Increasing Frequency of Pediatric Asthma Essay Sample
Pediatric asthma refers to asthma in children (Accetta 2006). Over the past decades, pediatric asthma has been rampant worldwide. “In 2002, an estimated 30.8 million people in the United States had asthma diagnosed at some point in their life, including some 8.9 million children. Asthma is estimated to affect as many as 300 million people worldwide. Asthma is the leading cause of hospitalization in children, the most prevalent chronic disease in childhood, and the most common cause of school absenteeism due to chronic disease. It is more common and more severe in African-Americans and in people with a low income living in urban areas” (“Asthma: What We Know” n.d.).
What is asthma?
According to the article reviewed by Owens (2004), “asthma is a chronic condition in which narrowing of the passages from the lungs to the nose and mouth (airways) leads to difficulty breathing. These changes commonly occur in response to changes in the environment, including weather, allergens (such as dog or cat dander, mold, or dust), foods, or respiratory infections (colds).”
Asthma is a chronic inflammatory disorder of medium and small airways (Klinek 1997). Airway inflammation involves numerous cells including antigen presenting cells (such as macrophages), lymphocytes that produce cytokines (T-cells) and IgE molecules (B cells), mast cells that release various mediators when IgE receptors cross-linked by allergens, and eosinophils that can cause epithelial damage via Major Basic Protein.
Based on “Asthma and Children” (2007), “childhood asthma is caused by the child’s genetic predisposition and allergies. The majority of children with asthma have allergies. Even exposure to low-grade allergens (those that do not cause significant allergic reactions) may increase the severity of a child’s asthma. In addition, allergies may play a role in undiagnosed asthma cases.”
Children with asthma may be able to breathe normally most of the time. When they encounter a trigger, however, an attack (exacerbation) can occur (“Pediatric Asthma” 2003). There are a number of triggers in asthma and this may include tobacco smoke, dust, pollen, strenuous physical activity (such as exercise), viral infections (such as the common cold), mold and mildew, animals/pets (hair or dander), insects (cockroaches), chemicals in the air or in food (food additives), mold, changes in weather (frequently cold weather), strong emotions and certain drugs/medications.
Other factors may include viral upper respiratory infections, rhinitis or sinusitis and gastroesophageal reflux disease (GERD) where stomach acids goes up into the esophagus.
As stated in “Asthma and Children” (2007), “approximately 6.2 million children have been diagnosed with asthma according to the American Lung Association. Asthma is one of the most common, serious, chronic diseases among children, accounting for 14 million absences from school each year. Moreover, asthma is the third-ranking cause of childhood hospitalizations under the age of 15.”
In another study, “asthma is affecting approximately one in 20 children” around the world “and the prevalence is increasing” (Maynard 2001).
A whole host of risk factors for the development of asthma have been explained and may include: male gender, atopy, genetic and familial factors (family history of asthma, allergic rhinitis, hives or eczema), respiratory infections, outdoor air pollutants, indoor aeroallergens, smoke, pre-maturity (low birth weight), diet (obesity) and climate. Atopy is the strongest identifiable predisposing factor for the development of asthma (Klinek 1997).
Signs and Symptoms
The most common signs and symptoms of pediatric asthma include coughing, wheezing, shortness of breath (breathlessness), chest tightness and chest congestion. Other signs and symptoms in children are rattly cough and recurrent bronchitis (croup, broncholitis, pneumonia or bronchopneumonia).
Even if wheezing is closely associated to asthma, not all asthmatic children wheeze. Vice versa, not all children who wheeze have asthma. Not all of the above-mentioned signs and symptoms may be present in children with asthma since they may be correlated with other ailments, not only with asthma. The final diagnosis can only be made after pulmonary tests are run by a pediatrician or specialist.
Symptom differences between childhood and adult asthma
As mentioned in “Asthma and Children” (2007), “although childhood asthma symptoms are the same as adult asthma symptoms, they may not be as noticeable and easy to detect. Wheezing, often a positive indicator of asthma may not be as noticeable in a child with asthma as in an adult. However, most children who have asthma will cough – a common characteristic of asthma, regardless of age. If your child coughs after running or crying, or during the night, consult a physician for a diagnosis. Your child may have “hidden” (undiagnosed) asthma. Other childhood asthma symptoms may include the following:
- Frequent coughing or respiratory infections, such as pneumonia or bronchitis, may indicate undiagnosed asthma.
