Gå direkt till huvudinnehållet

Astma, barn <12 år

Senast uppdaterad: Senast reviderad:
Sakkunnig:
Definition: 
Heterogen sjukdom med inflammation i luftvägar som leder till sammandragning av luftvägarna och hyperreaktivitet (överdrivet kontraktilt svar vid diverse stimuli).
Förekomst:
Prevalensen är 5–7 % hos barn i skolåldern, 8–10 % under 15 år, incidensen är högst i småbarnsåren. Infektionsastma drabbar 15–20 % av 1 till 2-åringar.
Symtom:
Vanliga symtom är pipande/väsande andning; tung, ansträngd andning; natthosta; hosta eller pipande/väsande andning vid ansträngning; nedsatt ork/fysisk prestationsförmåga. Vid infektionsastma symtom som ovan, samt ofta långvarig hosta vid och i efterförloppet av en luftvägsinfektion. 
Kliniska fynd: 
Ibland spridda, högfrekventa ronki som har olika tonhöjd och längd. Vid mer allvarlig astma kan man finna ett tyst lungauskultationsfynd, nedsatt fysisk aktivitet, nedsatt förmåga att tala, tecken på dyspné, hög puls och nedsatt saturation (exacerbation av astma/akut astma ).
Diagnostik:
Lungfunktionsmätningar kan påvisa variabel luftvägsobstruktion. I första hand rekommenderas dynamisk spirometri , eventuellt kan PEF-mätningar  användas.
Behandling:
Behandlingen består av icke-farmakologiska åtgärder för att minska exponering av utlösande faktorer och farmakologisk behandling med antiinflammatoriska läkemedel och luftrörsvidgande läkemedel.
  1. Nationella riktlinjer för vård vid astma och KOL – Stöd för styrning och ledning (2018) 
  2. Läkemedelsverket. Läkemedelsbehandling vid astma. 2015:(26):3. 
  3. UpToDate . Olika kapitel om astma hos barn. (Hämtad 2016-08-04)
  4. Global Initiative for asthma , Pocket guide for asthma management and prevention 2019 (hämtad 2019-04-17)
  1. Läkemedelsverket (2015). Läkemedelsbehandling vid astma. www.lakemedelsverket.se  
  2. Russell G, Ninan TK. Respiratory symptoms and atopy in Aberdeen school children: evidence from two surveys 25 years apart. BMJ 1992; 304: 873-5. PubMed  
  3. Skadhauge LR, Bælum J, Siersted HC, et al. Forekomst af astma hos yngre voksne. Ugeskr Læger 2005; 167: 648-51. PubMed  
  4. Alm B, Erdes L, Möllborg P, et al. Neonatal antibiotic treatment is a risk factor for early wheezing. Pediatrics. 2008;121(4):697–702. PMID:18381533. PubMed  
  5. Wahn U. What drives the allergic march? Allergy 2000; 55: 591-9. PubMed  
  6. Bergmann RL, Edenharter G, Bergmann KE, Forster J, Bauer CP, Wahn V, et al. Atopic dermatitis in early infancy predicts allergic airway disease at 5 years. Clin Exp Allergy 1998; 28: 965-70. PubMed  
  7. Pocket Guide for Asthma Management and Prevention for Adults and Children Older than 5 Years. Based on the Global Initiative for Asthma Management and Prevention. Global Initiative for Asthma (GINA). Updated 2019. ginasthma.org  
  8. Platts-Mills T, Vaughan J, Squillace S, Woodfolk J, Sporik J. Sensitisation, asthma, and a modified Th2 response in children exposed to cat allergen: a population-based cross-sectional study. Lancet 2001; 357: 752-6 PubMed  
  9. Jartti T, Korppi M.. Rhinovirus-induced bronchiolitis and asthma development.. Pediatr Allergy Immunol. 2011; Jun;22(4): 350-5. doi:PMID: 21535176 PubMed  
  10. Illi S, von Mutius E, Lau S, Bergmann R, Niggemann B, Sommerfeld C, Wahn U. Early childhood infectious diseases and the development of asthma up to school age: a birth cohort study. BMJ 2001; 322: 390-5. PubMed  
  11. Upton MN, McConnachie A, McSharry C et al. Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring. BMJ 2000; 321(7253): 88-92. pmid:10884260 PubMed  
  12. Wang YH, Wintzell V, Ludvigsson JF, Svanström H, Pasternak B. Association Between Proton Pump Inhibitor Use and Risk of Asthma in Children published online ahead of print, 2021 Feb 8. JAMA Pediatr. 2021;10.1001/jamapediatrics.2020.5710. PMID:33555324. PubMed  
  13. Greenhawt M. Environmental exposure to peanut and the risk of an allergic reaction. Ann Allergy Asthma Immunol. 2018;120(5):476–481.e3. PMID:29555352. PubMed  
