Take a Deep Breath Asthma in Children Michael W. Peterson, M.D. Professor and Chief of Medicine UCSF Fresno

Why should we talk about asthma?  The most common chronic disease in children  The most common cause for children missing school  One in six Fresno children have asthma!  Asthma is increasing in the developed world  Asthma deaths are increasing

What is asthma?

The Lung Airways Airways= bronchi alveoli

What Happens to the Airways in Asthma? Smooth muscle Epithelial cells

What happens to the Airways in Asthma? Muscle contraction = Bronchoconstriction Constricted airway Airway inflammation = Swelling (edema) Inflamed airway Inflammation + Constriction

What happens during an asthma attack? Animation

What does it feel like to have this happen?

What causes asthma?

??  Genetics/ Inheritance  Living in a house with parents who smoke  Frequent and recurrent viral URI  Abnormal immune responses to environmental agents (allergy)  Unhealthy air (air pollution)

How do I know if I have asthma?  Coughing  Shortness of breath  Waking up at night (with a cough)  Coughing after exercise or cold air exposure  Wheezing (example)  Breathing tests (spirometry and peak flow)

Managing Asthma  Prevention: Recognizing and Avoiding triggers (1 ounce of prevention = 1 pound of cure?)  Treating asthma: Controllers Relievers

Preventing Dust mites Dust mites: live on human skin debris in carpets, pillows, Clothes, bedding

Managing Dust Mite Exposure  Minimize carpets (hardwood floors)  Wash bedding with hot water  Dry cleaning or washing clothing  Use of barriers  Low humidity

Preventing Cockroaches Cockroaches: most important in urban environments. Management with cleanliness, keeping food containers sealed, etc.

Prevention  Avoiding situations known to exacerbate the asthma (strong odors, smoke, etc.)  Pretreating where you anticipate exacerbations (cold air, exercise)

Treating Asthma  Controllers: Asthma is an inflammatory disease Anti-inflammatory medication: inhaled steroids and oral steroids Use in any patient with symptoms that occur more often than twice a week, if any night-time symptoms more often than twice per month or if abnormal lung function Leukotriene inhibitors (Singulair or Accolate)

Treating Asthma  Controllers/ Relievers Long acting beta agonist inhalers (Serevent)  Relievers: should only be used for short- term symptom relief. Heavy use signals TROUBLE Short-acting beta agonists (albuterol) Anticholinergic medications (Atrovent)

Treating Asthma  Asthma is a chronic disease like diabetes  Patients need to understand their own disease  Every patient should have an action plan: What to do in the event of problems-when to call the doctor, when to increase medications

Asthma  Asthma is a chronic disease that can be managed and controlled  The goal should be “NORMAL ACTIVITY”