Transcript of Does this child get asthma
- 1. *Does this child get Asthma?
- 2. *A ,10 mon old male infant present with coryza , ,cough ,
shortness of breath and poor feeding *O/E he had : Tachypnea and
tachycardia Hyperinflated chest Intercostal and subcostal recession
Wheeze and crepitations Pallor *Chest X-ray showed: Hyperinflation
Patchy collapse 6/12/2015 Does this child get Asthma Prof.Dr.Saad S
Al Ani Khorfakkan Hospital 2
- 3. *E ,2 year old female child present with: Recurrent chest
infections Not put much weight since she was born Frothy cough
especially at night Shortness of breath and poor feeding Bulky ,
greasy ,difficult -to-flush stools Malnutrition *O/E she had :
Failure to thrive Wheeze and crepitations *Chest X-ray showed:
Hyperinflation & Patchy lesions 6/12/2015 Does this child get
Asthma Prof.Dr.Saad S Al Ani Khorfakkan Hospital 3
- 4. *L ,8 year old girl gives a 6- month history of a
progressive cough . * In the past she had dry cough lasted several
weeks after each cold . *A tentative diagnosis of asthma has been
made and stepping up anti-asthma therapy along with oral
antibiotics with eventual improvement of each coughing episodes.
*She was hospitalized for acute pneumonia on several occasions to
give I.V. antibiotics *Her present cough is productive of purulent
phlegm 6/12/2015 Does this child get Asthma Prof.Dr.Saad S Al Ani
Khorfakkan Hospital 4
- 5. *N ,a 4 year old boy who has been referred by his GP. *He
has suffered frequent wheezing episodes in winter associated with
cold *He get day-to day symptoms of cough and he is breathless with
exercise *Last month he was up all night wheezing after having
pillow fight with his sister *His mother has hay fever ,and his
older sister had frequent wheezing in infancy with eczema *He has
mild eczema 6/12/2015 Does this child get Asthma Prof.Dr.Saad S Al
Ani Khorfakkan Hospital 5
- 6. *
- 7. *
- 8. *Asthma is probably overdiagnosed by a factor of 5 Michael
Seear ,MD pediatrician, respirologist, and instructor with the
University of British Columbia Certificate in International
Development, Vancouver . Miles Weinberger, MD professor of
pediatrics at the University of Iowa Childrens Hospital, Iowa City,
* Although asthma is at times overdiagnosed ,it is also at times
underdiagnosed
- 9. * Preschool-aged children have the highest hospitalization
rate for asthma, reporting that 5% to 10% of all hospitalizations
for US children are for asthma
- 10. *Asthmatic aged younger than 5 years has twice the number
of hospitalizations as school-aged asthmatics and 5 times the
number as teenaged asthmatics.
- 11. *There are other studies that suggest that patients are
being overdiagnosed with pneumonia, and very often when you look at
those studies, probably a lot of whats called pneumonia in young
kids is actually manifestations of asthma, Miles Weinberger
- 12. * *A chronic respiratory disease, often arising from
allergies, that is characterized by sudden recurring attacks of :
Labored breathing Chest constriction Coughing 6/12/2015 Does this
child get Asthma Prof.Dr.Saad S Al Ani Khorfakkan Hospital 12
- 13. *An estimated 25.9 million people, including almost 7.1
million children, have asthma National Health Interview Survey
(NHIS) Data, 2011 http://www.cdc.gov/asthma/nhis/2011/data.htm
- 14. *
- 15. *Asthma prevalence is higher among persons with family
income below the poverty level Akinbami, L., et al. Trends in
Asthma Prevalence, Health Care Use, and Mortality in the United
States, 2001-2010
http://www.cdc.gov/nchs/data/databriefs/db94.pdf
- 16. *Asthma accounts for more than 15 million physician office
and hospital outpatient department visits National Ambulatory
Medical Care Survey: 2010 Summary Tables
http://www.cdc.gov/nchs/data/ahcd/namcs_summary/2010_namcs_web_tables.pdf
And nearly 2 million emergency department visits each year National
Hospital Ambulatory Medical Care Survey: 2010 Outpatient Department
Summary Tables
http://www.cdc.gov/nchs/data/ahcd/nhamcs_outpatient/2010_opd_web_tables.pdf
National Hospital Ambulatory Medical Care Survey: 2010 Emergency
Department Summary Tables
http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf
- 17. *An average of 1 out of every 10 school- aged children have
asthma United States Environmental Protection Agency. Asthma Facts.
March 2013.
http://www.epa.gov/asthma/pdfs/asthma_fact_sheet_en.pdf.
