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Tag: asthma in children
WORLD ASTHMA DAY 2024,Dr Dev Kumar Jha,MD,Child and child Chest specialist Delhi NCR
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Is my child suffering from Asthma,Dr Deo Kumar Jha,MD. Pediatrician and Pulmonologist,Ghaziabad,Noida,Delhi-NCR
Know the fact, directly from expert-Dr.Dev,Child and child chest specialist
Is your child facing repeated episodes of cough-Yes/No
Is the cough more problematic during night-Yes/No
Is the cough more problematic while child is playing-Yes/No
Is the cough more problematic when the child eats or drinks cold items-Yes/No
Is the child facing shortness of breath/difficulty in breathing repeatedly-Yes/No
Is your doctor,preferring to nebulise the child more frequently-Yes/No
Is your child facing more cough and or shortness of breath while season is changing-Yes/No
Is your child having itchy skin rashes any time,in addition to cough and shortness of breath-Yes/No
Is your child having itchy nose,frequent running nose,stuffy nose,nose block more frequently in addition to cough and shortness of breath-Yes/No
Is your child takes more time for the recovery of cough and cold than other children-Yes/No
Is your child having cough and shortness of breath when there is no running nose or sneezing-Yes/No
Is any family member whether he or she lives with the child or does not live with the child ,facing symptoms of any kind of allergy-Yes/No
If the answer of most of the questions are YES, there is maximum probability that, your child is suffering from ASTHMA
Asthma is not a disease to be scared of but should be accepted and then appropriate treatment should be given to the needy child.
Asthma is one of the most common chronic disease of respiratory tract in children.
It affects 10%-30% children worldwide.
It is the most common cause of frequent school absenteeism for children.
It affects mental and physical health of children.
It gives financial burden to the family
After appropriate treatment there is negligible school absenteeism,no challenge to the physical and mental health of child and financial burden to the family is significantly reduced.
Dr Deo Kumar Jha,
MBBS(Gold Medalist)
MD(Pediatrics)
Fellowship in Pediatric Pulmonology,AIIMS,New Delhi
Depression and financial instability of Parents-more asthma symptoms in children,Dr Deo Kumar Jha,MD.Pediatrician and Pulmonologist,Delhi-NCR
Asthma is the most common chronic respiratory disease in children.
It is responsible for significant days of school absenteeism.
It gives financial burden to the family by frequent visits to OPD and emergency department.
Child has to spend many sleepless nights during the period of symptoms.
It also disturbs the sleep of parents and the whole family.
Sleepless nights leads to decrease in work efficiency of child and parents.
According to the first study of its kind on 3900 Australian children,between the age of 1-15 years,the researcher observed that ,wheezing episodes in children with stressed parents were far more than the children with parents having no stress or negligible stress.
Specifically they observed that the wheezing episodes were 77% more in children of parents leading a stressful life with moderate to severe stresses, 55% more in children with mother having depression and 40% more in children with parents facing financial hardships.
Environmental factors which trigger asthma are well known in the form of pollutants,allergens,environmental tobacco smokes which are modifiable.
Depression and anxiety in children are also known to trigger asthma.
But Psychosocial factors, like parental stress due to workload or career making,depression and anxiety in parents, and financial hardships faced by parents are less recognised or ignored factors which may trigger symptoms of asthma.
In the care of asthmatic children, 
psychosocial factors should be addressed so as to control the symptoms of asthma
REFERENCES:
Shahunja KM, Sly PD, Mamun A. Trajectories of psychosocial environmental factors and their associations with asthma symptom trajectories among children in Australia. Pediatric Pulmonology. 2023:ppul.26733. doi: 10.1002/ppul.26733
How to predict Asthma Severity and adverse outcome in children,Dr.Dev,M.D.,Pediatrician and Pediatric Pulmonologist,Noida, Ghaziabad Delhi NCR
It is very difficult to predict the course of asthma in children.
Some children with asthma as a diagnosis by physician,do not have any problem after a few months.
Some children with asthma go on to wheeze for years together.
Some children have only mild symptoms although for a prolonged period of time.
