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Astma hos barn (< 12 år)

Sist oppdatert: Sist revidert:
Sist revidert av:


Definisjon:
Heterogen sykdom som vanligvis er karakterisert ved kronisk inflammasjon i luftveiene, varierende luftveissymptomer og variabel ekspiratorisk luftstrømsobstruksjon
Forekomst:
 10-12% av norske skolebarn har astma. Tilstanden er assosiert med atopiske sykdommer. Ofte triggerfaktorer som luftveisallergener og -irritanter
Symptomer:
 Luftveissymptomer som pipende pust, tungpusthet, tetthet i brystet og hoste som varierer over tid og intensitet 
Funn:
Ofte normale funn. Ved anfall/eksaserbasjoner ev. takypné, interkostale inndragninger, forlenget ekspirium og pipelyder ved auskultasjon
Diagnostikk: 
Klinisk diagnose som bekreftes av spirometri eller påvist økt døgnvariabilitet. Spirometri bør utføres hos barn fra 5 års alder. Hos yngre barn blir diagnosen ofte stilt på grunnlag av en god anamnese alene, ev. med hjelp av behandlingsforsøk. Allergiutredning kan bli aktuelt
Behandling:
Trinnvis behandling med inhalasjonssteroider og β2-agoniste. Ev. leukotrienhemmer. Redusert eksponering for kjente utløsende faktorer
  • Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2020. Available from: www.ginasthma.org
  • Norsk forening for allmennmedisin: Astmaveileder for allmennpraksis, 2015. www.legeforeningen.no
  • Norsk barnelegeforening, Pediatriveiledere  
  • Lunger i Praksis , kliniske råd 
    • Allergi
    • Spirometri
    • Utredning og behandling av astma
    • Allergenspesifikk immunterapi for allergisk sykdom på legekontoret
  1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2020. Available from: www.ginasthma.org ginasthma.org  
  2. Asher MI, Montefort S, Björkstén B, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006; 368(9537): 733-43. pmid:16935684 PubMed  
  3. Pearce N, Aït-Khaled N, Beasley R, et al. Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2007; 62(9): 758-66. pmid:17504817 PubMed  
  4. Rød G, Øymar K, Skadberg B. Astma bronkiale. Norsk barnelegeforening. Generell veileder i pediatri. Revidert 2009 www.helsebiblioteket.no  
  5. Akar HH, Tahan F, Gungor HE. The association of forced expiratory volume in one second and forced expiratory flow at 50% of the vital capacity, peak expiratory flow parameters, and blood eosinophil counts in exercise-induced bronchospasm in children with mild asthma. Asia Pac Allergy 2015 Apr; 5(2): 98-102. doi:10.5415/apallergy.2015.5.2.98 DOI  
  6. Riedler J, Braun-Fahrländer C, Eder W, Schreuer M, et al. Exposure to farming in early life and development of asthma and allergy: a cross-sectional survey . Lancet 2001; 358: 1129-33. PubMed  
  7. Moffatt MF, Gut IG, Demenais F, et al. A large-scale, consortium-based genomewide association study of asthma. N Engl J Med 2010; 363: 1211-21. New England Journal of Medicine  
  8. Norsk forening for allmennmedisin: Astmaveileder for allmennpraksis, 2015. www.legeforeningen.no
  9. Liu AH. Hygiene theory and allergy and asthma prevention. Paediatr Perinat Epidemiol 2007 Nov; 21 Suppl 3: 2-7. pmid:17935569 PubMed  
  10. Ker J, Hartert TV. The atopic march: what's the evidence?. Ann Allergy Asthma Immunol 2009 Oct; 103(4): 282-9. pmid:19852191 PubMed  
  11. Mener DJ, Lin SY. Improvement and prevention of asthma with concomitant treatment of allergic rhinitis and allergen-specific therapy. Int Forum Allergy Rhinol 2015; 5 Suppl 1: 45-50. pmid:26072703 PubMed  
  12. Sánchez-García S, Rodríguez del Río P, Escuerdo C, et al. Exercise-induced bronchospasm diagnosis in children. Utility of combined lung function tests. Pediatr Allergy Immunol 2015 Feb; 26(1): 73-9. pmid:25444583 PubMed  
  13. van der Hulst AE, Klip H, Brand PL. Risk of developing asthma in young children with atopic eczema: A systematic review. J Allergy Clin Immunol 2007; 120: 565-9. PubMed  
  14. Renzetti G, Silvestre G, D'Amario, et al. Less air pollution leads to rapid reduction of airway inflammation and improved airway function in asthmatic children. Pediatrics 2009 Mar; 123(3): 1051-8. pmid:19255039 PubMed  
  15. Lu KD, Manoukian K, Radom-Aizik S, et al. Obesity, Asthma, and Exercise in Child and Adolescent Health. Pediatr Exerc Sci 2015; Nov 30: Epub ahead of print. pmid:26618409 PubMed  
  16. Örtqvist AK, Lundholm C, Kieler H, et al. Antibiotics in fetal and early life and subsequent childhood asthma: nationwide population based study with sibling analysis. BMJ 2014; 349: g6979.