- 18. *Asthma is the third-ranking cause of hospitalization in
children United States Environmental Protection Agency. Asthma
Facts. March 2013.
http://www.epa.gov/asthma/pdfs/asthma_fact_sheet_en.pdf
- 19. *In 2009, 1 in 5 children with asthma went to the emergency
department CDC. National Center for Environmental Health. Asthmas
Impact on the Nation: Data from the CDC National Asthma Control
Program.
- 20. *Boys are more likely to have asthma than girls United
States Environmental Protection Agency. Asthma Facts. March 2013.
http://www.epa.gov/asthma/pdfs/asthma_fact_sheet_en.pdf.
- 21. * *The annual economic cost of asthma, including direct
medical costs from hospital stays and indirect costs such as lost
school and work days, amount to more than $56 billion annually
Centers for Disease Control and Prevention, (May 2011) Asthma in
the U.S. Vital Signs http://www.cdc.gov/vitalsigns/asthma/
- 22. Abstract: About 334 million people worldwide suffer from
asthma, and this figure may be an underestimation. It is the most
common chronic disease in children. Asthma is among the top 20
chronic conditions for global ranking of disability-adjusted life
years in children; in the mid-childhood ages 514 years it is among
the top 10 causes. Death rates from asthma in children globally
range from 0.0 to 0.7 per 100000. There are striking global
variations in the prevalence of asthma symptoms (wheeze in the past
12 months) in children, with up to 13-fold differences between
countries. Although asthma symptoms are more common in many
high-income countries (HICs), some low- and middle-income countries
(LMICs) also have high levels of asthma symptom prevalence. The
highest prevalence of symptoms of severe asthma among children with
wheeze in the past 12 months is found in LMICs and not HICs. From
the 1990s to the 2000s, asthma symptoms became more common in some
high-prevalence centres in HICs; in many cases, the prevalence
stayed the same or even decreased. At the same time, many LMICs
with large populations showed increases in prevalence, suggesting
that the overall world burden is increasing, and that therefore
global disparities in asthma prevalence are decreasing. The costs
of asthma, where they have been estimated, are relatively high. The
global burden of asthma in children, including costs, needs ongoing
monitoring using standardised methods. Asthma is among the top 20
chronic conditions for global ranking of disability-adjusted life
years in children In the mid-childhood ages 514 years it is among
the top 10 causes Int J Tuberc Lung Dis. 2014 Nov;18(11):1269-78.
doi: 10.5588/ijtld.14.0170. Global burden of asthma among children.
Asher I1, Pearce N2.
- 23. * *Episodic viral-associated wheezing *Classic atopic
asthma *Cough variant asthma 6/12/2015 Does this child get Asthma
Prof.Dr.Saad S Al Ani Khorfakkan Hospital 23
- 24. *Episodic viral- associated wheezing *Episodes are more
frequent in winter *Almost always associated with colds *Usually
completely asymptomatic between episodes *Response to regular anti-
inflammatory therapy is poor 6/12/2015 Does this child get Asthma
Prof.Dr.Saad S Al Ani Khorfakkan Hospital 24
- 25. *Classic atopic asthma *An Atopic background (allergies or
eczema) *Positive family history of atopy and asthma *Day-to-day
symptoms triggered with exercise or occurring at night when no cold
*Response well to regular anti- inflammatory asthma therapy
6/12/2015 Does this child get Asthma Prof.Dr.Saad S Al Ani
Khorfakkan Hospital 25
- 26. *Cough variant asthma *Nocturnal and/or exercise induced
cough when free from cold *Wheezing may never been heard *Personal
of family history of other atopic disorders *Response rapidly to
anti- asthma therapy *Symptoms relapse when therapy withdrawn
6/12/2015 Does this child get Asthma Prof.Dr.Saad S Al Ani
Khorfakkan Hospital 26
- 27. * 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan
Hospital 27
- 28. Chronic inflammatory disease of the airways Airways spasm
and swelling Obstruction to air flow Wheezing or gasping for air
Resolves spontaneously Responds to a wide range of treatments *
6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital 28
- 29. * *Continuing inflammation makes the airways
hyper-responsive to stimuli such as: * Cold air * Exercise * Dust
mites * Pollutants in the air * Stress *Anxiety 6/12/2015 Asthma
Prof.Dr. Saad S Al Ani Khorfakkan Hospital 29
- 30. * www.giglig.com 6/12/2015 Asthma Prof.Dr. Saad S Al Ani
Khorfakkan Hospital 30
- 31. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
31 * *Asthma is the most common chronic disease of childhood in
industrialized countries *Boys are more likely than girls to have
asthma *Children with asthma have symptoms of: Coughing Wheezing
Shortness of breath or rapid breathing Chest tightness
- 32. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
32 *Nighttime symptoms are common * *Physical examination may show
evidence of other atopic diseases such as eczema or allergic
rhinitis *Many childhood conditions can cause wheezing and coughing
of asthma *Not all cough and wheeze is asthma
- 33. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
33 * *Asthma can be aggravated by: Rhinosinusitis Gastroesophageal
reflux Nonsteroidal anti-inflammatory drugs (especially
aspirin)
- 34. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
34 * *Presentation during acute episodes: Tachypnea Tachycardia
Cough Wheezing Prolonged expiratory phase
- 35. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
35 *
- 36. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
36 *
- 37. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
37 *
- 38. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
38 is used to: Monitor response to treatment Assess degree of
reversibility with therapeutic intervention Measure the severity of
an asthma exacerbation * *Children older than 5 years of age can
perform spirometry maneuvers.
