Obstruktive Lungenerkrankungen gehören zu den häufigsten Erkrankungen im Kindesalter überhaupt und umfassen ein ganzes Spektrum von Entitäten. Differenzialdiagnosen, Pathogenese, Diagnostik und Therapiemöglichkeiten von der Bronchiolitis im frühen Säuglingsalter über obstruktive Bronchitiden bei Kleinkindern bis hin zum großen Thema Asthma bronchiale, dies alles stellt dieser Beitrag kompakt vor.
Abstract
Obstructive lung diseases are the most common childhood pulmonary diseases. Bronchial asthma is the most common chronic pulmonary disease of childhood. In pediatric bronchial asthma there are clear S2 guidelines for diagnosis and therapy, which can also be carried out by the treating pediatrician. RSV-related bronchiolitis is a potentially life-threatening disease. Passive immunization with pavilizumab is indicated seasonally in preterm infants below the 29th week of gestation and in those between the 29th and 34th week of pregnancy with other risk factors. The pathophysiological triad of bronchial asthma consists of bronchoconstriction, mucosal hyperplasia and increased mucus production. If bronchial asthma is suspected, an underlying allergic disease should be confirmed or excluded. If the clinical course is abnormal, further diagnosis may be required to exclude relevant differential diagnoses such as cystic fibrosis or primary ciliary dyskinesia. The treatment of bronchial asthma is gradually adapted and consists of short-acting β2-sympathomimetics as a demand medication and ICS, LTRA and/or long-acting β2-sympathomimetics in different dose and combination as a long-term medication. For severe, uncontrolled allergic asthma, omalizumab or eosinophilic asthma mepolizumab are available. If symptoms are controlled, long-term medication should be reduced. Patient education plays an essential role. In case of allergic asthma the indication for a specific immunotherapy should always be considered, if allergen avoidance is not possible.
Schlüsselwörter
RSV-Bronchiolitis - ziliäre Dyskinesie - neonatale pulmonale Anpassungsstörungen - Wheeze
Key words
RSV bronchiolitis - ciliary dyskinesia - neonatal pulmonary adjustment disorders - wheeze
