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Does this child get asthma

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Does this child get asthma

  1. 1. *Does this child get Asthma?
  2. 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. 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. 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. 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. 6. *
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  8. 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 Children’s Hospital, Iowa City, * Although asthma is at times overdiagnosed ,it is also at times underdiagnosed
  9. 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. 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. 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 what’s called pneumonia in young kids is actually manifestations of asthma,” Miles Weinberger
  12. 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. 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. 14. *
  15. 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. 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. 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. 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. 19. *In 2009, 1 in 5 children with asthma went to the emergency department CDC. National Center for Environmental Health. Asthma’s Impact on the Nation: Data from the CDC National Asthma Control Program.
  20. 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. 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. 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 5–14 years it is among the top 10 causes. Death rates from asthma in children globally range from 0.0 to 0.7 per 100 000. 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 5–14 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. 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. 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. 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. 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. 27. * 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital 27
  28. 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. 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. 30. * www.giglig.com 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital 30
  31. 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. 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. 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. 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. 35. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital 35 *
  36. 36. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital 36 *
  37. 37. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital 37 *
  38. 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. 39. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital 39 *
  40. 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. 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. 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. 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. 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. 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. 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. 47. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital 47 *
  48. 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. 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. 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. 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. 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. 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. 54. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital 54 * *Long-acting β2-agonists: Formoterol and Salmeterol, have:  Twice-daily dosing  Relax airway smooth muscle for 12hours *Do not have any significant anti-inflammatory effects
  55. 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. 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. 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. 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. 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. 60. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital 60 * Quick-Relief Medications Short-Acting β2- Agonists Anticholinergic Agent Oral Corticosteroids
  61. 61. 6/12/2015 Asthma Prof. Dr. Saad S Al Ani Khorfakkan Hospital 61 * *Short-acting β2-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. 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 β2- agonists when used for acute asthma exacerbations.
  63. 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. 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. 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. 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. 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. 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. 69. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital 69 *
  70. 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. 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. 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. 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. 74. 6/12/2015 Asthma Prof.Dr. Saad S Al Ani Khorfakkan Hospital 74 *

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