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Coughing, shortness of breath, and wheezing usually appear within a few hours or days. These usually resolve within 1 or 2 days, but often persist for 1 or 2 weeks. Shortness of breath is manifested by wheezing, faster than normal and shallower. Sometimes the child may need to use the muscles between the ribs and in the neck, above the sternum, causing a visible retraction of the spaces between the ribs. We call wheezing to whistling noises (whistles) that are usually heard without the need for a stethoscope and that are sometimes accompanied by other noises called rhonchi and, sometimes, a kind of gurgling that some parents refer to as a pot of snails. Most children also have a dry cough that increases the sensation of shortness of breath, which is usually worse at night. Very rarely do children report chest pain or tightness. During the days the cough becomes moist and productive, although the expectoration is exceptional, due to the swallowing of the secretions, which can be emitted with spontaneous vomiting or triggered by the cough itself. Pediatricians often refer to this sequence of signs and symptoms as untrimmed onset, and it is usually characteristic of asthma attacks triggered by non-allergic, viral infections.

Children with asthma need to have inhaled bronchodilators and are well trained in their use. (Credits, F. 50)

In older children, the onset of the crisis is usually shortened, with no previous symptoms of infectious disease. Sudden coughing and wheezing appear and, in a few minutes or hours, they may develop respiratory distress of greater or lesser severity. Typically, the crisis responds very well to the use of bronchodilators and usually occurs in children with asthma of allergic etiology.

If asthma is a syndrome that groups together different types of asthma, how many types of asthma are there?

During childhood, synthesizing a lot, there are basically two types of asthma: the first is an asthma that appears at a very early age, generally during the first 12 months of life. It is characterized by presenting an asthmatic crisis that in the previous section we have described as untrimmed onset. It is associated with maternal smoking, prematurity, living with older siblings, attending daycare centers and, in general, it is preceded by viral infections. It is very common (around 30% of children can present it) and it is not associated with a personal or family history of allergy. Its prognosis is excellent and in the greatest number of cases it remits spontaneously throughout childhood.