Are children with asthma ill more often and more susceptible to infections than children who do not have a chronic respiratory disease? In our interview, paediatrician Emmanuel Nellen explains the reasons behind this and shares how parents can best support their children with asthma.
Children with asthma have more frequent and more severe respiratory infections as their chronically inflamed airways are more vulnerable. Paediatrician Emmanuel Nellen recommends the following to ease symptoms and prevent infection:
Paediatrician Nellen: Yes, that is absolutely right. The airways of these children are more susceptible. The chronic inflammation in their bronchial tubes makes them more vulnerable, i.e. more susceptible. In the last cough and cold season we saw it again in our practice. There were many cases of flu and RSV infections, more rarely COVID-19.
What we noticed was that on the whole, children with asthma not only have more frequent, but also more serious infections.
Paediatrician Nellen: Exactly, the symptoms are worse and the children are also ill for longer as a result. It can often take weeks before they are fully recovered, especially after an RSV infection. This is why children with asthma should ideally have long-term therapy with inhalative cortisone, especially during the winter months, to protect their airways from inflammation.
Paediatrician Nellen: The type of inhalation therapy in the long-term treatment of asthma depends very much on the family’s preferences and what they can realistically integrate into their daily lives.
Some opt for spray inhalation while others prefer inhalation therapy with an anti-inflammatory or bronchodilator in combination with saline solution. I like to recommend the PARI NaCl 0.9% inhalation solution as the 2.5 ml ampoule size is very practical.
For spray inhalation therapy, it is important to note that the younger the child, the more important it is to use a spacer such as the VORTEX® holding chamber. This ensures that the medication is delivered to the airways and does not end up going no further than the mouth and throat. It should be noted that the risk of side effects caused by the asthma spray may increase without a holding chamber. Cortisone, for instance, can cause oral thrush.
Paediatrician Nellen: Children with asthma have more shortness of breath, cough more and produce more mucus. They are also more prone to secondary infections as their immune system has been severely challenged. The risk of falling ill increases when children are exposed to a host of respiratory infections in group environment such as childcare settings, nursery school and school. It would be advisable to reduce the risk of infection.
That is not possible in children of school age. In children with asthma who attend a crèche or nursery school, it would be advisable to keep them at home if you know that infections are doing the rounds in the groups. Whether this is an option of course depends on whether the parents can stay home to look after the child.
Paediatrician Nellen: Treatment is underpinned by long-term and consistent asthma therapy. You are also advised not to delay contacting the child’s paediatrician. It may be necessary to adjust the long-term therapy, for example to add another bronchodilator or to increase the dosage.
In children under one year of age inhaling a saline solution with a nebuliser can also be helpful to moisten and support the mucous membranes to make it easier to cough up the mucus from the small, narrow airways. In older children, I assess the option of saline inhalation on a case-by-case basis depending on the individual patient.
Paediatrician Nellen: That depends on how susceptible the child is. Children who are often ill should see a doctor sooner rather than later. As soon as they start coughing more than usual, they should see a doctor. Sometimes one infection leads to another. It is difficult for parents to recognise if these are the after-effects of the old infection or if the next infection is already starting.
Paediatrician Nellen: I would say, take them to a doctor early on, stick closely to the long-term inhalative therapy and ensure they are inhaling properly. This means that for spray inhalation, use a holding chamber like the VORTEX (the younger the child, the more important this is) and for inhalation therapy, use an effective inhalation device with a mask that fits.
If the acute infection is very severe, it is advisable to involve a pulmonologist. The paediatrician will arrange this. In newborns or infants the RSV vaccination is important as it really benefits babies with asthma. Aside from that, there are the usual rules for acute infections, which also apply to children who do not have a chronic respiratory disease: Rest, drink plenty of fluids, TLC, regularly open the windows and spend time outside in the fresh air if they do not have a fever.
Paediatrician Nellen: To avoid catching a cold or to keep colds as mild as possible, it is important to consistently follow the prescribed long-term therapy. Avoid allergens, such as pets, houseplants (mould can develop in the soil of pot plants) and pollen.
I have had cases in my practice where we did an allergy test for pet hair. If the test is positive, you would have to discuss how to proceed.
If the child has a dust mite allergy, encasing barrier covers should be used on mattresses, duvets and pillows.
We also know that children with asthma should be especially protected from air pollutants such as cigarette smoke. To avoid catching infections, asthmatics should not be in contact with people who have an acute respiratory infection. There are also the general recommendations to avoid infections such as sport and a balanced, healthy diet.
Emmanuel Nellen is a specialist in paediatric and adolescent medicine with his own practice in Ostfildern. After training as a medical technical radiology assistant, he studied medicine in Heidelberg-Mannheim and qualified in 2006 when he did his state exams. He then worked as a junior physician at the Stadt Hanau Clinic, at the Verbundkrankenhaus Bernkastel-Wittlich and the Reutlingen Regional Clinics. From 2014 to 2016 he was employed as a paediatrician in a practice in Rechberghausen.
Note: The information in this blog post is not a treatment recommendation. The needs of patients vary greatly from person to person. The treatment approaches presented should be viewed only as examples. PARI recommends that patients always consult with their physician or physiotherapist first.
An article written by the PARI BLOG editorial team.
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