Asthma in the pediatric population SEARCH Rotation 2 August 23, 2010

Objectives Define asthma as a chronic disease Discuss the morbidity of asthma in pediatrics Discuss a few things that a health center needs to affectively manage their asthma patients

Asthma http://rileychildrenshospital.com/parents-and-patients/programs-and-services/asthma.jsp

What is asthma? Chronic respiratory disorder Characteristics Symptoms Airway inflammation Reversible airway obstruction Airway hyper-responsiveness Symptoms Wheezing Cough Chest tightness Shortness of breath

Causes of asthma Genetic component – Allergic March1 Triggers2 Asthma Allergic rhinitis Atopic dermatitis Food allergies Triggers2 Viral infections Allergens (dust mites, pet dander, pollen, mold) Tobacco smoke Air pollution Exercise Extreme weather changes

Complications of asthma3 Frequent hospitalizations and ER visits Repeated absences from school Limited physical activity if not controlled properly Psychologic impact of having a chronic disease Declining lung function over a long period of time Prognosis Excellent prognosis with proper therapy and patient compliance with the treatment regimen3

Asthma Treatment4 Short-acting Beta Agonists Ipratropium ICS Quick-Relievers Long-term Controllers Short-acting Beta Agonists Ipratropium ICS Long-acting Beta Agonists Combined ICS & LABA Leukotriene Modifiers Oral corticosteroids Cromolyn Sodium Anti-IgE therapy SABA = bronchodilator ICS = anti-inflammatory http://www.101healthsolution.com/category/asthma/

Preventing exacerbations2 Having an asthma management plan is the best way to prevent symptoms. Components of an asthma management plan: Identify and minimize contact with your asthma triggers Take your medications as prescribed by your doctor Monitor your asthma and recognize early signs that your asthma may be worsening (which medicine to take, how much to take, when to take it, when to call your doctor, and when to seek emergency care) Know what to do when your asthma is worsening In taking these steps, a child should be able to play, exercise, and participate in sports without having symptoms, sleep through the night without symptoms, not have absences from school d/t asthma, and limit ER visits for asthma

Scope of the Issue http://www.uttyler.edu/faculty/jplacyk/PlacykTeaching2.htm

Asthma Statistics Asthma is the most common chronic condition that children in the US suffer from5 Childhood asthma prevalence has more than doubled from 1980 to the mid-1990s 5 Affects about 1 in every 20 children 5 Affects how children play, learn, and sleep 5

Asthma Statistics continued Morbidity and mortality of asthma are highly correlated with Poorer socioeconomic status Poverty status 6 17.4% of those who have ever had asthma are poor 14.6% of those who have ever had asthma are near poor 12.8% of those who have ever had asthma are not poor Health insurance6 17% of those who have ever had asthma are on Medicaid or other public insurance 9.9% of those who have ever had asthma are uninsured 12.4% of those who have ever had asthma have private insurance Lack of proper patient education Inadequate medical care 32%

Connecticut has the 11th highest asthma prevalence among children 0-17 years at 9.9% http://www.cdc.gov/nchs/data/ad/ad381.pdf

How can I help?

Asthma Education! What are the benefits of effective asthma education7? Quality of life improved Symptoms improved Decreased limitations in activities Medication adherence improved Decreased urgent care visits and hospitalizations Decreased asthma-related costs http://www.epa.gov/iaq/schools/managingasthma.html

What should be included7? Definition of asthma Key points about signs and symptoms of asthma Asthma triggers Roles of medication How to manage an asthma attack How to prevent asthma attacks

Solutions! Tracking methods Patient education Asthma diary Clinical practice guidelines from the National Asthma Education and Prevention Program recommend that asthma patients have close monitoring of their symptoms and adjustment of therapy to be continued over time7 Patient education Asthma action plan Asthma education brochure “Asthma self-management education which consists of information, self-monitoring, regular medical reviews, and a written action plan is effective and leads to a reduction in hospitalization and ER visits for asthma, unscheduled doctor visits, days lost from work, episodes of nocturnal asthma, indirect costs and an improvement in quality of life”8 http://www.pslweb.org/site/News2?page=NewsArticle&id=11691&news_iv_ctrl=1008

