Bronchial asthma can be defined as, increased sensitivity of respiratory air passage to various stimuli leading to-

1. Spasm of the bronchial smooth muscles
2. Edema and inflammation of the mucous membrane of the bronchial tree
3. Intraluminal collection of mucous, cellular debris and inflammatory cells

All these things lead to increased air- ways resistance resulting in wheezing. Bronchospasm may get relieved spon- taneously or with bronchodilators.

Bronchial Asthma in kids

Etiology-

Many theories have been postulated to explain the occurrence of the disease. These theories are mentioned below, without giving details of each one of them.

1. Immunological theory: Reaction between allergen and cell bound IgE leads to degranulation of mast cells and release of chemical substances like histamine. These chemical substances cause bronchospasm.

2. Endocrine theory: There is some correlation between bronchospasm and onset of puberty and menstru- ation.

3. Beta Adrenergic theory: Decreased sensitivity of Beta receptors of bronchial tree results in broncho- spasm.

4. Increased physical activities during viral infection.

5. Psychological factor: Though un- common in children, emotional stress may increase broncho- spasm.

In addition to this there is some cor- relation of family history and bronchial asthma.

Symptoms of Bronchial Asthma in kids

The attack of bronchial asthma may be acute, or insidious. In acute sudden, cough, breathlessness, wheezing starting suddenly and seriously.  Cold drinks, ice creams, and chewing gums these things might act as precipitating factors for the fresh attack.

Cough, breathlessness and wheezing these are the main symptoms.  child may vomitout  secretion during time of cough. Breathlessness started increasing, making the child restless and uncomfortable. The older child prefers tripod like sitting position by bending forward and supporting the body with both the hands. If breathlessness is severe it might lead to cyanosis.

Signs of Bronchial Asthma in kids

1. Increased respiratory rate
2. Increased functioning of accessory muscles of respiration- a. Flaring of alae nasi b. Subcostal and intercostal re- traction
3. If the child is getting recurrent attacks, the chest may have barrel shape deformity.
4. Auscultation of chest: Expiratory phase is prolonged, Bronchospasm (Rhonchi) is present.  The Degree of bronchospasm depends upon the severity of the attack.

Investigations of Bronchial Asthma in kids

In severe cases investigations are not required for confirming the diagnosis. However in small child during first attack of bronchospasm, it is difficult to differentiate between bronchiolitis and bronchial asthma.

1. W.B.C. Count: Eosinophilia total eosinophil count is above 400

2. X-ray chest: Hyperinflation lungs.

3. Skin allergy testing: For common allergen. Advised only in cases with frequent recurrent attacks not responding to routine line of treatment.

4. Pulmonary function test

 Differential Diagnosis of Bronchial Asthma in kids

1. Bronchiolitis
2. Foreign body in respiratory tract: Spasm may be localized.
3. Endobronchial tuberculosis: Other evidence of tuberculosis such as positive Mantoux test, lymphocy- tosis, raised ESR, hilar lymphade- nopathy may be present.

Treatment of Bronchial Asthma in kids

1. Treatment of acute attack, 2. Prevention of recurrent attacks, 3. Hyposensitization of chronic cases getting frequent recurrence, 4. Alternative to allopathy treatment: Homeopathic or Ayurvedic drugs.