Acute Asthma in Children

Acute Asthma in ChildrenAfrilia Intan Pratiwi12176Noor Adibah Hanum Che Hashim 12299Meita Ucche 12122Zamrina Adilafatma 12159

RSUD Banyumas Minggu II

Case ReportA seven-year-old girl came to the Emergency and AccidentUnit (A&E) with chief of complaint she had difficulty inbreathing and shortness of breath.

History TakingPhysical ExaminationRadiologic ExaminationChest X-rayAnteroposterior (AP)Lateral I. DefinitionRecurrent cough and/or wheezy, characterized: episodic, nocturnal (variability), reversible (with or without medication), history of atopic.

69. Cough and Difficult Breathing Block 2.3, Dec 10, 2008 Week 2 International Programmedr. Amalia, Sp.AII. How does asthma affect breathingA narrowing of the breathing airways, which interferes with the normal movement of air in and out of the lungs. Involves only the bronchial tubes and does not affect the air sacs or the lung tissue.The narrowing is caused by three major factors: InflammationBronchospasmhyperreactivity.inflammation

The first and most important factor causing narrowing of the bronchial tubes is inflammation. The bronchial tubes become red, irritated, and swollen. This inflammation increases the thickness of the wall of the bronchial tubes and thus results in a smaller passageway for air to flow through. The inflammation occurs in response to an allergen or irritant and results from the action of chemical mediators (histamine, leukotrienes, and others). The inflamed tissues produce an excess amount of "sticky" mucus into the tubes. The mucus can clump together and form "plugs" that can clog the smaller airways. Specialized allergy and inflammation cells (eosinophils and white blood cells), which accumulate at the site, cause tissue damage. These damaged cells are shed into the airways, thereby contributing to the narrowing.8bronchospasm

The muscles around the bronchial tubes tighten during an asthma attack. This muscle constriction of the airways is called bronchospasm. Bronchospasm causes the airway to narrow further. Chemical mediators and nerves in the bronchial tubes cause the muscles to constrict. Bronchospasm can occur in all humans and can be brought on by inhaling cold or dry air.9hyperreacivity-hypersensitivity

In patients with asthma, the chronically inflamed and constricted airways become highly sensitive, or reactive, to triggers such as allergens, irritants, and infections. Exposure to these triggers may result in progressively more inflammation and narrowing.10INFLAMMATIONAirflow LimitationSYMPTOMSCough Wheeze DyspnoeaTRIGGERS Allergens, Exercise, Cold Air, SO2 Particulates

Pathogenesis:AirwayHyperresponsivenessGenetic*INDUCERSAllergens,Chemical sensitisers,Air pollutants, Virus infections11 Inflammation of the airways not only causes symptoms associated with widespread but variable airflow obstruction, it also results in an increase in airway hyperresponsiveness to a variety of stimuli (triggers) Environmental and genetic influences in asthma (inducers) act mainly by provoking airway inflammation, rather than directly stimulating airway hyperresponsiveness Triggers of bronchoconstriction, which are factors that provoke contraction of the sensitised airway wall, include a wide range of stimuli, such as exercise, cold air and pollen Allergens can act as both inducers and triggersIII. Signs and Symptoms4 major recognized asthma symptoms:Shortness of breath, especially with exertion or at nightWheezing is a whistling or hissing sound when breathing outCoughing may be chronic, is usually worse at night and early morning, and may occur after exercise or when exposed to cold, dry airChest tightness may occur with or without the above symptomsIV. Physical Examination Wheeze :Usually heard without a stethoscope

Dyspnoea :Rhonchi heard with a stethoscopeUse of accessory muscles

*Remember -Absence of symptoms at the time of examination does not exclude the diagnosis of asthma

IV. Radiologic ExaminationChest X-ray:Anteroposterior (AP)Lateral

Babygram V. Radiologic Imaging

VI. Radiologic FindingThe diaphragms should normally have a smooth rounded contour. This PA and lateral upright chest x-ray was obtained as a part of the evaluation of child who was experiencing wheezing, chest pain, and acute shortness of breath. The PA radiograph on the left demonstrates depression and flattening of the diaphragms (yellow arrows). On the lateral radiograph there is an increase in the anterior-to-posterior chest diameter (double-headed black arrow). These findings are consistent with air-trapping in a case of acute asthma.Posteroanterior chest radiograph demonstrates a pneumomediastinum in bronchial asthma. Mediastinal air is noted adjacent to the anteroposterior window and airtrapping extends to the neck, especially on the right side

Lateral chest radiograph demonstrates a pneumomediastinum in bronchial asthma. Air is noted anterior to the trachea

High-resolution CT scan of the thorax obtained during inspiration demonstrates airtrapping in a patient with asthma. Inspiratory findings are normal

High-resolution CT scan of the thorax obtained during expiration demonstrates a mosaic pattern of lung attenuation in a patient with asthma. Lucent areas (arrows) represent areas of airtrapping

Asthma. High-resolution CT scan of the thorax demonstrates mild bronchial thickening and dilatation in a patient with bilateral lung transplants and bronchial asthma

Baseline high-resolution CT scan of the thorax obtained during expiration in a patient with bronchial asthma.

ConclusionAsthma involves chronic inflammation, swelling, and narrowing of the airways. The bronchial narrowing is usually totally reversible with treatments.Asthma is now the most common chronic childhood illness affecting one in every 15 children.Asthma involves only the bronchial tubes and usually does not affect the air sacs or the lung tissue. The narrowing that occurs in asthma is caused by three major factors: inflammation, bronchospasm, and hyperreactivity. Symptoms of asthma include shortness of breath, wheezing, cough, and chest tightness.Asthma is usually diagnosed based on the presence of wheezing and confirmed with breathing tests.Chest X-rays are often normal in asthma patients.Thank YouMatur Nuwun