  17. Etminan M, Sadatsafavi M, Jafari S, et al. Acetaminophen use and the risk of asthma in children and adults: a sytematic review and metaanalysis. Chest 2009; 136: 1316-23. PubMed  
  18. Lowe AJ, Carlin JB, Bennett CM, et al. Paracetamol use in early life and asthma: prospective birth cohort study. BMJ 2010; 341: c4616. BMJ (DOI)  
  19. Robinson P, Chang AC. Asthma in children. BMJ Best Practice. Last updated Oct 05, 2015. bestpractice.bmj.com  
  20. Kemp JP, Kemp JA. Management of asthma in children published correction appears in Am Fam Physician 2002; 65:386. Am Fam Physician 2001; 63:1341-8, 1353-4. American Family Physician  
  21. Mintz M. Asthma updage: Part II. Medical management. Am Fam Physicians 2004; 70: 1061-6. PubMed  
  22. Bruun Mikalsen I, Karlstad Ø, Furu K, Øymar K. Forskrivning av legemidler mot astma til barn i perioden 2004–15. Tidsskr Nor Legeforen 2018; 4; 138: 345-51. doi:10.4045/tidsskr.17.0227 DOI  
  23. Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database of Syst. Rev. 2013, Issue 9. Art. No.: CD000052. DOI: 10.1002/14651858.CD000052.pub3. DOI  
  24. 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 of Syst Rev 2015, Issue 11. Art. No.: CD007949. DOI: 10.1002/14651858.CD007949.pub2. DOI  
  25. Griffiths B, Ducharme FM. Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children. Cochrane Database of Syst Rev 2013, Issue 8. Art. No.: CD000060. DOI: 10.1002/14651858.CD000060.pub2 DOI  
  26. Vezina K, Chauhan BF, Ducharme FM. Inhaled anticholinergics and short-acting beta(2)-agonists versus shortacting beta2-agonists alone for children with acute asthma in hospital. Cochrane Database Syst Rev 2014;7:Cd010283 Cochrane (DOI)  
  27. Rowe BH, Spooner C, Ducharme FM, Bretzlaff JA, Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids (Cochrane review). Cochrane Database Syst Rev 2004; (4): CD002178. Cochrane (DOI)  
  28. Smith M, Iqbal S, Elliott TM, Rowe BH. Corticosteroids for hospitalised children with acute asthma (Cochrane review). Cochrane Database Syst Rev 2004; (4): CD002886. Cochrane (DOI)  
  29. Norsk barnelegeforening: Akuttveileder i pediatri. Akutt astma bronkiale. Sist revidert 2012 (Lødrup Carlsen KC, et al.). Siden besøkt 20.02.2018. www.helsebiblioteket.no  
  30. Ducharme FM, Chabot G, Polychronakos C, Glorieux F, Mazer B. Safety profile of frequent short courses of oral glucocorticoids in acute pediatric asthma: impact on bone metabolism, bone density, and adrenal function. Pediatrics 2003; 111: 376-83. Pediatrics  
  31. Chang AB, Clark R, Sloots TP, et al. A 5- versus 3-day course of oral corticosteroids for children with asthma exacerbations who are not hospitalized: a randomized controlled trial. Med J Aust 2008; 189: 306-10. PubMed  
  32. Keeney GE, Gray MP, Morrison AK, et al. Dexamethasone for acute asthma exacerbations in children: a meta-analysis.Pediatrics. 2014 Mar;133(3):493-9. doi: 10.1542/peds.2013-2273.
