PEDIATRIC ASTHMA

Anna M. Suray, M.D.

2008 Respiratory Update

Weirton Medical Center

March 17, 2008

OBJECTIVES

• Identify How Asthma Presents In Children and Its Underlying Causes.

• Current Asthma Management of Pediatric Patients.

• Importance of Peak Flow Meter Use.

Pediatric Asthma

• Significant Public Health Problem in US.• 8.9%(6.5 million) children dx with Asthma in

2005,up from 3.6% in 1980.• Mortality rose during 1990’s and only recently

has shown decline.• However, Hospitalization Rates HIGH by 1990’s

and leveled off at historical rates…27/10,000 age 0-17yrs by 2004.

• Asthma Hospitalizations--No Improvement over past 15 years for kids <15yrs.

Pediatric Asthma

• ER Visits in US (under age 18years).

• 750,000 in 2004, 3% of all visits to ER setting.

• Primary Care Office Visits.

• Increasing since 2000-(YEAH!!!!???)

Pediatric AsthmaPresentation

• Chronic disease with both genetic and environmental influences.

• Airway Hyper-responsiveness

• Inflammation

• Reversible Airway Obstruction

• Onset during first 4 years of life.

Pediatric Asthma

• Predictable in kids with atopic dermatitis and food allergy during their first 1-2 years of life.

• Progression of aeroallergen sensitization, allergic rhinitis, and asthma.

• 90% of children with asthma have allergies.

Pediatric Asthma

• Stages of Asthma Pathogenesis:

• Induction Phase• Maintenance/Progression Phase

• Lancet 2006 article on large study-Age 3 vs 1390% of nonatopic wheezers resolved symptoms vs. only 56% of atopic wheezers.

Atopic Wheezers with significant loss of lung fxn between 7-13yrs.

Pediatric AsthmaDifferences with Adults

• Lung growth affected during development.

• Smaller airway size and lower inspiratory flow rates.

• Difficulty with objective lung function testing.

Pediatric AsthmaWheezing in Young Children

Transient Early Wheezing • Most prevalent• Recurrent wheezing episodes in first year

of life.• Can have severe episodes, requiring

hospitalizations.• Resolves by age 3-5 years.

Pediatric AsthmaWheezing in Young Children

Non-atopic Wheezing

• 20% of wheezing under age 3 years.

• History of Prematurity

• Onset with Lower Respiratory Tract Infection <1year age, ie RSV.

• Improves by early adolescence.

Pediatric AsthmaWheezing in Young Children

Atopic Wheezing

• 20% of wheezing under age 3years.• Presents in 2nd-3rd year of life.• Personal/Family history of ATOPY.• Episodic wheezing.• Normal lung fxn in infancy but reduced by

age 6 years.

Pediatric Asthma

• History and Physical Exam

• CXR

• Upper GI

• CBC for eosinophilia

• Sweat Chloride for CF

• IGE, Allergy Testing

• Pulmonary Function Tests

Pediatric Asthma

• NAEPP Guidelines in Asthma Management- Revision released in 2007.

• Focus on Control of Asthma.

• Addressing Impairment and Risk.

Pediatric Asthma

• The key elements of assessment and monitoring are severity, control and responsiveness to treatment.