

Russian Federation, Moscow

Elena G. Kondiurina

Novosibirsk State Medical University

Email: geppe@mail.ru

D. Sci. (Med.), Prof., Novosibirsk State Medical University

Russian Federation, Novosibirsk

Vera A. Reviakina

Federal Research Centre of Nutrition and Вiotechnology

Email: 5356797@mail.ru
ORCID iD: 0000-0002-1149-7927

D. Sci. (Med.), Prof., Federal Research Centre of Nutrition and Вiotechnology

Russian Federation, Moscow

Aleksandr B. Malakhov

Sechenov First Moscow State Medical University (Sechenov University)

Email: alexis4591m@mail.ru
ORCID iD: 0000-0002-2686-8284

D. Sci. (Med.), Prof., Sechenov First Moscow State Medical University

Russian Federation, Moscow

Natalia G. Kolosova

Sechenov First Moscow State Medical University (Sechenov University)

Email: kolosovan@mail.ru
ORCID iD: 0000-0001-5071-9302

Cand. Sci. (Med.), Sechenov First Moscow State Medical University (Sechenov University)

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. Algorithm of bronchial asthma (BA) diagnosis [2, 3].

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3. Fig. 2. Relationship of delivery conditions and aerosol deposit. Distribution of radiolabeled aerosol in children (3 years) during inhalation: a – through a loose-fitting mask; b – during crying during inhalation; c – during quiet inhalation [15].

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4. Fig. 3. Nebulas for budesonide suspension.

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5. Fig. 4. Comparison of the efficacy of montelukast and Pulmicort® suspension: a – proportion of patients who required systemic GCS; b – peak expiratory rate on montelukast therapy and budesonide suspension therapy.

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6. Fig. 5. Comparison of baseline therapy algorithms for BA according to GINA and the National Program in children aged 0–5 years [1, 9].

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7. Fig. 6. Therapy algorithm for children aged 6–11 years according to GINA (2020) [9].

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8. Fig. 7. Therapy for patients 12 years and older [9].

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9. Fig. 8. Potential outcomes with different BA treatment regimens in response to worsening symptoms [28].

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