Asthma is one of the most common childhood diseases. However, the first manifestations of asthma in children often go unnoticed, and in many cases the diagnosis comes too late. Coughing and wheezing may occur as early as the first few years of life, as isolated episodes or associated with bronchitis or another respiratory infection. This is because a child’s airways are smaller and narrower than an adult’s, and when they experience an infectious episode, they may present with symptoms reminiscent of bronchial asthma. For this reason, it is not easy to distinguish between recurrent cold symptoms and asthmatic manifestations. Fortunately, the tests available today allow accurate diagnoses that allow the child to be prescribed appropriate therapies to control symptoms and train the whole family to deal with the disease. We talked about it with Francesco Guglielmo, a specialist in pediatrics and allergology, a member of the Italian Society of Pediatric Allergy and Immunology (SIAIP) and of the Italian Society of Infant Respiratory Diseases (SIMRI), former regional coordinator of the Italian Society of Pediatric Allergy . and Immunology for the Sicily Region.
What are the tests to diagnose asthma in children?
“Despite the high incidence of asthma, around 5.5 million children in the EU, there is currently no single gold standard test to confirm the diagnosis. But spirometry is a basic test for diagnosing asthma and, above all, for following its trend. over time.It is especially important in recurrent and chronic forms of asthma in school-age children with respiratory problems.It provides information about the amount of air (volumes) emitted outside the body and about the rate (flows) at which it portable devices are currently available that allow this examination to be performed in the pediatrician’s office, both under “basic” conditions and by comparing the values obtained with those after bronchodilator treatment.To recognize asthma from the very first signs however, is very important to prescribe appropriate treatments for the child, to keep the symptoms under control and to train the whole family to cope the disease.
How is spirometry performed?
“Spirometry consists in the execution of a maximum inhalation which reaches the total lung capacity, followed by a rapid and forced exhalation, which must be continued until the lungs are empty, and which corresponds to the attainment of residual volume, i.e. the amount of Air that always remains in the lungs and cannot be exhaled.Before starting the spirometric test, the operator will perform an anamnestic test to detect indications for the test and any contraindications.The small patient will be asked to breathe through a disposable mouthpiece after have clogged their nose with a nasal clamp (to prevent air leakage through the nose) by performing the required breathing maneuvers, which will be carefully explained by the operator.The mouthpiece is connected to a meter of the flow and volume of air mobilized by the patient, which converts the signal to numerical values and graphical images ».
From what age is it possible to take the test?
“Traditionally, school age was considered the best age to perform spirometry. The test actually requires a certain degree of cooperation, and is therefore usually feasible in children over 5-6 years. Although with modern techniques, especially with the use of incentives and with adequately trained staff, it is possible to perform reliable tests even from the age of 3-4 years. The incentives are applications created specifically for children that make the flow of air emitted visible through highly captivating animations, thus helping them achieve the best possible performance ».
How is a spirometry exam interpreted?
«It is based on the measurement of the main spirometric indices: FVC, FEV1 and FEV1 / VC% ratios. Determination of static lung volumes is required to confirm the diagnosis. The correct execution of the study will require the interpretation of the data and it is therefore important to contact pediatric centers with consolidated experience and professionals with experience in performing and interpreting spirometry in pediatric age “.
Why is a bronchodilation test performed?
The reversibility or bronchodilation test completes the diagnosis of suspected bronchial asthma as it shows whether the obstruction detected by spirometry is reversible after administration of a bronchodilator. The small patient performs a simple spirometry, after which he receives a bronchodilator drug by inhalation. After 20 minutes, spirometry will be repeated and compared to the basal. In case there is a significant improvement in the obstructive deficit after administration of the drug, we are in the presence of bronchial asthma: a chronic disease of the respiratory tract, reversible with proper treatment “.