#Children #asthma #repeated #coughing #wheezing #lungs #checked
▶ Kyung-Hoon Kim, Professor of Pediatrics and Adolescents, Seoul National University Bundang Hospital
Gyeong-Hoon Kim, Professor of Pediatrics and Adolescents at Seoul National University Bundang Hospital. [분당서울대병원 제공]
Asthma causes the bronchi in the lungs to become sensitive, causing wheezing, chest tightness, and repetitive coughing. Asthma due to allergies often occurs in the spring, and even if children suffer from asthma, if they do not receive proper treatment, growth problems can occur and severe asthma attacks can be life-threatening. ‘Children’s asthma treatment expert’ Kyeong-Hoon Kim, Seoul National University Bundang Hospital, Pediatrics I met with youth and professors. Professor Kim said, “When symptoms such as wheezing and repetitive coughing appear in childhood, early diagnosis and treatment should be made through lung function tests, etc.” He added, “50 to 80% of children with asthma have symptoms that disappear on their own after puberty, but vague fears arise. Therefore, if you avoid using steroid inhalants, your lung function may gradually decline.”
-What is childhood asthma?
Asthma in children is a chronic respiratory disease that causes repetitive coughing, wheezing, and difficulty breathing. Approximately 9% of children under the age of nine visited hospitals due to asthma (as of 2019, Health Insurance Review and Assessment Service). In addition, chest tightness and a feeling of phlegm in the throat are also symptoms of asthma.
If asthma symptoms are mild, there are no significant problems in daily life, so follow-up observation is sufficient. However, the symptoms can be so severe that you may not be able to sleep or have trouble breathing when talking or eating. Additionally, if asthma is severe, it can be life-threatening, so early diagnosis and treatment are important.
Asthma in children is caused by a combination of genetic and environmental factors. Environmental factors are related to allergies caused by antigens such as house dust mites, animal fur, mold, and spring pollen, which result in chronic airway inflammation, airway hypersensitivity, and airway obstruction.
-How are diagnosis and tests carried out?
50-80% of children with asthma develop symptoms before the age of five. However, about 30% of children who develop symptoms such as wheezing before the age of three are diagnosed with asthma by the age of six, so early diagnosis is important for children with these symptoms.
Among clinical indicators that predict asthma, the ‘Modified Asthma Predictive Index’ is the most widely used. A child with repeated symptoms of wheezing is highly likely to have asthma if one of the major diagnoses or two or more of the minor diagnoses among the modified asthma index diagnoses are met.
The main diagnostic criteria are ▲ a parent who is asthmatic, ▲ suffering from atopic dermatitis, or ▲ sensitization to ‘airborne antigens (pollen, animal hair, dust mites, etc.)’ other than food (the body reacts sensitively to external stimuli). status), etc.
Criteria for subdiagnosis include ▲wheezing without having a cold, ▲eosinophils in the blood over 4%, and ▲sensitization to food antigens.
In general, lung function tests are performed in asthma to check for airway hyperresponsiveness and airway obstruction caused by chronic airway inflammation. However, it is not easy to perform lung function tests on young infants and toddlers. Therefore, patients who are too young are diagnosed based on clinical characteristics, family history of allergic disease, allergy testing, and modified asthma index.
Recently, children are diagnosed using Impulse Oscillometry (IOS) testing (lung function is determined through vibration when a mouthpiece is held in the mouth for about 30 seconds) and exhaled nitric oxide testing.
-I heard that artificial intelligence (AI) can be used to find children’s wheezing sounds.
Wheezing is a breathing sound that makes a ‘wheezing’ sound every time you breathe due to pressure caused by the narrowing of the air passage to and from the lungs (airway). Since many children with asthma have this type of wheezing, it is used as a key indicator in diagnosing asthma.
However, the method of identifying wheezing is still limited to the traditional auscultation method, in which a doctor directly places a stethoscope on the chest and listens to breathing sounds. Therefore, since it is not a test method that expresses objective values, even the same wheezing sound can vary significantly depending on the doctor’s experience and judgment.
To solve this problem, the Department of Pediatrics at Seoul National University Bundang Hospital developed an algorithm to distinguish wheezing sounds using AI. We developed an algorithm with an accuracy of 91.2% and a precision of 94.4% by machine learning the breathing sounds of 287 actual child respiratory patients cross-verified by children’s respiratory experts.
This algorithm has very high accuracy and stability, so it can be used without difficulty in clinical settings, and since it uses only a small amount of memory space, it will be able to be applied to mobile devices in the future to monitor regardless of time and place.
-How is it treated?
Early diagnosis and treatment of asthma are very important because if asthma symptoms begin before the age of three, the risk of lung function decline is higher than in children whose symptoms begin later. The goal of treating asthma in children is to use minimal medication and control asthma for a long period of time to maintain lung function and enable a normal life.
For patients under five years of age, a stepped approach is used in which the condition is evaluated at two to three month intervals and treatment steps are adjusted. Inhaled steroids are recommended as first-line treatment, and anti-leukotriene drugs can be used as alternative drugs. Drug selection takes into account patient compliance, proficiency in using inhalers, and drug preference.
Daeik Kwon, medical reporter>
