Text III. Prevention of Asthmatic Attacks in Children

There are many instances when children suffer from acute asthmatic attacks. However, an acute asthmatic attack should not be regarded as an isolated clinical entity, but as one manifestation of a complex constitutional defect. Therefore successful treatment depends not on the management of the attack itself, but it should be aimed at elimination of chronic physiologic defect, at minimizing its impact on a child’s physical and emotional development. Prevention should be regarded as the best strategy in case of “status asthmaticus”.

The earliest possible recognition and treatment of developing asthma attack should be considered as the first step in prevention of “status asthmaticus”.

The medical history of an asthmatic child must contain all the findings concerning the onset and progression of symptoms as they have a great significance in the evaluation of this condition.

Acute attacks of dyspnea or wheezing may be preceded by a prodromal period, it being characterized by upper respiratory congestion, cough or nonrespiratory symptoms, among which loss of appetite, headache, irritability and listlessness should be mentioned. The overt attack may follow the prodromal period in a few hours or in several days.

In order to follow the management of choice in overt attacks two types of such episodes should be differentiated. Rapidly evolving attacks of acute onset may follow stimuli such as antigen contact or exercise. Prophylactic treatment should be considered best in this case. After the onset of symptoms the child should be instructed to sit down, slowly sip a cup of tepid water, this being followed by slow deep diaphragmatic breathing. Though such maneuvers may have no physiologic effect on the asthmatic process, they may have a calming effect, and allow time for medication to be prepared. The attack may be relieved with rest alone. However, if it does not subside the child should be administered an aerosol sympathomimetic drug, it being given by a pressurized hand-held nebulizer, or with an air compressor unit.

A more gradual onset evolving over hours or days is characteristic of the other type of attack. On the one hand weather change or upper respiratory infection may result in such an attack; on the other hand, it may represent an exacerbation of poorly controlled chronic asthma. In this kind of attack “status asthmaticus” is most likely to develop therefore such a situation presents the more important treatment problem. If a child suffers only a mild asthma, which does not require maintenance therapy, the administration of a rapidly absorbed theophylline preparation every four to six hours for a few days may suffice. However if the child has already been receiving oral theophylline therapy it may be necessary to add an inhaled sympathomimetic bronchodilator several times a day.

Those occasional children whose symptoms are not relieved by prompt and regular use of adrenergic drugs and theophylline during the attacks, frequently require hospitalization. In such cases the early use of a three or four day course of corticosteroid consisting of prednisone 1 mg/kg three times a day should be considered effective.

Cases of acute attacks and constant control of disease should be regarded separately. If the child suffers from frequent acute attacks the presence of chronic airway obstructions seems reasonably to be looked for. For this purpose a complete pulmonary function evaluation should be performed. In the presence of a small airway obstruction and hyperinflation aggressive pharmacologic management should be initiated with the aim of returning pulmonary function to normal and maintaining it at that level. Such a program is supposed to prevent the occurrence of acute attacks. Occasionally cases are encountered when the child has normal interim pulmonary function in spite of frequent acute episodes. Such a variety requires therapy aimed at early recognition of prodromal signs, the whole course of treatment being more intensive and acute.

15. Choose the right answer to each question:

1) What is “asthma”? 2) Isn’t there any other definition of the disease? 3) What definition of the disease “asthma” was adopted by the Asthma Thoracic Society in their statement of 1962? 4) What steps must clinicians take to manage asthmatic patients? 5) What can these factors include? 6) Can the patient’s history provide a clue to provocation of his asthma? 7) What treatment is required for patients with severe asthma?

A) For patients with great bronchial hyper-reactivity, continuous treatment with bronchodilators is mostly advisable. B) “Asthma” is a disease characterized by an increased responsiveness of the trachea and bronchi to various stimuli and manifested by a narrowing of the airway that changes in severity either spontaneously or as a result of therapy. C) According to Webster’s New Dictionary “asthma” is labored breathing, accompanied by wheezing, a sense of chest construction, and often by attacks of coughing or gasping caused by conditions that interfere with the normal inflow of air in the lungs. According to Oxford’s Dictionary “asthma” is a disease of respiration characterized by difficult breathing, a cough, etc. D) Certainly. Usually the patient’s history provides the best clue to provocation of his asthma. E) They can include immunologic reactions, infection, aspirin intolerance, irritant inhalation, atmospheric changes, emotional upset, associated disease or a combination of these factors. F) They need to discover those factors which contribute to bronchospasm. They must recognize and treat the factors that initiate and aggravate the bronchospastic state. G) Asthma is recurrent paroxysmal dyspnea with wheezing cough and sense of chest construction. It is a clinical syndrome reflecting a state of hyperactivity of the bronchial airways.

16. Read and translate the dialogue:

-I’ve just examined a new patient. She has been admitted to the clinic with a history of bronchial asthma.

-What could you reveal at the examination, please?

-Well, she is 27. She was in distress with shortness of breath. Her chest was distended and there was increased resonance to percussion. There were inspiratory and expiratory coarse dry râles in the bronchial tubes and wheezes throughout her chest.

-Is her past history available?

-Well, in a way yes. First she had episodes of wheezing at 5, soon after successive attacks of children diseases: measles, mumps, and chicken-pox. Mild wheezing recurred during her early childhood and lasted through the year.

-Were there any records of allergic factors? Sensitiveness to any food or drugs? Sensibility to emotional and external impressions? To changes of conditions, for example?

-No, there was no information about it.

