This document is a paper presentation on pediatric asthma by Mr. Namdeo Shinde of Satara College of Pharmacy in India. The presentation defines asthma, discusses its increasing prevalence in children worldwide and in India specifically, and outlines the challenges of diagnosing and treating asthma in younger children. It also covers asthma symptoms, triggers, risk factors, investigations, differential diagnosis, long-term management including medications, and concludes by emphasizing the importance of patient education.

1. A PAPER PRESENTATION
ON
PEDIATRIC ASTHMA
BY
Mr. NAMDEO SHINDE
M. Pharm
SATARA COLLEGE OF PHARMACY DEGAON, SATARA.(MH)
INDIA.

2. ASTHMA - DEFINITION
• A disease characterized by an increased responsiveness of
the airways to various stimuli resulting in airway
obstruction that is reversible either spontaneously or as a
result of treatment
• Acute asthma - presence of active symptoms from
airway obstruction and/or inflammation
• Chronic asthma - absence of extended periods free of
symptoms without treatment

3. Asthma is a chronic respiratory disorder in which there is primarily swelling of
airways in the lungs. The airways are therefore narrowed making it difficult to
breathe Normal Inflamed (untreated)
Regular
Inhaled
Steroid Partly
Treated

4. • As per WHO, India has 30 million asthmatics which is 10% of the
global asthmatic population
• The prevalence of asthma is higher in children. Today, up to 1 out
of 10 children in India has asthma.
• Asthma is the most common chronic condition in children
• As per a study, Asthma in children has doubled over the past 5
years and is rapidly increasing
• There will be an additional 100million asthmatics worldwide by
2025

5. Kashmir lockdown claims the life of a young asthma patient
Indian Express, 9th July 2010
Mohali boy dies of asthma attack
Tribune, 16th April 2010
>1 year after the death of Akruti Bhatia in Delhi
~ 180,000 people die of asthma each year
……….almost all of these are preventable

7. Asthma Inflammation

8. Factors Influencing the Development
and Expression of Asthma
Host factors –
• Genetic
1. Genes predisposing to atopy
2. Genes predisposing to airway hyper responsiveness
• Obesity
• Sex

9. Asthma is the swelling of the airways and excessive mucus production which
causes cough and difficulty in breathing. When the swollen lungs come into the
contact with any of the following, an asthma attack is triggered
Dust and smoke Pollen from plants Chalk dust in school
Physical exertion
and exercise
Change in weather Strong emotions Furry animals &
such as laughing bird feathers
and crying

10. Other Challenges
• Most of the children are below 5 years of age, who cannot tell
their problems
• Parents are proxy story teller, who may mislead the doctor
• PEF cannot be performed in children below 5 years of age
• Fear of addiction to inhalation therapy
• Physicians lack of knowledge and time

11. Risk factors of Asthma in younger children
• Sensitization to allergen.
• Maternal diet during pregnancy and/ or lactation.
• Pollutants (particularly environmental tobacco smoke).
• Microbes and their products.
• Respiratory (viral) infections.
• Psychosocial factors.

12. The prevalence of childhood asthma has continued to
increase on the Indian subcontinent over the past 10 yrs
ISAAC Phase 3 Thorax 2007;62:758

13. Symptomatology
• Cough – 90%
• Wheezing – 74%
• Exercise induced wheeze or cough – 55%
Ind J Ped 2002;69:309-12

14. When does Asthma begin?
• By 1 year – 26%
• 1-5 years – 51.4%
• > 5 years – 22.3%
77% Of Asthma Begins
In Children Less Than 5
Years
Ind J Ped 2002;69:309-12

15. Physical Examination (Look)
• General Attitude And Well Being
• Deformity Of The Chest
• Character Of Breathing
• Thorough Auscultation Of Breath Sounds
• Signs Of Any Other Allergic Disorders On The Body
• Growth And Development Status
CHILDHOOD ASTHMA by KHUBCHANDANI R.P. et al

16. What all features one should look for specifically?
Cough
• Persistent/ recurrent / nocturnal/ exercise-induced
Associated conditions
• Eczema
• Allergic Rhinitis
 Weight/Height
CHILDHOOD ASTHMA by KHUBCHANDANI R.P. et al

17. What all investigations can be performed in
asthmatic children? (PERFORM)
Peak expiratory flow rate: It is highly suggestive of
asthma when:
• >15% increase in PEFR after inhaled short acting
β2 agonist
• >15% decrease in PEFR after exercise
• Diurnal variation > 10% in children not on
bronchodilator OR
>20% In children on bronchodilator
1. Asthma by Consensus, IAP 2003
2. CHILDHOOD ASTHMA by KHUBCHANDANI R.P. et al

