Nutritional issues for children with asthma

High Incidence Rate Among: Males Low socioeconomic status African Americans Family history of asthma or allergies

Asthma symptoms

What happens when a child has an asthma episode? The insides of the airways get irritated and inflamed The linings of the airways get swollen Irritated airways make more mucus The muscles around the airways spasm and get tight

Asthma Medications

Preventer Medications Are for children who have frequent asthma symptoms (at least weekly) Are taken daily PREVENT most asthma episodes Help children live normal lives

Flovent™ Singulair™ Theophylline Pulmicort™ Intal™ Serevent™

Rescue Medications “Rescue” children when asthma symptoms appear (cough, wheeze, short of breath…) Relieve muscle spasm but not inflammation Inhaled: works right away Pills and liquid take 30 minutes to act

Rescue Medications Albuterol™ Xopenex™ Serevent™ Alupent™

Steroids Prednisone Anti-inflammatory actions essential for chronic and acute asthma exacerbations

Effects of chronic (daily or every other day) oral steroids Slowed linear growth Decreased bone density Excessive weight gain

Asthma and Height Poorly controlled asthma in children may delay linear growth Asthmatic children have longer periods of decreased growth rates before puberty Final adult height is not affected

Corticosteroids

Asthma & Food Allergies Food Allergies Do Not Significantly Add to Asthma Symptoms! Research Says...

Asthma & Food Allergies ALERT! Dawson, 1990

Recent meta-analysis on weight and asthma in children BMI > 85 th %ile in middle childhood increases the risk of future asthma by 50% High birthweight (> 3.8 kg) increases the risk of asthma by 20%

Calcium & Vitamin D Antioxidants

PFT’s and PEF before and after 9 oz cow’s milk in “positive” and “negative” perceivers No significant differences in either group Milk does not cause or worsen mucus production Woods, 1998

Chronic steroid use can lead to osteoporosis Recent report that asthmatic children have decreased bone density regardless of steroid use The “milk-mucus connection” myth is widespread Parents often report avoiding dairy products in their asthmatic childrens’ diets Ducharme 2003 Dawson, 1990

Age (years) Ca intake (mg) AIPeersVit D ><NS NS <NS

Antioxidant Supplementation Study Gave 250 mg Vitamin E & 50 mg Vitamin C to asthmatic children in Mexico City x 18 months Romieu et al. 2002

Antioxidant Supplementation Study Children with moderate to severe asthma were effected less by ozone levels Romieu et al Protective effects of Vitamin C and E against air pollution in children with asthma?

4 recent studies (US and Australia) At least 50% used 1 or more alternative therapy to treat asthma Herbs Vitamins Chest massage with rubs Prayer Shenfield, 2001

Breast feeding and the prevention of asthma in children: Is there a connection?

Many suggest that there may be benefit first 2- 3 years Recent report found no long term protection against allergic tendencies and asthma Sears MR. Et al. Lancet 2002;360:901-7

Nutrition interventions for asthma

BMI or weight % ile? Elimination of food groups? Calcium and vitamin D intakes? Alternative therapies? Corticosteroid use?

BMI or weight % ile? Elimination of food groups? Calcium and vitamin D intakes? Alternative therapies? Corticosteroid use? Route & frequency Weight control Adjust diet Supplement to DRI levels Counsel accordingly

Summary Cystic fibrosis, BPD and asthma are chronic diseases which affect nutrition and growth in children. Nutritional interventions are necessary to improve growth and outcome in children with pulmonary diseases