17. Make up your own dialogue “The doctor and the pediatric patient with some allergy history”.

18. Point out the conjunctions introducing the adverbial clauses of condition. Translate the sentences:

1. The difference between the asthmatic and control groups will become more dramatic if they are compared for incidence of birth complications. 2. Supposing the operation for ovarian cysts was done late in pregnancy, one must always consider the necessity of cesarean section. 3. In case surgical intervention for uterine myoma becomes necessary during pregnancy, there is practically no danger to the patient. 4. Unless there is no improvement of cardiac symptoms, the pregnancy may have to be terminated. 5. In case you study these data carefully, you will notice that genetic factor plays an important role in the etiology of this condition. 6. Very little difficulty should be expected with delivery in any of its stages unless there is abnormal presentation in a woman who has had poliomyelitis. 7. On condition toxemia of pregnancy is very severe, the necessity of certain section is considered. 8. The pregnant woman should continue to eat foods which she likes, providing, of course, that no complications arise. 9. All advantages of adequate neonatal supervision may be lost unless satisfactory care during childhood is ensured. 10. These drugs will produce satisfactory results provided they are given in proper dosage.

19. Translate the sentences paying special attention to rendering elliptical clauses (в эллиптических предложениях могут быть опущены подлежащее и сказуемое, или одно из них; при переводе недостающие члены предложения должны быть восполнены).

Model: Attacks of bronchial asthma, if frequent, may seriously affect the child’s general health. – Приступы бронхиальной астмы, если они случаются часто, могут серьезно повредить общему состоянию здоровья.

1. If virus is present, even though inapparent clinically, a sesarotomy should be considered. 2. The causative allergen, if detected, should be immediately removed from the home of an asthmatic. 3. All these measures, if practiced generally, will reduce the fetal mortality considerably. 4. The symptoms of brain disturbances in a newborn, if present, require immediate surgical help. 5. During childhood growth continues with a rapidity which, though great, is less than in infancy. 6. Artificial termination of pregnancy, if undertaken, must have close cooperation between the gynecologist and radiotherapist. 7. The first signs of allergic response, unless properly treated, may become a fixed condition. 8. What significance, if any, the use of this preparation in the human neonate may have is not yet known. 9. The serum immunoglobulins were assessed in order to determine their relationship, if any, to the type and severity of respiratory allergy. 10. Many of the fetal organs, though perfect, are not yet active.

20. Fill in blanks with suitable prepositions. Translate the sentences:

1. Much progress has been achieved in treating bronchial asthma … the last few years. 2. The child’s sensitiveness … penicillin should be studied before the treatment is begun. 3. The term “analgesics” is applied … the drugs which cause pain to subside. 4. The discovery of the reactions of the human organism to the changes of weather gave rise … a new branch of medicine – medicometereological forecasting (прогнозирование). 5. Prevention of infectious diseases should be organized … a way which ensures the maximum effectiveness of prophylactic measures. 6. This group of antibiotic drugs is bactericidal … nature. 7. The findings of the intradermal tests proved … great diagnostic importance. 8. All infectious diseases are similar … origin. 9. Exposure … rubella was detected in the mothers of (at least) one third of children with congenital rubella syndrome. 10. Children with metabolic disorders should be guided … from eating harmful foods. 11. The child was noted to be allergic … definite inhalant materials. 12. Preventive therapy is of great importance … bronchial asthma and other allergic conditions.

21. From the words given below choose the synonyms of the words and word combination in bold type. Translate the sentences:

1. Individuals thought to be susceptible to house dust were challenged with the house dust antigen. 2. Local allergic reaction in the operative site to dressing material may be brought about by medications given pre- and postoperatively. 3. Allergic responses vary depending on different environmental, climatological and emotional factors. 4. The mechanism of many diseases which do not belong to allergic ones, have symptoms which are characteristic of allergic responses. 5. Some substances which are absolutely harmless to one person may produce an allergic response in another. 6. Because of recurrent digestive disorders, the child had to be hospitalized. 7. The difficulties the pediatric surgeons meet with are of highly specific nature.

food-upset, fall into category (of), to encounter, innocuous, response, diverse, to be allergic

22. Translate the sentences paying special attention to rendering the word “background”:

1. The background levels were the same. 2. The two diseases have common etiological background. 3. The background of these phenomena remained unresolved until the end of the 1970s. 4. The term “dose” has many meanings depending on the background and expertise. 5. The present study was aimed to form a background for future studies with mutant animals.

23. Translate the following sentences into Russian:

1. They didn’t have the course of their disease changed by this therapy. 2. Many pediatric patients have had allergy reduced after guiding away from their homes. 3. There are some of the tests the patient will have to get done. 4. Our problem at the moment is that we have no way of predicting which patients will tolerate which class of drugs. 5. Asthmatic children often become much improved when separated from their parents. 6. Allergic diseases have several characteristic features in common. 7. If doctors could prevent sensitization to foreign proteins, the problem of many allergic patients would be solved.

24. Translate the following sentences into English:

1. Причины различных аллергических состояний могут быть одинаковы. 2. Многие заболевания, обычно наблюдаемые у детей, имеют аллергический характер. 3. Существует много способов предотвращения аллергий у детей. 4. 9-летняя девочка поступила в больницу с острым приступом бронхиальной астмы. 5. Был поставлен диагноз аллергической бронхиальной астмы и хронической неспецифической пневмонии. 6. Опубликованные данные показали, что мать должна как можно дольше кормить грудью младенца, если в семье есть случаи аллергии. 7. Лечение детей-астматиков следует начинать под строгим медицинским контролем.

25. Read and translate text IV in written form: