Text II. Management of Bronchial Asthma

True bronchial asthma is an allergic condition which is usually preceded or associated with seasonal or perennial rhinitis and with partial obstruction of the lower air passages. Bronchial asthma is characterized by wheezing, dyspnea, orthopnea, bronchial congestion, and cough. Demonstration of the causative allergens, especially in patients in whom asthma has begun after the age of 40 years, is not always possible; in children, however, the discovery of the allergen is almost always a comparatively simple matter.

A good case history must concern itself not only with possible allergic factors but also with past illness, emotional problems and details relating to previous immunizations. The physical examination must be thorough, with special attention to the lungs and heart as well as to the nasal passages. A complete blood count should be made in each case, as well as a skin test, nasal smear, urinalysis, and determination of the erythrocyte sedimentation rate. Skin tests are indicated in almost all allergic conditions, but they are usually useless in urticaria and migraine. Skin tests should be made by scratch method, but intradermal tests must follow unless the scratch method yields adequate information.

Therapy may be specific, symptomatic, or preventive. The specific management of asthmatic children consists in avoidance of causative allergens, with or without hyposensitization, usually the results are good. Symptomatic therapy of bronchial asthma is nonspecific, and nothing more than temporary relief of symptoms can be expected. Reassurance is the most important single measure especially if the child is having his first severe attack. For mild to moderate symptoms bronchodilators and substances that alleviate or arrest the paroxysm are used. Such substances are adrenaline (subcutaneous) and ephedrine (orally). Hormonotherapy, cortisone, prednisolone are useful in the control of the most severe cases (status asthmaticus).

Proper hygienic measures, mental influence, fresh air, and if possible keeping the child outdoors all the time are most reliable agents for checking asthma. The administration of such a regimen for a prolonged period causes the attacks to subside.