1. BRONCHIAL ASTHMA IN CHILDREN lecture for the 6-th year students

2. CONTENT DEFINTIONS EPIDIEMOLOGY ETIOLOGY
CLINCAL PRESENTATION: HISTORY AND OBJECTIVE EXAMS
DIAGNOSIS
CLASSIFICATIONS
DIFFERNTIAL DIAGNOSIS
TREATMENT AND MANANGEMENT

3. DEFINITION
A chronic inflammatory disease of the airways with the following clinical features:
Episodic and/or chronic symptoms of airway obstruction
Bronchial hyperresponsiveness to triggers
Evidence of at least partial reversibility of the airway obstruction
Alternative diagnoses are excluded

4. Definitions
Asthma exacerbation: symptoms that require a change in medication from baseline
Status asthmaticus: increasingly severe asthma that is not responsive to drugs that are usually effective
Review Article in Chest Status Asthmaticus in Children. A Review. Heinrich A Werner, MD

5. Epidemiology
10% of children in the US: 5 million children under the age of 18
Prevalence is increasing
Asthma morbidity and mortality is increasing
50% have family history of asthma, rhinitis, eczematous dermatitis, or urticaria
10 % of children in the US: the most common chronic illness of childhood in the US Reference: Pediatric Asthma:Promoting Best Practices. Guide for managing asthma in child, 1999
Prevalence is increasing—especially among children less than 12: Source: NCHS, national health interview survey,
Diagnostic shift (use of “asthma” for conditions classified differently)
cannot fully account for this development—asthma prevalence is increasing
world-wide
Asthma morbidity is also on increase—rates have doubled for kids aged 1-4
About 50% of children with asthma improve or become symptom free on reaching early adulthood but a very early onset of disease is associated with a less favorable prognosis

6. Etiology
Although the cause of childhood asthma has not been determined, contemporary research implicates a combination of environmental exposures and inherent biological and genetic vulnerabilities
Respiratory exposures in this causal environment include inhaled allergens, respiratory viral infections, and chemical and biological air pollutants such as environmental tobacco smoke
In the predisposed host, immune responses to these common exposures can be a stimulus for prolonged, pathogenic inflammation and aberrant repair of injured airways tissues. Lung dysfunction (i.e., AHR and reduced airflow) develops.

7. Stepwise Approach for Managing Asthma in Children 12 Years of Age and Adults

12. CLINICAL PRESENTATION
WHEEZING
COUGH
NIGHTLY COUGHS AND EXERCISE INDUCED
DYSPNOEA
CHEST TIGHTNESS
REFUSAL OF FEEDING
SITTING UPRIGHT
WORD TALKING NOT IN SENTENCES
AGITATION

13. WHEEZING
Wheezing is a high pitched musical sound produced by airflow turbulence and is also seen in upper respiratory infections is very common in small children, but:
Wheezing in asthma is exhalational except in sever cases.
Many of these children will not develop asthma
Asthma medications may benefit patients who wheeze whether or not they have asthma

14. COUGH Usually nonproductive and non paroxysmal
Consider asthma in children with:
Recurrent episodes of cough with or without wheezing
Nocturnal awakening because of cough
Cough that is associated with exercise/play
Cough without wheeze is often not asthma

15. OBJECTIVE/ PHYSICAL Respiratory rate; > 30 bpm
Accessory Muscles of respiration involved
Suprasternal retractions
Heart rate >120bpm
Loud biphasic wheezing can be
Pulsus Pardoxicus
Oxyhemoglobin saturation in room air<91%

16. In Status Asthmaticus Paradoxical abdominal movements Absent wheezing
Severe hypoxemia
Pulsus paradoxicus

17. Diagnosis Pulmonary Function test: Spirometry and Plethysmography
Exercise challenge target >60% of predicted maximum
Fraction of exhaled nitric oxide
Radiography
Allergy testing
Histology

18. Differential diagnosis
Air way foreign body
Allergic Rhinitis
Aspiration Syndromes
Bronciolitis
Cystic Fibrosis
Aspergilloisis
Primary Ciliary Dyskinesia

20. Defining Asthma Severity and Control
0–4 years
5–11 years
12 years and older

21. Managmement summary Assement and monitoring
Education of care givers and children
Environmental control
Pharmacologic treatment

22. Pharmacologic treatment
Short acting broncodilators; Albuterol
Long Acting Bronchodilators; Levalbuterol
Theophyliine
Leukotriene Modifiers;Montelukast
Inhaled coticosteroids; Beclomethazone, Budezonide
Inhaled cromolyn
Systemic coticosteriods
Monoclonal antibodies; Omalizumab
Combination Inhaled Steroids/ Long Acting B2 agonists; Budesonide/ Formoterol

26. Test for Respiratory and Asthma Control in Kids (TRACK)

28. Classifying Asthma Severity and Initiating Treatment in Children 5 to 11 Years of Age

29. Assessing Asthma Control and Adjusting Therapy in Children 5 to 11 Years of Age

30. Childhood Asthma Control Test™

32. Classifying Asthma Severity and Initiating Treatment in Youth ≥12 Years of Age and Adults

33. Assessing Asthma Control in Children ≥12 Years of Age and Adults

35. Role of Viral Infections

37. Forced Expiratory Volume in 1 Second (FEV1) Percent Predicted