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Altersentsprechendes Management des Asthma bronchiale

Age-dedendent paediatric asthma management

  • Leitthema
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Zusammenfassung

Asthma ist die häufigste chronische Erkrankung bei Kindern und Jugendlichen. Die Diagnose wird dann gestellt, wenn anamnestisch typische Symptome auftreten und eine variable Atemwegsobstruktion besteht; optimaler Weise kann die chronische Entzündung der Atemwege gezeigt werden und/oder auch eine bronchiale Hyperreagibilität nachgewiesen werden. Zusätzlich ist Asthma bronchiale in jedem Lebensalter eine heterogene Erkrankung, die durch unterschiedliche Phänotypen charakterisiert ist und differenzialdiagnostisch vor allem bei Kleinkindern eine besondere Herausforderung darstellt. Ab dem frühen Schulalter ist die Spirometrie mit Bronchodilatation eine sinnvolle Untersuchung, insbesondere bei gleichzeitigem Vorhandensein von Symptomen. Allerdings ist die Lungenfunktion bei Kindern mit Asthma bronchiale zumeist normal, vor allem im beschwerdefreien Intervall. Kleinkinder sollten ebenso wie ältere Kinder und Jugendliche mit Asthma beschwerdefrei sein, insbesondere auch nachts. Das therapeutische Langzeitmanagement muss dem Beschwerdegrad und dem Alter des Patienten angepasst sein. Exposition gegenüber Allergenen oder Noxen und eine fehlerhafte Anwendung der inhalativen Therapie spielen eine wesentliche Rolle bei fehlender Asthmakontrolle. Das Ziel der kompletten Beschwerdefreiheit und vollständigen Symptomkontrolle wird bedauerlicherweise bei einem Teil der pädiatrischen Patienten nicht erreicht. Ein klares Verständnis der möglichen Triggerfaktoren, gute Therapieadhärenz, Optimierung der Inhalationstechnik sowie eine regelmäßige Kontrolle und Anpassung nach Asthmastufenschema sind entscheidend für ein erfolgreiches Langzeitmanagement von Asthma bronchiale bei Kindern und Jugendlichen.

Abstract

Asthma is the most frequent chronic disease in children and adolescents. The diagnosis depends on typical symptoms in the patient history and a variable airway obstruction. Optimally, chronic airway inflammation is present and/or bronchial hyperreactivity can be demonstrated. In addition, in every age group asthma is a heterogeneous disease characterized by different phenotypes and is especially challenging in the differential diagnostics particularly in preschool children. After early school age spirometry with bronchial dilatation testing may be performed, in particular in the presence of symptoms; however, lung function in small children with bronchial asthma is usually normal, especially when the patients are symptom-free at the time of testing. All children and adolescents with asthma should be symptom-free, especially at night. The therapeutic long-term management must be adjusted to the severity and the patient’s age. Exposure to allergens or noxa and failure to correctly use the inhalation devices play an important role in treatment failure; however, the goal of freedom from complaints and complete asthma symptom control is unfortunately often not achieved in a large proportion of pediatric patients. A clear understanding of possible trigger factors, good treatment adherence, optimization of the inhalation technique and regular visits and adjustment of treatment according to asthma treatment protocols are of major importance in the long-term management of bronchial asthma in children and adolescents.

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Authors and Affiliations

  1. Pädiatrische Pneumologie, Abt. für Kinder- und Jugendheilkunde, Wilhelminenspital Wien, Lehrkrankenhaus, Universität Wien, Montleartstraße 37, 1160, Wien, Österreich

    A. Zacharasiewicz MBA

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A. Zacharasiewicz hat Vortragshonorare von Abbvie, AOP, Astra Zeneca, Chiesi, Hagleitner Hygiene, Heine und Löwenstein, Gilead, Novartis und Vertex erhalten. Im Bezug auf den Inhalt dieses Artikels gibt es keinen Interessenskonflikt.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Rose, Stuttgart

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Zacharasiewicz, A. Altersentsprechendes Management des Asthma bronchiale. Pneumologe 16, 10–18 (2019). https://doi.org/10.1007/s10405-018-0216-4

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