Join The Cribsiders as our guest Dr. David Stukus (@AllergyKidsDoc) to discuss “all that wheeze” as he takes us on an in-depth journey through the epidemiology, diagnosis, severity, and management of pediatric asthma. Learn everything from how to handle that wheezing kid in front of you, recommended treatment modalities before inhalers, and how to teach children proper inhaler technique. We also discuss the newest asthma GINA treatment strategies and what they mean for your practice.
We are excited to announce that the Cribsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out cribsiders.vcuhealth.org and create your FREE account!
The average mortality is six times higher in Black children with asthma as compared to Hispanic and white children. (Arroyo et al. 2017)))))
Asthma is recurrent episodes of respiratory symptoms over time.
It is vital to understand the chronicity of symptoms. It is very difficult to diagnose asthma with the first symptoms of cough or wheeze. Some questions to start with include:
Not all that wheezes is asthma and lots of kids with asthma don’t wheeze at all!
(Producer’s note: our guest said 40% of toddlers wheeze and ⅓ go on to develop asthma but the actual statistic is flipped) *See Pearl 2*
Some other common causes of a wheeze include:
There is no specific age at which you can diagnose asthma, but you do need to have a pattern of symptoms, so it may be challenging at 6 months old, for example. *See Pearl 3*
Expert opinion: After 4 episodes of asthma-like symptoms you can make a diagnosis. Take this into consideration with the family history and allergic history of the child including food allergies, environmental allergies, and eczema: This is because asthma-related inflammation is associated with a broader Th2 inflammatory pathway.
What happens when they receive albuterol? If albuterol has never helped, it is probably not asthma.
There are also scores to use that are particularly useful in ruling out persistent asthma in a wheezing child (based on other Th2 pathway comorbidities):
Triggers can be both acute and chronic and can change over time.
By far, the most common trigger in children is viral URI (Johnston et. al, 1995)
Other common triggers include:
You can only assess severity in someone who is not on a daily controller, but you also need to assess control over time. “Asthma is a roller coaster–it is not a “set it and forget it” disease!” Assess control on every single visit. Assess control by looking at the previous 4 weeks and use a validated questionnaire like the Asthma Control Test.
Goals should be individualized to every patient and family. The goals can vary widely, but in general should be to reduce symptoms/exacerbations, let kids sleep through the night, exercise without limitations. Asthma is the leading cause of missed school days. (Hsu et al. 2016)
You can use the Asthma Action Plan as the final take-home message for the family.
Some patients cannot perceive bronchoconstriction. These patients may benefit from a peak flow meter. But you need to teach them how to use it.
The 2020 GINA treatment strategies made a major change:
Expert opinion: Medicine is the last aspect of changing asthma therapy. Instead, the order of assessment should be:
Overarching rules of management (mini pearls):
Asthma and Allergy Foundation of America
The Martian by Andy Weir–Yes, it is also a book!
Bad Advice by Paul Offit–A vaccine guru talks about politics and misinformation.
The Checklist Manifesto by Atul Gawande–Put pride aside and use a checklist!
Listeners will develop frameworks to recognize, treat, and follow children with asthma.
After listening to this episode listeners will…
Dr. Stukus reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures.
Stukus D, Corty EW, Chiu C, Berk J. “Step Up to Pediatric Asthma with David Stukus, MD (@AllergyKidsDoc).” The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/
The Cribsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit cribsiders.vcuhealth.org and search for this episode to claim credit.
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