The acute attack occurs regardless of the different phenotypes (observable clinical characteristics) and endotypes (underlying mechanisms of pathogenesis) of asthma. Severe attacks can manifest with respiratory failure and need prompt medical examination.
The attack can resolve spontaneously or after appropriate treatment. Spirometry often shows variable expiratory airflow limitation.
Some variation in airflow can also occur in people without asthma, but it is greater in untreated asthma. These symptoms are associated with difficulty in breathing air out of the lungs due to bronchoconstriction (airway narrowing), airway wall thickening and increased mucus. Symptoms include cough, wheezing, chest tightness, dyspnea and difficulty in carrying out daily activities. The acute attack of asthma is characterized by bronchoconstriction of the bronchial smooth muscles, inflammation and mucus secretion. Asthma control has two domains: symptom control and risk factors for future poor outcomes, particularly flare-ups (exacerbations). Asthma control means the extent to which the effects of asthma can be seen in the patient, or have been reduced or removed by treatment. A careful medical history, physical examination, assessment of atopy, comorbidities and lung function are essential to confirm the diagnosis of asthma and exclude other diseases. Biologic drugs are recommended for patients with exacerbations or poor symptom control despite taking at least high dose ICS/LABA, and who have allergic or eosinophilic biomarkers or need maintenance oral corticosteroids (OCS). Asthma severity may change over months and can be classified when the patient has been on controller treatment for several months as: (1) mild, if asthma is well controlled with step 1 or step 2 treatment (as needed inhaled corticosteroids -formoterol or low dose ICS or leukotriene receptor antagonists) (2) moderate, if asthma is well controlled with step 3 or step 4 treatment (low or medium dose ICS/long-acting β-agonists ) (3) severe, if asthma is well controlled with step 5 treatment (high dose ICS/LABA or biologics). According to GINA recommendations, asthma severity is assessed retrospectively from the level of treatment required to control symptoms and exacerbations. The symptoms have these characteristics: they occur variably over time and vary in intensity they often occur or are worse at night or on waking they are often triggered by exercise, laughter, allergens or cold air they often occur with or worsen with viral infections they are associated with evidence of variable expiratory airflow limitation. People with asthma generally have more than one of these symptoms. Asthma causes symptoms such as wheezing, shortness of breath, chest tightness and cough that vary over time in their occurrence, frequency and intensity.
It is characterized by chronic airway inflammation and airway hyper-responsiveness in response to triggers that can cause acute symptoms and eventually airway remodeling. Monitoring the progress of asthma through spirometry could allow the pediatrician in the area to intervene early by modifying the maintenance therapy and help the patient to achieve good control of the disease.Īsthma is the most frequent chronic disease of childhood, affecting up to 20% of children depending on the geographical area. An important point of union between the primary care pediatrician and the specialist hospital pediatrician was the need to share spirometric data, also including the use of new technologies such as teleconsultation. The RAND method was found to be useful for the selection of good practices forming the basis of an evidence-based approach, and the results obtained form the basis for further interventions that allow optimizing the care of the child with acute asthma attack at the family and pediatric level. Through the application of the RAND method, which obliges to discuss the statements derived from the guidelines, there was a clear increase in the concordance in the behavior on the management of acute asthma between primary care pediatricians and hospital pediatricians. The project was developed in the awareness that for the management of these patients, broad coordination of interventions in the pre-hospital phase and the promotion of timely and appropriate assistance modalities with the involvement of all health professionals involved are important. The aim of this project was to define the care pathway for pediatric patients who come to the primary care pediatrician or Emergency Room with acute asthmatic access. Asthma symptoms vary over time and in intensity, and acute asthma attack can resolve spontaneously or in response to therapy. Bronchial asthma is the most frequent chronic disease in children and affects up to 20% of the pediatric population, depending on the geographical area.
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