- 39. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
39 *
- 40. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
40 * *Repeat chest radiographs are not needed with new episodes
unless: There is fever (suggesting pneumonia) Localized findings on
physical examination should be performed with: The first episode of
asthma Recurrent episodes of undiagnosed cough or wheeze to exclude
anatomic abnormalities
- 41. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
41 * *In vitro serum tests are generally: Less sensitive in
defining clinically pertinent allergens More expensive Require
several days for results compared to several minutes for skin
testing Such as: Radioallergosorbent test ( RAST) Fluorescentenzyme
immunoassay ( FEIA) Enzymelinkedimmunosorbent assay (ELISA)
- 42. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
42 * Positive skin tests results: *Identifying immediate
hypersensitivity to aeroallergens *Correlate strongly with
bronchial allergen provocative challenges Should be included in the
evaluation of all children with persistent asthma but not during an
exacerbation of wheezing.
- 43. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
43 * *The most common causes of wheezing in children include:
Asthma Allergies Infections Gastroesophageal reflux disease
Obstructive sleep apnea
- 44. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
44 *Less common causes include : Congenital abnormalities Foreign
body aspiration Cystic fibrosis *
- 45. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
45 * *Optimal medical treatment of asthma includes several key
components: Environmental control Pharmacologic therapy Patient
education, including attainment of self-management skills Steps to
minimize allergen exposure
- 46. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
46 * *Asthma medications can be divided into: Long-term control
medications Quick-relief medications
- 47. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
47 *
- 48. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
48 * Are: *The most effective anti-inflammatory medications for the
treatment of chronic, persistent asthma *The preferred therapy when
initiating long term control therapy
- 49. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
49 * *Early intervention with inhaled corticosteroids reduces
morbidity but does not alter the natural history of asthma
- 50. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
50 * *Regular use of inhaled corticosteroids reduces: Airway
hyperreactivity The need for rescue bronchodilator therapy Risk of
hospitalization Risk of death from asthma
- 51. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
51 * *Do not have clinically significant adverse effects on:
Hypothalamic-pituitary-adrenal axis function Glucose metabolism
Subcapsular cataracts or glaucoma When used at low-to-medium doses
in children
- 52. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
52 * *Two classes of leukotriene modifiers include : Leukotriene
receptor antagonists (zafirlukast and montelukast) Leukotriene
synthesis inhibitors (zileuton)
- 53. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
53 * *Usefulness of leukotriene : Modifiers in mild asthma
Attenuation of exercise-induced bronchoconstriction
- 54. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
54 * *Long-acting 2-agonists: Formoterol and Salmeterol, have:
Twice-daily dosing Relax airway smooth muscle for 12hours *Do not
have any significant anti-inflammatory effects
- 55. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
55 * *Is approved for use in children older than 5 years of age
for: Maintenance asthma therapy Prevention of exercise-induced
asthma *It has a rapid onset of action similar to albuterol (15
minutes).
- 56. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
56 * Is approved for children 4 years of age or older Has an onset
of 30 minutes
- 57. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
57 * It is mildly to moderately effective as a bronchodilator Is
considered an alternative, add-on treatment to low- and medium-dose
inhaled corticosteroids
- 58. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
58 * Humanized anti-IgE monoclonal antibody that prevents binding
of IgE to high-affinity receptors on basophils and mast cells It is
approved for moderate to severe allergic asthma in children 12
years of age and older.
- 59. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
59 * Xolair is delivered by subcutaneous injection every 2 to 4
weeks, depending on body weight and pretreatment serum IgE
level
- 60. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
60 * Quick-Relief Medications Short-Acting 2- Agonists
Anticholinergic Agent Oral Corticosteroids
- 61. 6/12/2015 Asthma Prof. Dr. Saad S Al Ani Khorfakkan
Hospital 61 * *Short-acting 2-agonists, such as albuterol,
levalbuterol, and pirbuterol, are: Effective bronchodilators that
exert their effect within 5 to 10 min They last for 4 to 6 hours.
