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The fundamental problem in asthma appears to be immunological: young children in the early stages of asthma show signs of excessive inflammation in their airways. Epidemiological findings give clues as to the pathogenesis : the incidence of asthma seems to be increasing worldwide, and asthma is now very much more common in affluent countries.
Asthma phenotyping and endotyping has emerged as a novel approach to asthma classification inspired by precision medicine which separates the clinical presentations of asthma, or asthma phenotypes, from their underlying causes, or asthma endotypes. The best-supported endotypic distinction is the type 2-high/type 2-low distinction.
Asthma and viral bronchiolitis can also be nearly identical to each other when presented in very young children, since they both consist of wheezing, coughing, and nasal congestion. In addition, typical tests used to accurately diagnose children with asthma, such as the bronchial challenge test , are not considered to be accurate for children ...
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Due to the need for patient cooperation and an ability to understand and follow instructions, spirometry can typically only be done in cooperative children when they at least 5 years old [3] [4] or adults without physical or mental impairment preventing effective diagnostic results.
The Berlin definition included ALI as a mild form of ARDS. [53] However, the criteria for the diagnosis of ARDS in the Berlin definition excludes many children, and a new definition for children was termed pediatric acute respiratory distress syndrome (PARDS); this is known as the PALICC definition (2015). [54] [55]
The mild symptoms tend to be restricting upper airways. However, younger individuals are extremely vulnerable to developing "severe symptoms," which typically involve the lower airways. [41] Since infants have smaller airways than children do, "they might be obstructed by inflammation, edema, and mucus."
There is, of course, no reason why asthma and exercise-induced bronchoconstriction should not co-exist but the distinction is important because without successful treatment of underlying asthma, treatment of an exercise component will likely be unsuccessful.