|
.................................... Search the net .................................... |
Paediatric Pulmonology and Allergology
2005 October, Vol. VIII, No. 2 (2981-2989)
CURRENT ASSESSMENT AND TREATMENT OF CHRONIC AIRWAY INFLAMMATION IN CHILDREN
Iveta Skurvydiene2, Vanda Kriukiene1
1 Vilnius City University Hospital, Vilnius
2 Tauragė District Hospital, Tauragė, Lithuania
Non-atopic wheezing in children is associated with frequent respiratory infections before age of 2 years and maternal asthma. Atopic wheezing in childhood is associated with bronchial asthma or eczema in sibling, male gender and allergic rhinitis before age of 4 years. Differential diagnosis of inflammatory airway disease in pre-school children is a difficult task for the practical doctor. It is very difficult to diagnose a mild asthma in a very young child without using any invasive investigation (bronchoscopy, BAL). The role of wheezing in diagnosing of bronchial asthma is not still unclosed. Multiple data says that most of post-bronchiolitis wheezers tend to grow out of their problem before age of 10 years; however, some of them tend to develop bronchial asthma subsequently. USA medical statistics show the double increase in infant hospitalization rate due to RSV bronchiolitis and pneumonia during the last 10 years. After severe RSV bronchiolitis children develop long-lasting bronchial hyper reactivity symptoms resembling bronchial asthma. And steroid treatment is not effective in such cases. Cysteinyl-leucotriens are mediators of airway inflammation both of atopic and non-atopic origin. Danish study on 130 children with RSV induced post-bronchiolitis wheeze showed 5-fold reduction in night and day cough and wheeze symptoms in children treated with with montelucast for 4 weeks vs. placebo group. Leucotrien receptor antagonists should be successfully administered for children with atopic asthma and for post-bronchiolitis wheezers as well.