Asthma Diary Patient Name ________________________ Date of Birth_________________________ Asthma Diary Appt Date Had breathing problems during the day? Had breathing problems at night? Had breathing problems during physical activity? Had unexpected visit to the Dr or ER for asthma? What inhalers are you using? Provider Notes

Take these long-term control medications EVERY day Medication Name How much to take When to take it  Pulmicort (Budesonide)  2 puffs  Two times a day  Flovent (Fluticasone)  Azmacort (Triamcinolone)  Aerobid (Flunisolide)  Qvar (Beclomethasone) GREEN ZONE Doing Well Breathing is good No cough or wheeze Sleep through the night Can work and play  Singulair (Montelukast)  1 tablet  Once a day Before exercise take ____________________ ________ puffs 5-60 minutes before exercise YELLOW ZONE Asthma is getting worse First signs of a cold Exposure to a known trigger Cough Tight chest Mild wheeze Coughing at night Continue with your green zone medication and add Medication Name How much to take When to take it  Proventil, Ventolin (Albuterol)  2 puffs  every 20 min  Xopenex (Levalbuterol)  4 puffs  Maxair (Pirbuterol)  Nebulizer  once  Prednisone _________mg RED ZONE Medical Alert! Medicine is not helping Breathing is hard and fast Nose opens wide Ribs show Can’t talk well Lips or fingernails are blue Call your doctor NOW! Go to the hospital or call an ambulance if you are still in the red zone after 15 minutes or if you have not reached your doctor

http://fromyourdoctor.com/

References Liu, Andrew H. "The Allergic March of Childhood." Medical Scientific Update 22.1 (2006): 1- 12. National Jewish Medicine and Research Center. Summer 2006. Web. 20 Aug. 2010. <http://www.nationaljewish.org/pdf/zzz_library/23n1MSU_2006.pdf>. "Asthma Overview." Asthma and Allergy Foundation of America - Information About Asthma, Allergies, Food Allergies and More! 2005. Web. 20 Aug. 2010. <http://aafa.org/display.cfm?id=8&sub=14>. Schwartz, M. William. The 5-minute Pediatric Consult. Philadelphia: Lippincott Williams & Wilkins, 2005. Print. Mayo Clinic Staff. "Asthma - MayoClinic.com." Mayo Clinic Medical Information and Tools for Healthy Living - MayoClinic.com. 27 May 2010. Web. 19 Aug. 2010. <http://www.mayoclinic.com/health/asthma/DS00021>. Akinbami, Lara J. "The State of Childhood Asthma, United States, 1980-2005." Vital Health and Statistics (2006): 1-24. 26 Dec. 2006. Web. 08 Aug. 2010. <http://www.cdc.gov/nchs/data/ad/ad381.pdf>. Bloom B, Cohen RA, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, 2008. National Center for Health Statistics. Vital Health Stat 10(244). 2009. <http://www.cdc.gov/nchs/data/series/sr_10/sr10_244.pdf >. Mangan, Joan M., and William Bailey. "What Do Patients Need to Know about Their Asthma?" UpToDate Inc. 9 Mar. 2009. Web. 19 Aug. 2010. <http://www.uptodate.com/online/content/topic.do?topicKey=asthma/7978&source=see_li nk>. Gibsono, Peter G. "Asthma Education." Respiratory Medicine 97.9 (2003): 1036-044. ScienceDirect. Web. 20 Aug. 2010. <http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WWS-48NJ32K- 8&_user=77149&_coverDate=09%2F30%2F2003&_alid=1436643254&_rdoc=14&_fmt =high&_orig=search&_cdi=7138&_sort=r&_docanchor=&view=c&_ct=9840&_acct=C00 0006218&_version=1&_urlVersion=0&_userid=77149&md5=03fbfc9cad4cc448b7c6082 251fea79c>.