PEDIATRIC ASTHMA Anna M. Suray, M.D 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 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 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 Asthma Presentation 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 13 90% of nonatopic wheezers resolved symptoms vs. only 56% of atopic wheezers. Atopic Wheezers with significant loss of lung fxn between 7-13yrs.

Pediatric Asthma Differences with Adults Lung growth affected during development. Smaller airway size and lower inspiratory flow rates. Difficulty with objective lung function testing.

Pediatric Asthma Wheezing 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 Asthma Wheezing 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 Asthma Wheezing in Young Children Atopic Wheezing 20% of wheezing under age 3years. Presents in 2 nd -3 rd 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 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.