Complications
Viral-induced exacerbations remain a prominent feature of childhood asthma. Poorly controlled disease or exposure to known precipitants may increase the likelihood of exacerbation.
Children with asthma have a significantly higher risk of pneumonia and invasive pneumococcal disease than healthy controls, even after appropriate vaccination (e.g., pneumococcal conjugate vaccines).[252] Increased susceptibility to infection has been reported in children using oral but not inhaled corticosteroids.[169][170][180]
Chronic inflammation may lead to structural alteration of the airway wall (termed airway remodeling) and fixed airway obstruction. While not present in symptomatic infants, airway remodeling can occur at an early age.[253] Thickening of the epithelial reticular basement membrane has been documented in preschool children with recurrent wheeze and in school children with asthma from the age of 6 years.[45][254]
Asthma is associated with increased risk of caries in both the primary and permanent dentition. The causality effect, however, remains unproven.[255]
Accentuated middle lobe bronchus obstruction leads to atelectasis and consolidation as a result of hilar lymph node enlargement in addition to the pathophysiologic changes of asthma. Bacterial infection may be a contributing factor.
Local adverse effects of inhaled corticosteroids include oral candidiasis, pharyngitis, and hoarse voice, but are generally not a major issue, and can be minimized by spacer delivery limiting oropharyngeal deposition. Mometasone and ciclesonide appear to have a better adverse-effect profile.
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