  33. Edmonds ML, Milan SJ, Camargo Jr CA, Pollack CV, Rowe BH. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD002308. DOI: 10.1002/14651858.CD002308.pub2 DOI  
  34. Keeley D, McKean M. Asthma and other wheezing disorders of childhood. Clin Evid 2003; 9: 287-317. Clinical Evidence  
  35. 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.
  36. Chauhan BF, Ducharme FM. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children. Cochrane Database of Syst Rev 2012, Issue 5. Art. No.: CD002314. DOI: 10.1002/14651858.CD002314.pub3 DOI  
  37. Kelly HW, Sternberg AL, Lescher R, et al. Effect of inhaled glucocorticoids in childhood on adult height. N Engl J Med 2012; 367: 904-12. Pmid:22938716 PubMed  
  38. 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. DOI  
  39. 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. doi:10.1056/NEJMoa051378 DOI  
  40. Guilbert TW, Mauger DT, Allen DB, et al. Growth of preschool children at high risk for asthma 2 years after discontinuation of fluticasone. J Allergy Clin Immunol 2011 Nov; 128(5): 956-63. doi:10.1016/j.jaci.2011.06.027 DOI  
  41. Chauhan BF, Chartrand C, Ducharme FM. Intermittent versus daily inhaled corticosteroids forpersistent asthma in children and adults. Cochran Database Syst Rev 2013; 2: CD009611. pmid:23450606 PubMed  
  42. 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. New England Journal of Medicine  
  43. Chauhan BF, Ben Salah R, Ducharme FM. Addition of anti-leukotriene agents to inhaled corticosteroids in children with persistent asthma. Cochrane Database of Syst Rev 2013, Issue 10. Art. No.: CD009585. DOI: 10.1002/14651858.CD009585.pub2. DOI  
  44. Busse WW, Morgan WJ, Gergen PJ, et al. Randomized trial of omalizumab (Anti-IgE) for astma in inner-city children. N Engl J Med 2011; 364: 1005-15. New England Journal of Medicine  
  45. 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. Cochrane (DOI)  
  46. Boyd M, Lasserson TJ, McKean MC, et al. Interventions for educating children who are at risk of asthma-related emergency department attendance. Cochrane Database of Syst Rev 2009, Issue 2. Art. No.: CD001290. DOI: 10.1002/14651858.CD001290.pub2. DOI  
  47. 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. British Medical Journal  
  48. Gøtzsche PC, Johansen HK. House dust mite control measures for asthma. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD001187. DOI: 10.1002/14651858.CD001187.pub3. DOI  
  49. Murray CS, Foden P, Sumner H, et al. Preventing Severe Asthma Exacerbations in Children. A Randomized Trial of Mite-Impermeable Bedcovers. Am J Respir Crit Care Med 2017; 196: 150-8. pmid:28282501 PubMed  
  50. 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. Cochrane (DOI)  
  51. 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  
  52. Holbrook JT, Wise RA, Gold BD, et al. Lanzoprazole for children with poorly controlled asthma. JAMA 2012; 307: 373-80. Journal of the American Medical Association  
  53. Gautier C, Charpin D. Environmental triggers and avoidance in the management of asthma. J Asthma Allergy 2017 Mar; 7: 10:47-56. pmid:28331347 PubMed  
  54. Custovic A, Wijk PG. The effectiveness of measures to change the indoor environment in the treatment of allergic rhinitis and asthma: ARIA update (in collaboration with GA(2)LEN). Allergy. 2005;60(9):1112–1115
  55. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2016. Online appendix, p. 57. Available from: www.ginasthma.org
