Sanela Domuz Vujnović

By Sanela Domuz Vujnović, Adrijana Domuz and Slobodanka Petrović

Cough variant asthma (CVA) was first described by Glauser. CVA was described as the isolated chronic cough as the only presenting symptom responsive to bronchodilator therapy. The authors now suggest that CVA is present with airway hyperresponsiveness, eosinophilic inflammation of central and peripheral airways and bronchodilator responsive coughing without typical manifestation of asthma such as wheezing or dyspnea. Pathologically, CVA shares common features such as eosinophilic inflammation and remodeling changes with classic asthma. Because of that, CVA is clinically considered as a variant type of asthma, a phase at the beginning of asthma pathogenesis or as a precursor of classic asthma. Nearly 30% of patients with CVA eventually develop intermittent wheezing, an average of 3–5 years. It is clinically very important to recognize CVA because long-term inhaled corticosteroids can significantly decrease the development of classic asthma in these patients.

Part of the book: Asthma Diagnosis and Management

By Sanela Domuz Vujnović and Adrijana Domuz

Atopic dermatitis (AD) is one of the most common skin conditions in children and adolescents. This disease is characterized by acute and chronic lesions. Acute lesions can occur at any age and have a recurring character. Localization of acute lesions is a characteristic for a certain age of the child. Chronic lesions are present after the second year of life and characterized by pruritus and lichenification. Ichthyosis and xerosis are also characteristics of chronic lesions. The authors represent two hypotheses about pathophysiology of atopic dermatitis: “inside-out” hypothesis suggests that pathophysiological process is the result of an inflammatory response, while the “outside-inside” hypothesis suggests that changes of the epidermal barrier are responsible for the process in lesions in atopic dermatitis. There is no gold standard, clinical or laboratory, for the diagnosis of atopic dermatitis. The diagnosis should be based on anamnesis, clinical features and laboratory results. The therapeutic approach includes general and specific measures. General measures including topical moisturizers, bathing and bathing practices and wet-wrap therapy. Specific measures include topical corticosteroids and topical calcineurin inhibitors. Systemic immunosuppressant agents and phototherapy are a second-line treatment and used when the atopic dermatitis is not controlled. These patients must be treated by a dermatologist or pediatricians.

Part of the book: Corticosteroids

By Sanela Domuz Vujnovic and Adrijana Domuz

Bearing in mind the results of the epidemiological studies, the logical question arises whether allergic rhinitis represents an earlier clinical manifestation of allergic airway disease or itself is causative for asthma. Comorbidity or one disease, the diagnosis of allergic rhinitis often precedes the development of asthma. Literature reports that 40–90% of asthmatics have symptoms of allergic rhinitis. The epidemiological evidence also suggests that allergic rhinitis and asthma radially presented one united airway disease with two-stage than two separate diseases. Symptoms of one disease often predominate and are unrecognized or hidden of another disease even if they exist. The epidemiology evidence of comorbidity of allergic rhinitis and asthma confirmed the new concept of the united airway diseases. Despite the evidence of the correlation between allergic rhinitis and asthma, there is some resistance in clinical practice in recognizing this link.

Part of the book: Asthma Diagnosis and Management