This document discusses childhood asthma, including its prevalence, pathophysiology, risk factors, diagnosis, impact, and barriers to effective management. Some key points: - Asthma is a common chronic respiratory disorder affecting 15-20% of children globally. It causes inflammation and narrowing of the airways. - It has physical, social, and emotional impacts on children and families, including limitations on activities, school absenteeism, feelings of isolation, and increased stress. - Barriers to effective management include late or under diagnosis, lack of education, cultural beliefs, non-adherence to treatment, and limited healthcare resources. - Improving primary care, education programs for families and healthcare providers,

1. Childhood Asthma
Barriers to effective management
Dr . Chithra Gadambanathan
MD(Paed),DCH
Consultant Paediatrician
Teaching hospital,Batticaloa

2. • Basics of Asthma
• Impact of Asthma
• Management of asthma
• Defining “Asthma Control”
• Barriers to management
• What are the ways out?

3. What is Asthma?
• Chronic inflammatory disorder / Airway
• Completely / partially reversible
obstruction.
• With / without specific Rx.
• Inflammation : Hyper reactivity / hyper
responsiveness.

4. How common is Asthma?
• Most common chronic respiratory disorder
• M:F - 2:1
• Wheezing – commonest cause of admission /
SL children
• Prevalence rate : 15-20% some areas :
35-40%.(SL)
• Common cause - school absenteeism

5. Pathophysiology
Asthma is primarily an inflammatory disease
Mucus plugging
Smooth muscle
spasm
Airway oedema
:

6. What happens in asthma?
• Airway inflammation – Environmental & genetic
factors.
• Bronchospasm, Mucosal oedema & mucus plugs
• Increased resistance & decreased expiratory flow
• Hyperinflation & hypoventilation
• Hypoxaemia & hypercapnea

8. Risk factors (ISAC study,SL)
• Straw roofs
• Clay walls
• Un-cemented floors.
• Pets(Dogs and cats)
• Domesticated cattle
• Smoking.
• Fumes from keresone lamps
and firewood hearths

9. Diagnosis
• Clinical – Typical symptoms, trigger
factors, F/H , H/O atopy
• Improvement with bronchodilators
• Objective tests > 5 yrs
Variability of PEFR & FEV1 –
spontaneously / bronchodilator
% of PEF variability 20 or more - highly
suggestive

10. IMPACT
• PHYSICAL
• SOCIAL
• EMOTIONAL

11. SE Impact – Child and Family
• Social and leisure pursuits
• Schooling
• Practical aspects of daily life
• Emotional effects

12. Social and Leisure Pursuits
• Affect the ability to take part in sport.-Limitations or
avoidance
• Avoid coming into contact with animals
• Need to avoid pollen and smoke may similarly restrict
children's play and leisure activities.
• Holiday arrangements can be affected
• Siblings may be affected because of restrictions on the
asthmatic child.
• Parents may be prevented from going out in the evenings or
enjoying a life of their own.

13. Schooling
Asthma is the most common reason for children's
absence from school
• Affect academic performance
• Child feeling different or inferior or being overprotected.
STRESS
• Exacerbation of the symptoms of asthma

14. Practical aspects of daily life
For Children
• May have to avoid particular foods,
• Stay away from dusty or smoky environments
• Be protected against catching “colds”
Deprive the child from sources of pleasure and comfort.
For the Parents
• Extra Housework & Sleep loss(nocturnal pattern)
• Physically exhausted.
• Take leaves or give up their jobs STRESS
• Financial costs.

15. Emotional effects
• Any chronic illness can cause stigma, a loss of self esteem,
and family strain.
• In one study, 41% of parents of asthmatic children said that
asthma caused their children to feel self pity; 21% reported
that their children had a poor self opinion, and 23% felt their
children had poor relationships with their peers.
Restrictions on social activities can increase a child's
sense of isolation and create further difficulties in
establishing social contacts.

16. Emotional impact on family life
• ‘A constant worry‘ -'red alert' and unable to relax, even
when the asthma is essentially under control.
• Sense of guilt – “We are responsible”
• Over protectiveness and/or a failure to exercise adequate
discipline.
• 34% of parents in one study felt that their had an adverse
effect on their own (parental) relationship.
• Other children receive less than their fair share of
parental attention

17. Parent-Child Relationship
• Children may seek attention or avoid unpleasant activities-
able to play football at school while claiming to need a
wheelchair at home.
• Parents deny the existence of the condition and to pretend it
does not exist-become hostile and accuse the sufferer of
manipulation
Both children and parents need support
and guidance

18. Current situation……..
• Although treatment for asthma has improved considerably
over the past 30 years, many sufferers and carers continue to
experience problems in their everyday lives.
What is the reason?
• This may reflect the difficulty of fully controlling the disease

19. Defining Asthma Control

20. Measuring Asthma Control

21. Effective Management
• Initial early diagnosis
• Correct assessment.
• Regular Monitoring.
• Clear & ongoing education – Asthma Care
• Control of risk factors & co-morbid
conditions
• Regular use of medications.

22. Despite improved treatment regimens for
asthma, the prevalence and morbidity from
asthma are increasing among children.
Mona E. Mansour, Bruce P. Lanphear, and Thomas G. DeWitt From
the Children's Hospital Medical Center and the Department of
Pediatrics, University of Cincinnati, Cincinnati, Ohio.
PEDIATRICS Vol. 106 No. 3 September 2000, pp. 512-519
This is true and applicable for us as
well………………..

23. Current State………….
• Clinicians : Parents are not caring enough – late presentation
and exacerbation
• Parents :Impact of asthma on themselves and their children
is seldom fully recognised.
• School –Denial of opportunities
• Child – Lot of restrictions ??????!

24. Child
with
Symptoms
Identification
Diagnosis
Follow up
Barriers to Care………….

25. Barriers- Identification
• Parents - Native management (Symptomatic)
• Primary care staff – Inadequate awareness
• Cultural beliefs and misconceptions

26. Barriers - Diagnosis
• Under diagnosis
• No definite test
• Late presentation

27. Barriers – Follow up
• Inadequate explanation
• Inadequate knowledge.
• Denial – social stigma.
• “Busy” Clinics
• Urgency of parents
• Impatient children
“Poor drug compliance”
Non-affordability, Non-availability, Non-accessibility

28. WHAT ARE THE WAYS OUT?

29. Importance of Primary care
• An important determinant of health for children with asthma.
• Access to primary care is associated with better outcomes for
children with asthma, because the hallmarks of high-quality primary
care, namely, continuity, communication, comprehensiveness,
contextual knowledge, coordination, and accessibility, are key to
good asthma care.
(Expert guidelines from the National Asthma Education and
Prevention Program of the National Heart, Lung, and Blood
Institute, American Academy of Allergy, Asthma, and
Immunology)

30. PARENT(FAMILY)
CHILD
with
ASTHMA
HEALTH STAFF
SCHOOL
SHARED RESPONSIBILITY !

31. Few steps we have taken ........
HEALTH
EDUCATION
LEAFLET
MONTHLY HEALTH
EDUCATION
PROGRAMMES

32. Few steps we have taken…..
ACTION PLAN

33. Few steps we have taken ........
ASTHMA CHART

34. In planning stage………….
• Separate Asthma Clinic
• Continuous educational programmes for
primary care staff
• Awareness raising at school level

35. Take home messages
• Early diagnosis is the key
• Continuing health education to staff and parents is
essential
• A better appreciation of the social and emotional
impact of asthma is necessary
• Researches on asthma is a need
• “Working together” is mandatory

36. THANK
YOU!