To reduce the risk of developing exacerbations of bronchial asthma (BA) in children in the fall, during an increase in the incidence of respiratory infections, experts recommend “updating” the first-aid kit in advance and stocking up on inhaled glucocorticosteroids 1 . This year, when the season of colds and SARS coincided with the COVID-19 pandemic, prevention of exacerbations of bronchial asthma is especially relevant.
Autumn, as you know, is a difficult period for everyone: at this time,
the incidence of SARS increases. It is even more difficult for children with
bronchial asthma, since acute respiratory viral infections are one of the main
causes of asthma exacerbation 2 .
This season is doubly dangerous because the COVID-19 pandemic continues. This does not mean that children with asthma are more likely to get infected – they have the same risk of getting sick as others 1 . The problem is that a viral infection not only significantly increases the risk of exacerbations of bronchial asthma, but also worsens its course 3 . The way out is to approach the control of asthma even more responsibly, that is, stock up on the necessary medicines and always keep them at hand.
When it comes to controlling the course of bronchial asthma, regular anti-inflammatory therapy is meant, which is aimed at eliminating the main cause of the disease – allergic inflammation in the bronchial mucosa 2 . This applies to periods in which the risk of exacerbation increases: spring (plant flowering), vacation (climate change), autumn (seasonal SARS). Coronavirus is another rather serious risk factor that can cause an exacerbation of the disease, so while the pandemic is on, experts recommend not interrupting anti-inflammatory therapy.
IGCS are the first among the necessary
Inhaled glucocorticosteroids , or IGCS 1.2 , is the first thing that should be on the list of mandatory medicines for children with bronchial asthma. Currently, ICS are considered the most effective anti-inflammatory drugs for the treatment of asthma, as they can reduce the frequency of exacerbations and hospitalizations 3 , reduce daytime and nighttime symptoms of bronchial asthma, restore bronchial epithelial cells, and reduce the need for emergency drugs 1,2,4 . However, it should be remembered that a positive effect is achieved only through long-term, at least 3 months, therapy.
The most effective, safe (compared to injections and tablets), and also a convenient way of administering the drug, especially for children, is inhalation, since in this case the drug reaches the respiratory tract in a short time at maximum concentration.
The most essential gadget
In order for the medicine to “reach” its destination without loss, doctors recommend using special devices – nebulizers. First, they are easy to use. So, thanks to a simple technique for administering a drug, in which during inhalation it is not necessary to hold your breath, you do not need to synchronize the activation of the inhaler and inspiration, control the inhalation rate depending on the type of inhaler; nebulizers are recommended even for children in the first months of life, as well as for adult patients with exacerbation of asthma.
It is necessary to put the baby on your lap so that he is comfortable. After that, firmly press the mask to his face. Do inhalation until the drug runs out in the tank. After the procedure, the child should be washed and rinsed with his mouth.
Secondly, in one chamber of the nebulizer, you can simultaneously combine several drugs intended for nebulizer therapy, which reduces the number of inhalations during the day.
Thirdly, even long-term treatment with inhaled glucocorticosteroids through a nebulizer is considered the safest, because. drugs have a local effect in the bronchial mucosa and enter the systemic circulation in a very small amount 2.5 .
There are several types of devices: compressor type, mesh nebulizers and ultrasonic. For inhalation with steroids, compressor or membrane type nebulizers (mesh nebulizers) should be chosen. Ultrasonic nebulizers are not suitable for this therapy, as ultrasound destroys steroids.
By following the doctor’s recommendations, adhering to the prescribed dose and duration of inhaled steroids, it is possible to protect the child from exacerbation of asthma even in the midst of a seasonal SARS epidemic and a coronavirus pandemic. However, it is important that at this difficult time the supply of necessary medicines in the home medicine cabinet is sufficient and all the necessary drugs are always “at hand”.
ARVI – acute respiratory viral infection, BA – bronchial asthma, IGCS – inhaled glucocorticosteroids , COVID-19 – coronavirus infection.