- Infants with asthma may have a rattly cough, rapid breathing, and many respiratory infections.
- Chest tightness and shortness of breath, which may lead to severe anxiety, may be a symptom of childhood asthma.
- Unexplained irritability, which may be attributed to the discomfort of the chest tightness, can be a sign of asthma.”
The so-called “hidden asthma” is said to be undiagnosed asthma with undetected symptoms. These symptoms could be in the form of wheezing or difficulty in breathing (breathlessness), which can only be exposed through testing pulmonary abilities. Therefore, if a child undergoes airway obstruction or any abnormalities in respiratory function, it is advisable that the child be checked by a physician to determine if such symptoms are related to asthma or not.
Classification of Asthma
As determined by the National Institutes of Health (cited in “Asthma and Children” 2007 para. 7), “the following is a guideline used by physicians to help determine the extent of asthma in your child. It is classified as ‘steps,’ because each child may step up or step down to different levels at any time.
The steps are as follows:
- Step 1 or mild intermittent asthma
This group of children has symptoms less than two times a week, do not have problems in between flare-ups, and only have short flare-ups from a few hours to a few days. Nighttime symptoms occur less than two times a month.
- Step 2 or mild persistent
This group of children has symptoms more than two times a week, but no more than one time per day, and may have activity levels affected by the flare-ups. Nighttime symptoms occur greater than two times a month.
- Step 3 or moderate persistent
This group of children have symptoms every day, use their rescue medication every day, may have activity levels affected by the flare-ups, and have exacerbations greater than or equal to two times a week. Nighttime symptoms occur greater than one time a week.
- Step 4 or severe persistent
This group of children has symptoms constantly, have a decrease in their physical activity, and have frequent flare-ups. Nighttime symptoms occur frequently also.”
Screening and Diagnosis
Pediatric asthma is a very subjective condition. Its severity depends from one child to another. Among the physician’s considerations are the nature and frequency of symptoms together with the testing results to disregard other diseases before finally diagnosing the health problem as asthma. Usually, it is difficult to diagnose asthma among toddlers and infants since some signs and symptoms of asthma at these ages may disappear as they grow up. A more definite diagnosis of asthma can be made as soon as the child reaches after 6 years of age or adolescence.
The physician can use family history of the asthmatic, physical examination, and diagnostic tools such as chest x-ray (CXR) and lung function tests to diagnose asthma in pediatric patients. Pulmonary function tests may include spirometry (measures the amount of air inhaled) and peak flow meters. A spirometer helps to determine whether there is airflow obstruction and whether it is reversible over the short term. On the other hand, the peak flow meter is designed basically for monitoring asthmatic patients by measuring the amount of air that can be expelled from the lungs. A more accurate diagnostic result can be obtained when the doctor uses a combination of history, physical examination and pulmonary function tools (CXR).
For effective treatment of pediatric asthmatic patients, the families and physician should plan together in monitoring signs and symptoms and eradicating triggers of asthma. According to the review by Owens (2004), “there are two basic kinds of medication for the treatment of asthma:
- Long-term control medications — used on a regular basis to prevent attacks, not for treatment during an attack.
- inhaled steroids (e.g., Azmacort, Vanceril, AeroBid, Flovent) prevent inflammation
- leukotriene inhibitors (e.g., Singulair, Accolate)
- long-acting bronchodilators (e.g., famoterol, Serevent) help open airways
- cromolyn sodium (Intal) or nedocromil sodium
- aminophylline or theophylline (not used as frequently as in the past)
- combination of anti-inflammatory and bronchodilator
- Quick relief (rescue) medications — used to relieve symptoms during an attack.
- short-acting bronchodilators (e.g., Proventil, Ventolin, Xopenex, and others)
- oral or intravenous corticosteroids (e.g., prednisone, methylprednisolone) stabilize severe episodes.”
Most asthmatic children live a normal life as long as this disease is properly treated, monitored and managed. Nevertheless, asthma should not be taken for granted because if left untreated, it can be a life-threatening ailment. Therefore, family support together with the physician or allergist should develop a workable plan to fight this respiratory illness which causes impairment to children.
Grave complications of asthma include continuous cough, lack of sleep due to nighttime symptoms, decreased ability to perform exercises and participate in various activities, absence in school, missed work for parents/guardians, frequent emergency room visits and stays in hospital, difficult breathing requiring breathing assistance (ventilator/nebulizer), permanent changes in lung function and even death.