  14. Global Initiative för Asthma. Pocket guide for asthma management and prevention. Updated 2019. (Hämtad 2019-04-19) ginasthma.org  
  15. Wang Z, May SM, Charoenlap S,et al. Effects of secondhand smoke exposure on asthma morbidity and health care utilization in children: a systematic review and meta-analysis. Ann Allergy Asthma Immunol. 2015 Nov;115(5):396-401.e2. PMID: 26411971. PubMed  
  16. Mackay D, Haw S, Ayres JG, et al. Smoke-free legislation and hospitalizations for childhood asthma. N Engl J Med 2010; 363: 1139-45. PMID: 20843248 PubMed  
  17. Global Initiative for Asthma. Main report. 2019. ginasthma.org  
  18. Clark CE, Coote JM, Silver DAT, Halpin DMG. Asthma after childhood pneumonia: six year follow up study. BMJ 2000; 320:1514-6. PMID: 10834897 PubMed  
  19. Socialstyrelsen. Nationella riktlinjer för vård vid astma och KOL – Stöd för styrning och ledning (2018). www.socialstyrelsen.se  
  20. Reddel H, Jenkins C, Woolcock A. Diurnal variability--time to change asthma guidelines?. BMJ. 1999;319(7201):45–47. PMID:10390464. PubMed  
  21. Petsky HL, Kew KM, Chang AB. Exhaled nitric oxide levels to guide treatment for children with asthma. Cochrane Database Syst Rev. 2016 Nov 9;11:CD011439. pmid:27825189 PubMed  
  22. Keeley D, McKean M. Asthma and other wheezing disorders of childhood. Clin Evid 2003; 9: 287-317. PMID: 15366138 PubMed  
  23. Svenska barnläkarföreningens sektion för barn- och ungdomsallergologi, www.barnallergisektionen.se  
  24. Wolf FM, Guevara JP, Grum CM, Clark NM, Cates CJ. Educational interventions for asthma in children (Cochrane review). Cochrane Database Syst Rev 2004;(4):CD000326. PMID: 12535395 PubMed  
  25. Guevara JP, Wolf FM, Grum CM, Clark NM. Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis. BMJ 2003; 326: 1308-9. PMID: 12805167 PubMed  
  26. Beggs S, Foong YC, Le HC, et al. Swimming training for asthma in children and adolescents aged 18 years and under. Cochrane Database Syst Rev. 2013 Apr 30;4. PMID: 23633375. PubMed  
  27. Woodcock A, Forster L, Matthews E, Martin J, Letley L, Vickers M, et al. Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma. N Engl J Med 2003; 349: 225-36. PMID: 12867606 PubMed  
  28. Terreehorst I, Hak E, Oosting AJ, Tempels-Pavlica Z, de Monchy JG, Bruijnzeel-Koomen CA, et al. Evaluation of impermeable covers for bedding in patients with allergic rhinitis. N Engl J Med 2003; 349: 237-46. PMID: 12867607 PubMed  
  29. Kilburn S, Lasserson TJ, McKean M. Pet allergen control measures for allergic asthma in children and adults (Cochrane review). Cochrane Database Syst Rev 2004; (4): CD002989. PMID: 12535446 PubMed  
  30. Mintz M. Asthma updage: Part II. Medical management. Am Fam Physicians 2004; 70: 1061-6. PubMed  
  31. Global Initiative For Asthma. Global Strategy for Asthma Management and Prevention. 2021 Gina Main Report. (Hämtad 2021-05-24). ginasthma.org  
  32. National Asthma Education and Prevention Program. Expert panel report. Guidelines for the diagnosis and management of asthma: update on selected topics, 2002. Bethesda, Md.: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, 2003; NIH publication no. 02-5074. PMID: 12542074 PubMed  
  33. Verberne A, Frost C, Roorda R, van der Laag H, Kerrebijn K and the Dutch Paediatric Asthma Study Group. One year treatment with salmeterol compared with beclomethasone in children with asthma. Am J Respir Crit Care Med 1997; 156: 688-95. PubMed  
  34. The Childhood Asthma Management Program Research Group. Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med 2000; 343: 1054-63. PMID: 11027739 PubMed  
  35. Ducharme FM, Di Salvio F. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children (Cochrane review). Cochrane Database Syst Rev 2004; (4): CD002314. PMID: 15106175 PubMed  
  36. Ostrom NK, Decotiis BA, Lincourt WR, et al. Comparative efficacy and safety of low-dose fluticasone propionate and montelukast in children with persistent asthma. J Pediatr 2005; 147: 213-20. PubMed  
  37. Calpin C, Macarthur C, Stephens D, Feldman W, Parkin PC. Effectiveness of prophylactic inhaled steroids in childhood asthma: a systemic review of the literature. J Allergy Clin Immunol 1997; 100: 452-7. PubMed  
