Francisco Muñoz-López

By F. Muñoz-López

A proper diagnostic and therapeutic approach in children under 5 years who have symptoms of respiratory distress, of varying intensity, more or less continuously or in acute and repeated episodes must observed. In many cases, the dominant symptom is cough, which has been linked to the existence of asthma (‘equivalent asthmatic coughing’). As respiratory symptoms are common to many processes that affect this system, an appropriate differential diagnosis is required before starting treatment, which is often not appropriate.—Concept. Epidemiology—Predisposing factors, risk factors and triggers—Respiratory symptoms addressed from a pathogenic point of view, in order to better understand the possibilities of these symptoms to appear: Pathogenesis of dyspnea, cough, secretion and bronchial breath sounds.—The inflammatory reaction is the pathogenetic basis of asthma, and hence, anti-inflammatories are the most appropriate treatment. But there is no evidence that inflammation is a permanent fact from the start of the disease or that it exists in other respiratory processes. The appropriate methods to assess inflammation in children under 5 years and the evaluation of results in published studies will be presented. The conclusion is that it has been shown that in mild to moderate and sporadic cases, inflammation persists.—Atopy and asthma: onset and evolution—Clinical and allergologic diagnosis—Diagnostic evaluation of the dominant symptoms, relating directly to their pathogenesis.—Exploration of respiratory function, according to age: younger and older than 2 years.—Differential diagnosis based on the dominant symptoms.—Treatment. (a) Etiologic: immunotherapy in <5 years: standards. (b) Pathogenic: anti-inflammatory (corticosteroids). Indications of pre-inflammatory: chromones and anti-leukotriene: montelukast. (c) Treatment regimens: treatment of seizures.

Part of the book: Asthma

By Francisco Muñoz-López

Respiratory processes that take place in childhood (preschool and adolescence) have a predominant frequency, especially rhinitis and asthma. Family predisposition and the environment define the characteristics of the endotype and the phenotype. Heritage, both of the genes related to bronchial hyperresponsiveness and those related to atopy (production of specific IgE against allergens and hypereosinophilia) are the fundamental basis of those processes that begin at preschool age and continue into adulthood if they do not receive early and etiological treatment. The physiological vagal hyperresponsiveness of the infant; the environment in which it develops, even from the prenatal phase (pregnant smoker); and viral infections are responsible for frequent bronchial processes in the early years that, sometimes, also extend into adolescence. In summary, the coordination of the endotype and the phenotype has led to the acknowledgement and acceptance of these three tracheobronchial processes: transient early wheezing, non-atopic wheezing, and atopic wheezing/asthma.

Part of the book: Asthma Diagnosis and Management