1. Renato B. Herradura, M.D. F.P.C.P. Antonio F.P.C.C.P. Pulmonary & Internal Medicine University of the East R Magsaysay Medical Center

2.  1.Association between autism and asthma and other allergic disorders 2.Clinical presentations of pulmonary disease 3.Hindrances to medical care of autistic patients 4.Approach to autistic patients with respiratory symptoms/disease Lecture Outline

3.   A greater than 2-fold elevated risk of ASD was observed for maternal asthma and allergy diagnoses recorded during the second trimester of pregnancy. Croen JAMA Pediatrics 2007  Asthmatic infants and children exhibited a higher accumulative incidence rate of ASD than did the controls (1.3% vs 0.7%, P =.007). Po-Hsin Tsai et al 2014 (Taiwan study)  Asthmatic infants and children exhibited an elevated risk of developing ASD (hazard ratio: 2.01, 95% confidence interval: 1.19–3.40).  Overall, no clear association between autism and lung disease Po-Hsin Tsai et al 2014 (Taiwan study) Autism and Pulmonary Disease

4.   Logistic regression analysis showed that the  ADHD + ASD group,  ADHD-alone group, and  ASD-alone group had an increased risk of allergic co-morbidities compared to  the control groups (without ASD or ADHD) after adjusting for age, sex, and level of urbanization. Ting-yang Lin 2014 (Taiwan study)

5.   Abnormal chest radiograph  Cough  Dyspnea  Wheezes/stridor  Chest pain Clinical Presentations of Lung disease

6.   In asymptomatic patients, are commonly encountered during pre-employment check-up, annual exams, executive check-up.  Usually focal infiltrates or pulmonary nodule/s.  Not likely to be seen in autistic patients. Abnormal Chest Radiographs

7.   Duration  Phlegm production  Usually signifies airway irritation/inflammation  Associated symptoms  Other respiratory symptoms  Coryza  Fever  Weight loss Cough

8.   Acute: (< 3weeks)  Acute RTIs (URTI, LRTI)  Viral or bacterial  Subacute: (3-8 weeks)  Bacterial LRTIs (Pertussis, Lung abscess)  PTB  Postinfectious cough  Chronic (> 8 weeks)  Chronic lung diseases (infectious and noninfectious) Cough Duration

9.   Subjective complaint  Accompanying symptoms including chest pain  Signs of respiratory distress  Fast breathing  Alar flaring  Contraction of neck, shoulder, chest wall and abdominal muscles Dyspnea

10.   Wheezes – narrowing of the lower airways  asthma, bronchitis, bronchial edema  Stridor – upper airways obstruction  Diphtheria, foreign body aspiration, laryngeal edema Wheezing

11.   Chest constriction  Bronchogenic  Esophageal  Cardiac  Pleuritic pain  Pleural inflammation Chest Pain

12.   Symptoms not clearly expressed  Chest pain  Dyspnea  Patient uncooperative during physical exam  “Take deep breaths”  Patient uncooperative during lab procedures  Pulmonary function tests  Patient unable to follow treatment instructions  Inhaler devices Hindrances to Medical Care of lung disorders in persons with autism

13.   Close observation, with particular attention to symptoms that the patient can not verbalize (dyspnea, chest pain, wheezes/stridor)  Documentation of signs/symptoms (pictures, videos) Approach the ASD Patient through Caregiver

14.   Meticulous history-taking and physical exam  Awareness of “missing pieces” of data  Judicious non-invasive testing  Use of treatment aids (e.g. inhaler aids) Approach to the ASD Patient by Clinician

15.   Association between asthma, allergic disorders and ASD is seen; the exact relationship is unknown  Hindrances to medical care are present, and must be overcome  Awareness of caregivers is important  Proper care is very possible Summary