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Asthma bei Kindern und Jugendlichen

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Definition:
Asthma ist eine chronisch entzündliche Atemwegserkrankung mit bronchialer Hyperrreagibilität und reversibler Atemwegsobstruktion, die zu episodenartigen respiratorischen Symptomen führt.
Häufigkeit:
Im Kindesalter ist Asthma die häufigste chronische Erkrankung und tritt bei bis etwa 10 % aller Kinder in Deutschland auf.
Symptome:
Variable, episodenartig auftretende Symptome: Atemnot, Husten, Engegefühl in der Brust, pfeifende Atemgeräusche (Giemen). Anfallsartige Beschwerden oft im Zusammenhang mit Auslösern (z. B. Allergene, Atemwegsinfekte, körperliche Belastung).
Befunde:
Im beschwerdefreien Intervall möglicherweise unauffällig. Zeichen der Atemwegsobstruktion: verlängertes Exspirium, exspiratorischer Stridor, trockene Nebengeräusche (Giemen, Pfeifen, Brummen), hypersonorer Klopfschall.
Diagnostik:
Anamnese und klinische Untersuchung. Lungenfunktionsdiagnostik Nachweis einer (partiell) reversiblen Atemwegsobstruktion (Spirometrie mit Reversibilitäts- und ggf. Provokationstest).
Therapie:
Medikamentöse Stufentherapie abhängig von der Asthmakontrolle. Kombination aus Bedarfsmedikamenten („Reliever“) und Langzeittherapeutika („Controller“). Weitere nichtmedikamentöse Maßnahmen umfassen u. a. Patientenschulung, Allergenkarenz und (Atem-)Physiotherapie.
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  • Deutsche Gesellschaft für Allergologie und klinische Immunologie. Allergieprävention. AWMF-Leitlinie Nr. 061-016. S3, Stand 2021. www.awmf.org 
  • Ärztliches Zentrum für Qualität in der Medizin (ÄZQ). Nationale Versorgungsleitline Asthma. 4. Auflage, Stand 2020. www.leitlinien.de 
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  • Lino Witte, Dr. med., Arzt in Weiterbildung Allgemeinmedizin, Münster