  38. Loke YK, Blanco P, Thavarajah M, et al. Impact of Inhaled Corticosteroids on Growth in Children with Asthma: Systematic Review and Meta-Analysis. PLoS One. 2015 Jul 20;10(7):e0133428. pmid: 26191797 PubMed  
  39. Pruteanu AI, Chauhan BF, Zhang L, et al. Inhaled corticosteroids in children with persistent asthma: is there a dose response impact on growth? An overview of Cochrane reviews. Paediatr Respir Rev. 2015 Jan;16(1):51-2 pmid:25458795 PubMed  
  40. Zhang L, Prietsch SOM, Ducharme FM. Inhaled corticosteroids in children with persistent asthma: effects on growth. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD009471. DOI: 10.1002/14651858.CD009471.pub2. PMID: 25504974 PubMed  
  41. Loke YK, Gilbert D, Thavarajah M, et al. Bone mineral density and fracture risk with long-term use of inhaled corticosteroids in patients with asthma: systematic review and meta-analysis. BMJ Open. 2015 Nov 24;5(11):e008554. PMID: 26603243. PubMed  
  42. Courtney AU, McCarter DF, Pollart SM. Childhood asthma: Treatment update. Am Fam Physician 2005; 71: 1959-68. [url]http://www.aafp.org/afp/2005/0515/p1959.html[/url] PMID: 15926412 PubMed  
  43. Bisgaard H, Hermansen MN, Loland L, Halkjaer LB, Buchvald F. Intermittent inhaled corticosteroids in infants with episodic wheezing. N Engl J Med 2006; 354: 1998-2005. PMID: 16687712 PubMed  
  44. Guilbert TW, Morgan WJ, Zeiger RS, et al. Long-term inhaled corticosteroids in preschool children at high risk for asthma. N Engl J Med 2006; 354: 1985-97 . PMID: 16687711 PubMed  
  45. Castro-Rodriguez J, Rodrigo G. Efficacy of Inhaled Corticosteroids in Infants and Preschoolers With Recurrent Wheezing and Asthma: A Systematic Review With Meta-analysis. AAP 2009. [url]http://pediatrics.aappublications.org/content/123/3/e519.abstract[/url] PMID: 19254986 PubMed  
  46. Kew KM, Quinn M, Quon BS, et al. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children. Cochrane Database Syst Rev. 2016 Jun 7;6:CD007524. PMID: 27272563 PubMed  
  47. Bisgaard H, Szefler S. Long-acting beta2-agonists and paediatric asthma. Lancet 2006; 367: 286-8. PubMed  
  48. Debley JS, Carter ER, Gibson RL, Rosenfeld M, Redding GJ. The prevalence of ibuprofen-sensitive asthma in children: a randomized controlled bronchoprovocation challenge study. J Pediatr 2005; 147: 233-238. PubMed  
  49. Chauhan BF, Chartrand C, Ni Chroinin M, et al.. Addition of long-acting beta2-agonists to inhaled corticosteroids for chronic asthma in children.. Cochrane Database Syst Rev. 2015; 11: CD007949. pmid:26594816 PubMed  
  50. Castro-Rodriguez JA, Rodrigo GJ. The role of inhaled corticosteroids and montelukast in children with mild-moderate asthma: results of a systematic review with meta-analysis. Arch Dis Child 2010; 95: 365-70. PubMed  
  51. Cingi C, Muluk NB, Ipci K, et al.. Antileukotrienes in upper airway inflammatory diseases.. Curr Allergy Asthma Rep. 2015. pmid:26385352 PubMed  
  52. Chauhan BF, Ben Salah R, Ducharme FM. Addition of anti-leukotriene agents to inhaled corticosteroids in children with persistent asthma. Cochrane Database Syst Rev. 2013 Oct 2;10. PMID: 24089325. PubMed  
  53. FDA. FDA requires Boxed Warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair); advises restricting use for allergic rhinitis. 2020-04-03 (Hämtad 2020-04-30). www.fda.gov  
  54. Stordal K, Johannesdottir GB, Bentsen BS, et al. Acid suppression does not change respiratory symptoms in children with asthma and gastro-oesophageal reflux disease. Arch Dis Child 2005; 90: 956-60. PubMed  
  55. Kim JM, Lin SY et al. Allergen-specific immunotherapy for pediatric asthma and rhinoconjunctivitis: a systematic review. Pediatrics. 2013 Jun;131(6):1155-67. PubMed  
  56. Pifferi M, Baldini G, Marrazzini G, Baldini M, Ragazzo V, Pietrobelli A, et al. Benefits of immunotherapy with a standardized Dermatophagoides pteronyssinus extract in asthmatic children: a three-year prospective study. Allergy 2002; 57: 785-90. PubMed  
