PEDIATRIC ASTHMA

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					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 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 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.

				
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posted:11/5/2012
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