[Etiopathogenetic aspects of allergic pulmonary diseases in childhood].

Anamnestic findings and clinical signs of wheezing attacks, which respond to beta-2-agonists, are the most important criteria in deciding whether a wheezy bronchitis is already a part of bronchial asthma. In this scope advanced lung function testing permits to search for functional abnormalities already in early childhood. Clinically, a study, carried out in ten ambulatory practices on about 1000 schoolchildren has shown that three diagnostic elements have to be distinguished. An "obstructive element" is based on the presence of clinical signs like cough, wheezing and rales. The "chronic element" is defined by the duration of the wheezing attacks and the number of attacks. Finally a third element, the "pulmonary hyperinflation" must clinically be recognized. The critical goals in the long term management of children with asthma are freedom of symptoms and optimal lung function. In this approach stratification into different aetiopathogenetic groups based on anamnestic, clinical and immuno-allergic findings is helpful and the follow-up of subclinical functional sequelae must be considered by repeated lung function tests. Only by these measures can the ongoing immuno-allergic process of airway inflammation be handled.