Full prevention of asthma is yet to be discovered. However, the role of the families in the prevention of pediatric asthma cannot be undermined since each member can help in the elimination of triggers inside the home. A common example is avoiding cigarette smoke indoors. As soon as signs and symptoms of asthma in children start to show, immediate consultation to a doctor is advised for implementation of a plan of action for relief.
In general, the following are some tips on how to prevent asthma attacks among children. First, avoid triggers which may activate exacerbation of asthma. Second, encourage the asthmatic child to be active especially in activities which are good for the lungs such as swimming. Next, make a plan which will involve all the people surrounding the child to help in avoiding asthma attacks. And lastly, use a peak flow meter to constantly monitor the extent of lung function to be able to predict a possible asthma attack.
Increase of Frequency of Pediatric Asthma
According to “Asthma: What We Know” (n.d.), “asthma is increasing, especially in young children, both in the number of people affected and in severity. Asthma is increasing in the United States (figure to right) and most developed countries, in many developing countries (e.g., China, India), and indeed, worldwide.”
Number of people in USA with asthma. Data: American Lung Association
“The number of children and the total number of people with asthma in the U.S. has more than doubled since 1980. The number of women in the U.S. with asthma is increasing faster than the number of men with asthma. Comparing children hospitalized for asthma in California in 1993 and 1986, children in 1993 were twice as likely to experience an adverse outcome (such as having a breathing tube inserted into the windpipe, having normal breathing and heart functions stop, and death) compared with children hospitalized there seven years earlier. Experts agree that the increases in asthma are real and not just an increase in reporting due to increased awareness” (“Asthma: What We Know” n.d.).
Many studies have been conducted to derive at a logical explanation as to the increase of frequency of asthma among children lately. It has been proven that genetic and familial factors do affect risk of acquiring asthma. However, “Asthma: What We Know” (n.d.) further explained that “more and more people without a family history of asthma are getting the disease” and “the increase in frequency of asthma has been too fast and too large to be explained by inheritance of genetic susceptibility. Changes in gene frequency occur slowly over many generations, except under highly unusual circumstances that would leave many tell-tale signs.”
Concerned individuals have suggested that environmental factors might be involved in this upsurge of pediatric asthma cases. But “Asthma: What We Know” (n.d.) continued that “there has not been any significant increase in indoor allergen concentrations during the last few decades to account for the doubling of asthma rates during that time. There are no differences in asthma rates in dry, cool regions with low levels of house-dust mites and fungus compared to warm, humid areas where levels are high.” Moreover, “studies have not shown that children with less exposure to these allergens are any less likely to develop asthma” (Asthma: What We Know” n.d.).
Another hypothesis was proposed to explain the increase in asthma cases. This was called the “hygiene hypothesis” which stated that children who grew up “too clean” or hygienic and unexposed to childhood diseases, domestic animals, and bacteria possess an immune system which is hypersensitive and overactive to asthma allergens. Even so, this theory was not accepted because it failed to explain why incidence is higher among African-American children, among children living in urban areas in contrast to those residing in suburban communities, and the rising number of cases in highly-populated developing countries like China and India.
Some possible justifications as to the increase in incidence of pediatric asthma were given by recent researches which encompasses the following:
- “Exposures early in life (before birth and during infancy) can be important in setting the stage for later development of asthma. For example, a recent study found that infants exposed to herbicides and pesticides before age 1 were much more likely to develop early persistent asthma.
- Immune system development during infancy and childhood involves changes in the predominance of different immune system cells, ones called T-helper cells. Two types of T-helper cells exist. If a baby has too high a proportion of one of these types, they are much more likely to develop asthma symptoms. Hence asthma scientists actively looking for factors that affect the proportions of these cells.
- Breastfed infants are less likely to develop asthma and allergies compared to those fed infant formula. Breast-feeding enhances immune function.
- Indoor air quality has changed dramatically over the last 3 decades as new chemical products have been introduced into household goods and building materials, increasing exposures to many different volatile organic compounds. Very few have been tested for effects on the developing immune system, even though it is clear that exposure in the womb can alter immune function later in life. Some types of exposure weaken immune responses while others make the immune system over-react.