18. Differential diagnosis
Age Common Uncommon Rare
Less than Bronchiolitis Aspiration pneumonia Asthma
6 months Gastro- Bronchopulmonary Foreign body aspiration
esophageal dysplasia
reflux Congestive heart failure
Cystic fibrosis
6 months Bronchiolitis Aspiration pneumonia Congestive heart failure
- Foreign body Asthma
2 years aspiration Bronchopulmonary
dysplasia
Cystic fibrosis
Gastro-esophageal reflux
2 - 5 years Asthma Cystic fibrosis Aspiration pneumonia
Foreign body Gastro-esophageal reflux Bronchiolitis
aspiration Viral pneumonia Congestive heart failure
Gastro-esophageal
reflux
IPAG 2007

19. Confirm Asthma if,
If the child is having 3 attacks of airway obstruction in
last 1 yr.
If the child gets 1 attack of asthmatic symptoms after
the age of 2 yrs.
Irrespective of age in an attack in children with
allergy (eczema, food allergy etc.) or history of atopy.
If the child does not become free of symptoms when
infection has ceased or has persistent symptoms for
more than a month.
Respir Med. 2000;94(4):299-327

20. Impact of Asthma on Children
o 3rd-ranking cause of hospitalization among children
under 15
o Almost 13 million school days missed each year
o Affects sleep patterns, concentration
o Impairs ability to enjoy & partake in physical activities
If not managed properly may contribute to significant morbidity and mortality
Advance data from Vital and Health Statistics, NCHS,2003
Asthma Prevalence, Health Care Use and Mortality, CDC, 2003-2005

21. Asthma Treatments
• Classified into Controllers and Relievers
• Controllers – medications to be taken on daily long term basis.
• Relievers – medications to be used on as-needed basis to
relieve symptoms quickly.

23. • Choosing an inhaler device for children with asthma *-
Age group Preferred device Alternative device
Pressurized metered-dose inhaler
Younger than 4 years plus dedicated spacer with face Nebulizer with face mask
mask
Pressurized metered-dose inhaler
4-5 years plus dedicated spacer with Nebulizer with mouthpiece
mouthpiece
Dry powder inhaler or breath
actuated pressurized metered-
dose inhaler or pressurized Nebulizer with mouthpiece
Older than 6 years
metered-dose inhaler with spacer
with mouthpiece
*Based on efficacy of drug delivery, cost effectiveness, safety, ease of use, and convenience . GINA 2009

24. Asthma management and prevention
• The goals for successful management of asthma are
1. Achieve and maintain control of symptoms
2. Maintain normal activity levels, including exercise
3. Avoid adverse effects from asthma medications
4. Prevent asthma mortality

25. Tablet/ Syrup Medicine by Inhalers
Higher dose Much lower dose (1/20th of oral)
More side effects Much less side effects
Takes time to act Almost immediate onset of action

26. To summarize…
Diagnosis
• Asthma is an inflammatory illness
• Diagnosis of asthma is clinical, and relies on history
• All asthma does not wheeze
• In children < 3 yrs, WALRI is an important differential diagnosis
• 2 out of 3 children outgrow their asthma
• A family history of asthma / atopy increases risk of asthma

27. To summarize…
Long term management
• Patient education is a very important part of asthma management
• Drugs control, but do not cure asthma
• Clinical grading over time, decides long term management plan
• Mild intermittent asthma does not merit controllers
• Inhaled steroids are mainstay of long term asthma management
• Treatment should be stepped up or stepped down depending upon patient
response

28. CONCLUSION
So, today an asthma patient in
Any interiors of India can be given the
same quality of treatment
as an asthma patient in
New York
… and far more economically

29. Cipla has created an educational website with the help of
doctors
www.breathefree.com
Please inform one and all about the website

30. REFERENCES
www.medicinenet.com/asthma
www.mayoclinic.com/health/childhood-asthma/DS00849
www.bbc.co.uk/news/health-21067532
en.wikipedia.org/wiki/Asthma
http://www.mayoclinic.com/health/childhood-asthma/DS00849
http://en.wikipedia.org/wiki/Asthma
http://www.nhs.uk/conditions/Asthma-in-children/
http://www.patient.co.uk/doctor/diagnosing-childhood-asthma
http://www.medicalnewstoday.com/articles/257110.php
http://www.bbc.co.uk/news/health-21067532
http://www.noattacks.org/
http://www.environmentalhealthnews.org/ehs/news/2013/asthma-
www.healthecare.us/Asthma
http://www.bcguidelines.ca/pdf/asthma.pdf

31. Thank You