  57. Di Rienzo V, Marcucci F, Puccinelli P, Parmiani S, Frati F, Sensi L, et al. Long-lasting effect of sublingual immunotherapy in children with asthma due to house dust mite: a 10-year prospective study. Clin Exp Allergy 2003; 33: 206-10. PubMed  
  58. Bufe A, Eberle P, Franke-Beckmann E, et al. Safety and efficacy in children of an SQ-standardized grass allergen tablet for sublingual immunotherapy. J Allergy Clin Immunol 2009; 123: 167-73. PubMed  
  59. Warner JO, ETAC Study Group. Early treatment of the atopic child. A double-blinded, randomized, placebo-controlled trial of cetirizine in preventing the onset of asthma in children with atopic dermatitis: 18 months' treatment and 18 months' posttreatment follow-up. J Allergy Clin Immunol 2001; 108: 929-37. PubMed  
  60. Moller C, Dreborg S, Ferdousi HA, Halken S, Host A, Jacobsen L, et al. Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (the PAT-study). J Allergy Clin Immunol 2002; 109: 251-6. PubMed  
  61. Kull I, Melen E, Alm J, et al. Breast-feeding in relation to asthma, lung function, and sensitization in young schoolchildren. J Allergy Clin Immunol. 2010;125(5):1013–1019. PMID:20392479. PubMed  
  62. Kramer MS, Matush L, Vanilovich I, et al, for the Promotion of Breastfeeding Intervention Trial (PROBIT) Study Group. Effect of prolonged and exclusive breast feeding on risk of allergy and asthma: cluster randomised trial. BMJ 2007; 335: 815-23. PMID: 17855282 PubMed  
  63. Azad MB, Coneys JG, Kozyrskyj AL, et al. Probiotic supplementation during pregnancy or infancy for the prevention of asthma and wheeze: systematic review and meta-analysis. BMJ 2013; 347: f6471. doi: http://dx.doi.org/10.1136/bmj.f6471 PMID: 24304677 [url]http://dx.doi.org/10.1136/bmj.f6471[/url] PMID: 24304677 PubMed  
  64. Sokolow AG, Stallings AP, Kercsmar C, et al. Safety of live attenuated influenza vaccine in children with asthma. Pediatrics 2022. PMID: 35342923 PubMed  
  65. Kjellman B, Gustafsson PM. Children with asthma followed up for 21 years; severity improved, but patients seldom grow out of asthma by adulthood. Läkartidningen 2000; 97: 4572-7. PMID: 11107742 PubMed  
  66. Covar RA, Strunk R, Zeiger RS, et al. Predictors of remitting, periodic, and persistent childhood asthma. J Allergy Clin Immunol 2010; 125: 359-66. PubMed  
  67. Karlsson CA, Isaksson M, Janson C. Inhalationssteroider kan ge sekundär binjurebarkssvikt. Läkartidningen. 2014;111:CTAZ. www.lakartidningen.se  
  68. Horak E, Lanigan A, Roberts A, et al. Longitudinal study of childhood wheezy bronchitis and asthma: outcome at age 42. BMJ 2003; 326: 422-3. PMID: 12595380 PubMed  
  69. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995; 332: 133-8. PMID: 7800004 PubMed  
  70. Long-term effects of budesonide or nedocromil in children with asthma. The Childhood Asthma Management Program Research Group. N Engl J Med 2000; 343: 1054-63. New England Journal of Medicine  
  71. Pocket Guide for Asthma Management and Prevention for Adults and Children Older than 5 Years. Based on the Global Initiative for Asthma Management and Prevention. Global Initiative for Asthma (GINA). Updated 2016. http://ginasthma.org/2016-pocket-guide-for-asthma-management-and-prevention/
  72. Licari A, Castagnoli R, Brambilla I, et al. Asthma Endotyping and Biomarkers in Childhood Asthma. Pediatr Allergy Immunol Pulmonol. 2018;31(2):44–55. PMID:30069422. PubMed  
  73. Petsky HL, Kew KM, Chang AB. Exhaled nitric oxide levels to guide treatment for children with asthma. Cochrane Database Syst Rev. 2016;11(11):CD011439. doi:10.1002/14651858.CD011439.pub2 DOI  
  74. Fielding SS, Pijnenburg M, de Jongste J, et al. Does treatment guided by fractional exhaled nitric oxide improve outcomes in subgroups of children with asthma? published online ahead of print, 2020 Mar 12. Eur Respir J. 2020;1901879. PMID:32165403. PubMed  
  • Hanna Sandelowsky, specialist i allmänmedicin, Capio Ringen Vårdcentral, Stockholm; Med dr, Karolinska Institutet, Stockholm
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas