Asthma in the pediatric population

1. Asthma in the pediatric population SEARCH Rotation 2 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 http://rileychildrenshospital.com/parents-and-patients/programs-and-services/asthma.jsp

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

5. Causes of asthma • Genetic component – Allergic March1 • 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 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 http://www.101healthsolution.com/category/asthma/

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

9. Scope of the Issue http://www.uttyler.edu/faculty/jplacyk/PlacykTeaching2.htm

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

12. http://www.cdc.gov/nchs/data/ad/ad381.pdf

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 http://www.epa.gov/iaq/schools/managingasthma.html

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 • 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 http://www.pslweb.org/site/News2?page=NewsArticle&id=11691&news_iv_ctrl=1008

17. Patient Name ________________________ • Date of Birth_________________________ Asthma Diary

18. Take these long-term control medications EVERY day Medication NameHow 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 NameHow much to takeWhen 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

19. http://fromyourdoctor.com/

20. References • Liu, Andrew H. "The Allergic March of Childhood." Medical Scientific Update 22.1 (2006): 1-12. National Jewish Medicine and Research Center. Summer 2006. Web. 20 Aug. 2010. <http://www.nationaljewish.org/pdf/zzz_library/23n1MSU_2006.pdf>. • "Asthma Overview." Asthma and Allergy Foundation of America - Information About Asthma, Allergies, Food Allergies and More! 2005. Web. 20 Aug. 2010. <http://aafa.org/display.cfm?id=8&sub=14>. • Schwartz, M. William. The 5-minute Pediatric Consult. Philadelphia: Lippincott Williams & Wilkins, 2005. Print. • Mayo Clinic Staff. "Asthma - MayoClinic.com." Mayo Clinic Medical Information and Tools for Healthy Living - MayoClinic.com. 27 May 2010. Web. 19 Aug. 2010. <http://www.mayoclinic.com/health/asthma/DS00021>. • Akinbami, Lara J. "The State of Childhood Asthma, United States, 1980-2005." Vital Health and Statistics (2006): 1-24. 26 Dec. 2006. Web. 08 Aug. 2010. <http://www.cdc.gov/nchs/data/ad/ad381.pdf>. • Bloom B, Cohen RA, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, 2008. National Center for Health Statistics. Vital Health Stat 10(244). 2009. <http://www.cdc.gov/nchs/data/series/sr_10/sr10_244.pdf >. • Mangan, Joan M., and William Bailey. "What Do Patients Need to Know about Their Asthma?" UpToDate Inc. 9 Mar. 2009. Web. 19 Aug. 2010. <http://www.uptodate.com/online/content/topic.do?topicKey=asthma/7978&source=see_link>. • Gibsono, Peter G. "Asthma Education." Respiratory Medicine 97.9 (2003): 1036-044. ScienceDirect. Web. 20 Aug. 2010. <http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WWS-48NJ32K-8&_user=77149&_coverDate=09%2F30%2F2003&_alid=1436643254&_rdoc=14&_fmt=high&_orig=search&_cdi=7138&_sort=r&_docanchor=&view=c&_ct=9840&_acct=C000006218&_version=1&_urlVersion=0&_userid=77149&md5=03fbfc9cad4cc448b7c6082251fea79c>.