1. No Limits!- Maximizing School Participation for Students With Asthma John McQueston, MD, MBA, FAAP Medical Director, Pediatric Respiratory Therapy

2. No Disclosure Practice Gap: Need for increased education on the management of childhood asthma. Desired Outcome: Increase awareness and knowledge on the management ofchildhood asthma. Disclosure of relevant financial relationships in the past 12 months: I have no financial relationships with commercial entities producing healthcare related products and/or services.

3.  I do not have a financial interest in Joe camel or any other entity mentioned today  If everyone stopped smoking I would be out of a job

4. Objectives  Summarize the most current evidence based guidelines for diagnosing and treating asthma in patients less than 5 years of age  Describe the concept of asthma phenotypes  Describe the relationship between infection and atopy and the natural history of recurrent wheeze

5. Tis the Season to be Wheezin!

6. Asthma- Summary of the GINA Introduction  Most common chronic disease of childhood  Leading cause of childhood morbidity  Begins in early childhood, males earlier than females  Atopy is common but not preventable  Asthma is a triad of inflammation, airway hyperresponsiveness and symptoms  Symptoms are variable  Goal of therapy is to achieve symptom control for prolonged periods with regard for the safety and cost of therapy  Partnership with the family and inhaled therapy are the cornerstones of management  A trial of treatment for 8-12 weeks may provide guidance to the presence of asthma

7. The Melbourne Asthma Study.  In 1964, the late Howard Williams, initiated a community-based study of a group of children from the 1957 birth cohort with a history of episodes of wheezing. The subjects were subsequently reviewed at ages 10, 14, 21, 28, 35, and 42 years.  Willams's hypothesis was that wheezy bronchitis and asthma (phenotypes) were essentially part of the same disorder.  He also believed that children with wheezy bronchitis were at the milder end of the spectrum of asthma and ran a benign course, with many becoming free of wheezing episodes by later childhood.  Those considered to have asthma often continued to have episodes of wheezing into adolescence and were more troubled by the disorder. He was unconvinced that most children with asthma “grew out of it” and was more inclined to the view that “they grew out of their paediatrician.” Phelan J Allergy Clin Immunol 2002;109:189-94

8. Pulmonary Function Over Time- Melbourne FEV 1 Percent Predicted Oswald H, et al. Pediatr Pulmonol. 1997;23:14-20 110 Age (years) FEV 1 (% predicted) 100 90 80 70 71014212835 Mild, wheezy bronchitis Control Wheezy bronchitis Asthma Severe Asthma

9. Ann Woolcock’s Description of Asthma- A Starting Point Bronchial Hyperresponsiveness-Acquired Atopy- Inherited Symptoms- usually triggered by virus

10. Percentage of Cohort with Each Characteristic Persistent Wheeze Correlates with Atopy and BHR W Xuan et al Thorax 2002;57:104–109

11. Wheezing has Different Phenotypes- Asthma is like Red Hair and Freckles

12. Predictors- High Risk Infants  COAST JACI 2005

13. Dogs and Cats- Yes, No, Maybe?

14. Pets and the development of allergic sensitization  Sensitization to pets remains a risk factor for asthma and rhinitis, and can occur in people who have never lived with a pet.  In areas with high frequency of pet ownership, community exposure to pet allergens is almost certainly sufficient to induce sensitization among non-pet owners.  For cat ownership, the results are inconsistent between studies of similar design, with some studies suggesting an increase in risk and others a decrease among cat owners.  For dogs, results are more consistent, generally suggesting that owning a dog has no effect or indeed may be protective against the development of specific sensitization to dog and allergic sensitization in general. Curr Allergy Asthma Rep. 2005 May;5(3):212-20.

15. Passive Smoke

16. Treatment Guidelines- Education About Management  Basic Explanation about Asthma  Inhaler Technique- (not nebs)  Importance of Adherence  When to Increase Care  Symptom Based Plans Equally Effective for 5 and Under

19. Actions for the Physical Education Instructor and Coach Encourage exercise and participation in sports for students with asthma. When asthma is under good control, most students with asthma are able to play most sports. A number of Olympic medalists have asthma. Follow the student’s asthma action plan; if indicated, follow premedication procedures Warm-up and cool-down activities appropriate for any exercise will also help the student with asthma. Keep students’ quick relief medications readily available.  MANAGING ASTHMA: A GUIDE FOR SCHOOLS

20. Thanks