1. Asthma in the pediatric population
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August 23, 2010

2. Objectives Define asthma as a chronic disease
Discuss the morbidity of asthma in pediatrics
Discuss a few things that a health center needs to affectively manage their asthma patients

3. Asthma

4. What is asthma? Chronic respiratory disorder Characteristics Symptoms
Airway inflammation
Reversible airway obstruction
Airway hyper-responsiveness
Symptoms
Wheezing
Cough
Chest tightness
Shortness of breath

5. Causes of asthma Genetic component – Allergic March1 Triggers2 Asthma
Allergic rhinitis
Atopic dermatitis
Food allergies
Triggers2
Viral infections
Allergens (dust mites, pet dander, pollen, mold)
Tobacco smoke
Air pollution
Exercise
Extreme weather changes

6. Complications of asthma3
Frequent hospitalizations and ER visits
Repeated absences from school
Limited physical activity if not controlled properly
Psychologic impact of having a chronic disease
Declining lung function over a long period of time
Prognosis
Excellent prognosis with proper therapy and patient compliance with the treatment regimen3

7. Asthma Treatment4 Short-acting Beta Agonists Ipratropium ICS
Quick-Relievers
Long-term Controllers
Short-acting Beta Agonists
Ipratropium
ICS
Long-acting Beta Agonists
Combined ICS & LABA
Leukotriene Modifiers
Oral corticosteroids
Cromolyn Sodium
Anti-IgE therapy
SABA = bronchodilator
ICS = anti-inflammatory

8. Preventing exacerbations2
Having an asthma management plan is the best way to prevent symptoms.
Components of an asthma management plan:
Identify and minimize contact with your asthma triggers
Take your medications as prescribed by your doctor
Monitor your asthma and recognize early signs that your asthma may be worsening (which medicine to take, how much to take, when to take it, when to call your doctor, and when to seek emergency care)
Know what to do when your asthma is worsening
In taking these steps, a child should be able to play, exercise, and participate in sports without having symptoms, sleep through the night without symptoms, not have absences from school d/t asthma, and limit ER visits for asthma

9. Scope of the Issue

10. Asthma Statistics
Asthma is the most common chronic condition that children in the US suffer from5
Childhood asthma prevalence has more than doubled from 1980 to the mid-1990s 5
Affects about 1 in every 20 children 5
Affects how children play, learn, and sleep 5

11. Asthma Statistics continued
Morbidity and mortality of asthma are highly correlated with
Poorer socioeconomic status
Poverty status 6
17.4% of those who have ever had asthma are poor
14.6% of those who have ever had asthma are near poor
12.8% of those who have ever had asthma are not poor
Health insurance6
17% of those who have ever had asthma are on Medicaid or other public insurance
9.9% of those who have ever had asthma are uninsured
12.4% of those who have ever had asthma have private insurance
Lack of proper patient education
Inadequate medical care
32%

12. Connecticut has the 11th highest asthma prevalence among children 0-17 years at 9.9%

13. How can I help?

14. Asthma Education!
What are the benefits of effective asthma education7?
Quality of life improved
Symptoms improved
Decreased limitations in activities
Medication adherence improved
Decreased urgent care visits and hospitalizations
Decreased asthma-related costs

15. What should be included7?
Definition of asthma
Key points about signs and symptoms of asthma
Asthma triggers
Roles of medication
How to manage an asthma attack
How to prevent asthma attacks

16. Solutions! Tracking methods Patient education Asthma diary
Clinical practice guidelines from the National Asthma Education and Prevention Program recommend that asthma patients have close monitoring of their symptoms and adjustment of therapy to be continued over time7
Patient education
Asthma action plan
Asthma education brochure
“Asthma self-management education which consists of information, self-monitoring, regular medical reviews, and a written action plan is effective and leads to a reduction in hospitalization and ER visits for asthma, unscheduled doctor visits, days lost from work, episodes of nocturnal asthma, indirect costs and an improvement in quality of life”8

17. Asthma Diary Patient Name ________________________
Date of Birth_________________________
Asthma Diary
Appt Date
Had breathing problems during the day?
Had breathing problems at night?
Had breathing problems during physical activity?
Had unexpected visit to the Dr or ER for asthma?
What inhalers are you using?
Provider Notes

18. Take these long-term control medications EVERY day
Medication Name How much to take When to take it
 Pulmicort (Budesonide)  2 puffs  Two times a day
 Flovent (Fluticasone)
 Azmacort (Triamcinolone)
 Aerobid (Flunisolide)
 Qvar (Beclomethasone)
GREEN ZONE
Doing Well
Breathing is good
No cough or wheeze
Sleep through the night
Can work and play
 Singulair (Montelukast)  1 tablet  Once a day
Before exercise take ____________________ ________ puffs 5-60 minutes before exercise
YELLOW ZONE
Asthma is getting worse
First signs of a cold
Exposure to a known trigger
Cough
Tight chest
Mild wheeze
Coughing at night
Continue with your green zone medication and add
Medication Name How much to take When to take it
 Proventil, Ventolin (Albuterol)  2 puffs  every 20 min
 Xopenex (Levalbuterol)  4 puffs
 Maxair (Pirbuterol)  Nebulizer  once
 Prednisone _________mg
RED ZONE
Medical Alert!
Medicine is not helping
Breathing is hard and fast
Nose opens wide
Ribs show
Can’t talk well
Lips or fingernails are blue
Call your doctor NOW! Go to the hospital or call an ambulance if you are still in the red zone after 15 minutes or if you have not reached your doctor

20. References
Liu, Andrew H. "The Allergic March of Childhood." Medical Scientific Update 22.1 (2006): National Jewish Medicine and Research Center. Summer Web. 20 Aug <
"Asthma Overview." Asthma and Allergy Foundation of America - Information About Asthma, Allergies, Food Allergies and More! Web. 20 Aug <
Schwartz, M. William. The 5-minute Pediatric Consult. Philadelphia: Lippincott Williams & Wilkins, Print.
Mayo Clinic Staff. "Asthma - MayoClinic.com." Mayo Clinic Medical Information and Tools for Healthy Living - MayoClinic.com. 27 May Web. 19 Aug <
Akinbami, Lara J. "The State of Childhood Asthma, United States, " Vital Health and Statistics (2006): Dec Web. 08 Aug <
Bloom B, Cohen RA, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, National Center for Health Statistics. Vital Health Stat 10(244) < >.
Mangan, Joan M., and William Bailey. "What Do Patients Need to Know about Their Asthma?" UpToDate Inc. 9 Mar Web. 19 Aug < nk>.
Gibsono, Peter G. "Asthma Education." Respiratory Medicine 97.9 (2003): ScienceDirect. Web. 20 Aug < 8&_user=77149&_coverDate=09%2F30%2F2003&_alid= &_rdoc=14&_fmt =high&_orig=search&_cdi=7138&_sort=r&_docanchor=&view=c&_ct=9840&_acct=C &_version=1&_urlVersion=0&_userid=77149&md5=03fbfc9cad4cc448b7c fea79c>.