[Childhood asthma]

Abstract

The concept of chronicity in asthma, as emphasized by recent definitions of the disease, rests on the major characteristics of inflammatory response of the airways and progressive development of irreversible structural and functional alterations, or so-called airway remodeling. In childhood, however, such characteristics as chronicity and irreversibility are debatable. Various clinical phenotypes with variable degrees of severity of persistence are found in children. Furthermore, many patients with a history of recurrent wheezing in early infancy do not develop asthma later in life. The prevalence of asthma, especially in its mild forms, has increased markedly in recent years. Although the trend has stabilized in Italy, it continues to rise in other Western countries. Our research has shown that increased cutaneous response to histamine determines a major prevalence of positive skin tests. The rise in clinical forms of the disease accompanied by gastrointestinal symptoms is partly attributable to the dietary intake of food and beverages processed from environmentally engineered products. The features of the new forms of asthma demand accurate clinical and functional assessment. In addition to pulmonary function tests, determinations for eosinophils and inflammation markers in the blood and sputum, noninvasive methods have recently become available to assess airway inflammation. Among these, particularly useful studies include test for nitric oxide in exhaled air, along with tests for other markers of allergic inflammation and oxidative stress in the droplets of the exhaled air. Because in paediatric age, prolonged use of inhaled steroids increase the risk of growth impairment, asthma therapy should be guided by clinical criteria and examinations, rather than by rigid treatment guidelines. Moreover, to secure successful treatment, the parents and the child as well should be involved in monitoring the course of the disease.