  56. Folkehelseinstituttet, nettpublikasjoner: Vaksinasjonsveilederen for helsepersonell. Pneumokokkvaksine. Sist oppdatert 11.12.2017. Siden besøkt 19.02.2018. www.fhi.no  
  57. Vaksinasjonsveilederen fra folkehelseinstituttet. Influensavaksine - veileder for helsepersonell. Sist oppdatert 02.06.2017 www.fhi.no  
  58. Cates CJ, Rowe BH. Vaccines for preventing influenza in people with asthma. Cochrane Database Syst Rev 2013;2:CD000364. The Cochrane Library  
  59. Folkehelseinstituttet: Vaksineanbefalinger influensasesongen 2020-2021. Sist oppdatert 25.06.2020. www.fhi.no  
  60. Sokolow AG, Stallings AP, Kercsmar C, et al. doi: 10.1542/peds.2021-055432. Safety of Live Attenuated Influenza Vaccine in Children With Asthma. Pediatrics 2022; 149: e2021055432. pmid:35342923 PubMed  
  61. Valovirta E, Petersen TH, Piotrowska T, et al. Results from the 5-year SQ grass sublingual immunotherapy tablet asthma prevention (GAP) trial in children with grass pollen allergy. J Allergy Clin Immunol. 2018 Feb;141(2):529-538.e13. Epub 2017 Jul 6. PMID: 28689794.
  62. Avery C, Perrin EM, Lang JE. Updates to the Pediatrics Asthma Management Guidelines. JAMA Pediatr. 2021 Jun 7. Epub ahead of print. PMID: 34096987 PubMed  
  63. 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  
  64. Wolsk HM, Harshfield BJ, Laranjo N, Carey VJ, O'Connor G, Sandel M, Strunk RC, Bacharier LB, Zeiger RS, Schatz M, Hollis BW, Weiss ST, Litonjua AA. Vitamin D supplementation in pregnancy, prenatal 25(OH)D levels, race, and subsequent asthma or recurrent wheeze in offspring: Secondary analyses from the Vitamin D Antenatal Asthma Reduction Trial. J Allergy Clin Immunol. 2017 Nov;140(5):1423-1429.e5. Epub 2017 Mar 9. PMID: 28285844. PubMed  
  65. Bisgaard H, Stokholm J, Chawes BL, et al. Fish oil-derived fatty acids in pregnancy and wheeze and asthma in offspring. N Engl J Med 2016; 375: 2530-9. pmid:28029926 PubMed  
  66. Azad MB, Coneys JG, Kozyrskyj AL, et al. Probiotic supplementation during pregnanacy 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
  67. Pascual RM, Peters SP. The irreversible component of persistent asthma. J Allergy Clin Immunol 2009; 124: 883-90. pmid:19895980 PubMed  
  68. Karlsson CA, Isaksson M, Janson C. Inhalationssteroider kan ge sekundär binjurebarkssvikt. Läkartidningen 2014; 111: CTAZ
  69. 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 ; 10(7): e0133428. pmid:26191797 PubMed  
  70. Pedersen S. Clinical safety of inhaled corticosteroids for asthma in children: an update of long-term trials. Drug Saf 2006; 29(7): 599-612. pmid:16808552 PubMed  
  71. Pedersen S. Do inhaled corticosteroids inhibit growth in children?. Am J Respir Crit Care Med 2001 Aug; 164(4): 521-35. pmid:11520710 PubMed  
  72. 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. PubMed  
  73. 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.
  74. Robinson P, Chang A. Asthma in children. BMJ Best Practice. Updatet Oct 05, 2016. bestpractice.bmj.com  
  75. 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  
  • Arnulf Langhammer MD, Phd., Professor. NTNU, HUNT forskningssenter, Levanger
  • Peter D. Jost, spesialist i allmennmedisin og redaktør NEL, Trondheim

Tidligere fagmedarbeidere

  • Kurt Østhuus Krogh, spesialist i barnesykdommer, overlege Barne-og ungdomsklinikken, St. Olavs Hospital, Trondheim
  • Martin Handeland, seksjonsoverlege, Poliklinikk Barn og ungdom, Barne- og ungdomssenteret, Sykehuset i Vestfold HF