- While some types of outdoor air pollution are decreasing, ozone and fine particle pollution from diesel engine exhaust are ongoing or increasing problems, both in the US and in other countries and regions where asthma is on the rise. Kids who engage frequently sports activity in areas of high ozone have an increased risk of asthma. Several lines of evidence suggest that diesel exhaust may cause asthma. Diesel exhaust, for example, appears to change some immune cells to a type that is linked to the development of asthma. And kids growing up along streets with heavy truck traffic are more likely to have asthma-related respiratory symptoms.
- Exposure to second-hand smoke before and after birth is linked to asthma risk. But if this were a large factor, asthma rates should be declining because fewer people smoke.
- Interactions between different exposures may be important in the development of asthma. For example, one recent study found that asthma symptoms in children ill with a respiratory virus are likely to be more severe if they are exposed to the air pollutant nitrogen dioxide, even at levels of nitrogen dioxide below current air standards. In another study, combining exposure to low levels of pollen with exposure to levels of pollutants commonly found in urban air dramatically worsened asthma symptoms” (“Asthma: What We Know” n.d.).
As an initial conclusion to the preceding assumptions, “asthma is increasing in frequency and severity in all age groups and in most developed countries. In the U.S., it is most common in African-American children living in urban areas. Although genetic factors are involved, environmental factors are almost certainly responsible for the increases” (Asthma: What We Know” n.d.).
According to another study, “In 1994-96, 24 percent of children with asthma had to limit their activities due to their asthma, and the disease caused children to miss 14 million days of school. Studies have shown that outdoor and indoor air pollution causes some respiratory symptoms and increase the frequency or severity of asthma attacks” (cited in “Respiratory Diseases in Children” para. 2).
“Asthma among children is increasing in the United States. Researchers do not understand completely why children develop asthma. The tendency to develop asthma can be inherited, but genetic factors alone are unlikely to explain the significant increases that have occurred in the last 20 years” (cited in “Respiratory Diseases in Children” para. 6). To support this statement, “In the last 20 years, asthma prevalence has doubled, says Derek Johnson, MD, director of pediatric allergy at Temple University, in a news release” (cited in De Noon 2007).
In a recent article by De Noon (2007), Atlanta was named “Asthma Capital” in the United States for 2007 by the Asthma and Allergy Foundation of America (AAFA). “Atlanta earns its “worst” score from the city’s high asthma death rate, high pollen levels, and severe air pollution. The AAFA also cites Atlanta’s “worse-than-average” public smoking laws, although the city does ban smoking in 80% of hotel rooms and in bars and restaurants that allow access to minors (except in private, separately ventilated rooms)” (De Noon 2007).
The 10 worst asthma cities (in the United States), according to the AAFA, are Atlanta (last year: 4th), Philadelphia (last year: 3rd), Raleigh, N.C., Knoxville, Tenn., Harrisburg, Pa., Grand Rapids, Mich., Milwaukee, Wis. (last year: 5th), Greensboro, N.C. (last year: 7th), Scranton, Pa. (last year: 1st) and Little Rock, Ark. (De Noon, 2007).
“Research on environmental factors that exacerbate or may contribute to causing asthma has focused on environmental agents found outdoors and indoors. The Institute of Medicine concluded that exposure to dust mites causes asthma in susceptible children. Cockroaches and tobacco smoke are likely to cause asthma in young children. Other studies have evaluated the role of indoor air pollutants such as nitrogen dioxide, pesticides, plasticizers, and volatile organic pollutants. Some of these pollutants may play a role in asthma. One recent study suggests that chronic exposure to ozone may be associated with the development of asthma in children who exercise outside, and two other studies suggest that chronic exposure to particulate matter may affect lung function and growth” (cited in “Respiratory Diseases in Children” para. 7). Therefore, basing on these studies, environmental aspects along with genetic factors may cause an increase in frequency of asthma attacks in children who already have the disease and may cause the disease among non-asthmatic children.
In conclusion, development of asthma is yet to be determined. It may be the interplay of different factors such as genetic and environmental. Children may have greater mortality and morbidity rates than adults because of their body structure and function which may be weaker. For now, the best thing for adults to do is to work hand in hand with the physician to combat pediatric asthma. Emphasize on the triggers to prevent them and on inflammation to treat it immediately. Parents and guardians must be alert in assessing the child’s condition in order to act the soonest in case of asthma attacks. In critical situations, earlier detection can ensure an instant therapy, thus, the greater possibility of saving the child.
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