*Is prescribed for acute symptoms and as prophylaxis before
allergen exposure and exercise
- 62. 6/12/2015 Asthma Prof. Dr. Saad S Al Ani Khorfakkan
Hospital 62 * *Ipratropium bromide is an anticholinergic
bronchodilator that: Relieves bronchoconstriction Decreases mucus
hypersecretion Counteracts cough-receptor irritability *It seems to
have an additive effect with 2- agonists when used for acute asthma
exacerbations.
- 63. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
63 * * Short bursts of oral corticosteroids (3 to 10 days) are
administered to children with acute exacerbations *The initial
starting dose is 1 to 2 mg/kg/day of prednisone followed by 1
mg/kg/day over the next 2 to 5 days
- 64. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
64 * *Prolonged use of oral corticosteroids Can result in systemic
adverse effects such as: Hypothalamic- pituitary-adrenal
suppression Cushingoid features Weight gain Hypertension Diabetes
Cataracts& glaucoma Osteoporosis Growth suppression
- 65. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
65 *Status asthmaticus *Is an acute exacerbation of asthma that
does not respond adequately to therapeutic measures and may require
hospitalization
- 66. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
66 * Significant respiratory distress Dyspnea Wheezing Cough
Decrease in peak expiratory flow rate (PEFR)
- 67. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
67 * *During severe episodes of wheezing, pulse oximetry is helpful
in monitoring oxygenation
- 68. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
68 * *In status asthmaticus, arterial blood gases may be necessary
for measurement of ventilation
- 69. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
69 *
- 70. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
70 * *For children younger than 3 years of age who are at risk for
asthma include: Eczema Parental asthma or Two of the following:
1.Allergic rhinitis 2.Wheezing with a cold 3.Eosinophilia of
greater than 4%
- 71. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
71 *Successful education *Involves: Teaching basic asthma facts
Explaining the role of medications, Teaching environmental control
measures Improving patient skills in the use of spacer devices for
metered dose inhalers and peak flow monitoring
- 72. *Underdiagnosis and undertreatment of asthma in children: a
tertiary hospital's experience Ioanna Vasilopoulou*, Irene
Papakonstantopoulou, Katerina Salavoura, Nikoletta
Laliotou,Athanasios Kaditis and Vasiliki Gemou-Engesaeth Methods We
studied 82 children (age 2-15y) that were referred to our clinic
during 2013-2014 and their history and/or physical examination
revealed a clinical suspicion of asthma, according to GINA.
Children were evaluated by personal/family history, physical
examination, skin prick tests to common allergens, total/specific
IgE levels. Lung function tests were carried out where possible.
Chest X-ray and sweat test were performed if needed. Children were
divided into three groups: children with asthma diagnosed for first
time, children with asthma whose symptoms were uncontrolled and
children with severe/persistent asthma. Results 32/82 children were
diagnosed with asthma for the first time in our Unit and had never
received treatment before despite pediatric follow up. 12/32 came
for a reason other than asthma, such as Food Allergy (3), Urticaria
(2), Drug allergy (1), Eczema (1), Allergic Rhinitis (1) and
hospitalization due to foreign body aspiration (1). Of the 37/82
children who already had a diagnosis of asthma, 31 had poorly
controlled symptoms despite treatment. Reasons for uncontrolled
asthma in 21/31 were low doses of Inhaled Corticosteroids or
intermittent use, 7/31 had improper inhaler technique and 3/31 had
poor adherence to treatment. 9/82 children were referred for severe
asthma; 4/9 had improper inhalation technique. Non-adherence to
treatment and co-morbid conditions also contributed to persistent
symptoms. Patients were treated individually. After 6 months,
symptoms were well controlled in 67 children. 3 children were well
controlled at the 3 months follow up while 7 children's follow up
is pending. 1 child did not return, 1 child followed alternative
therapies and 3 were not compliant to our advice. Conclusions
Asthma in children is still often underdiagnosed. For correct
diagnosis/treatment a detailed clinical history is mandatory and
lung function tests should be performed in children with associated
comorbidities such as AR. Studies have shown that one demonstration
of the inhaler technique is not enough. It is essential to educate
clinicians, patients and parents and to promote compliance.
Conclusions Asthma in children is still often underdiagnosed. For
correct diagnosis/treatment a detailed clinical history is
mandatory and lung function tests should be performed in children
with associated comorbidities such as AR. Studies have shown that
one demonstration of the inhaler technique is not enough. It is
essential to educate clinicians, patients and parents and to
promote compliance
- 73. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
73 * * www.uic.edu * www.scienceopen.com * faculty.washington.edu *
http://www.aafp.org
- 74. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital
74 *