Some children require repeated hospital admissions for treatment
Few children require ICU admission and others may require mechanical ventilation
There is very few longitudinal studies for the factors which can tell that, how severe the asthma will be in a particular child
To know that ,researchers from National Taiwan University Hospital studied on 699 children with diagnosis of asthma.The study was done between September 2004 to December 2018 on 2 cohorts.One cohort of 383 children with levels of serum allergen sensitization with blood eosinophil level and other cohorts of 313 children with blood eosinophil level only
Researchers wanted to know the longitudinal outcomes of asthma in children related to serum total IgE level,blood eosinophil level ,serum specific allergen sensitization and dosages of inhalational steroids(ICS) used to control the asthma in children.
It was a retrospective study and data were collected for variability in Peak Expiratory flow(PEF),maximum predicted percentage of Peak expiratory flow,asthma severity and asthma control.
Study revealed that the severity of asthma was more in association with increased level of blood eosinophil (odds ratio [OR]: 1.043; 95% CI: 1.002–1.086; P =.0392) AND with sensitization to molds(OR: 2.2485; 95% CI: 1.3253–3.8150; P =.0027).
It was also seen over the time that, the allergen sensitization and dosage of Inhalational steroid used had the best area under receivers operator curve for asthma severity(0.5918),asthma control(0.6441),variability of PEF(0.6885) and percentage prediction of PEF(0.6609)
CONCLUSION:1.It was concluded from the study that the risk of adverse outcome was related to total serum IgE level,blood eosinophil level and specific allergen sensitization
2. Long term outcome was related to allergen sensitization and dosages of ICS used to control asthma in children
REFERENCES;
Lee JH, Lin YT, Chu AL, et al. Predictive characteristics to discriminate the longitudinal outcomes of childhood asthma: a retrospective program-based study. Pediatr Res. Published online January 24, 2022. doi:10.1038/s41390-022-01956-6
Current status of Azithromycin in Asthma control,Dr.D.K.JHA,M.D.,Pediatrician and Pediatric Pulmonologist,Delhi
Asthma is the most common chronic respiratory disease in children.
It is both underdiagnosed and overdiagnosed in children
The standard treatment for childhood asthma is inhalational corticosteroid(ICS) in different doses according to the severity of asthma.
If the asthma is not controlled, on highest permissible doses of inhalational steroid,Long acting beta agonist(LABA) is added to control it, provided the technique of inhalation is correct,comorbidities have been addressed properly and allegen avoidence has been taken care of and adherence to treatment is good.
If it is not controlled on ICS+LABA,other add on options are LTRA(Monteleukast) and Tiotropium
If still the asthma is not controlled ,biologicals in the form of Omalizumab(IgE antagonist) and Meplozumab(IL5 antagonist) are given to control the asthma
Biologicals are costly with the disadvantages of adverse events and it is not widely available.
Asthma control is usually assessed by Asthma control test(ACT) ,Childhood asthma control test(CACT) and more easily by GINA guideline for control of asthma
Higher the ACT,CACT scores ,better is the control of asthma.
Researchers from the division of Pulmonology,department of Pediatrics,All India Institute of Medical Sciences,conducted an open label randomized control trial for a drug Azithromycin.Azithromycin is recommended drug by Global Initiative of Asthma(GINA) and British Thoracic Society(BTS) guideline for control of Asthma in adults.It improves spirometer parameter and reduces number of exacerbation of asthma in adults.There is no sufficient data for its use in children.
This the reason, researchers from Pediatric Pulmonology, division of the department of Pediatrcs AIIMS New Delhi, studied on 120 children between the age group of 5-15 years,mostly male(74% ) with poorly controlled asthma according to ACT and CACT.They divided these children into two groups.One group (n60) received Azithromycin in the dose of 10 mg/kg thrice weekly for 12 weeks along with standard treatment.The other group(n60) received only standard treatment.
The primary outcome was level of control of Asthma, according to ACT and CACT.Secondary outcomes were spirometry parameter,number of exacerbations,,Fractional excretion of NO(FeNO),throat swab culture positivity and adverse events
At the end of study period,the group who received Azithromycin along with standard care were having high ACT and CACT score (21.71 vs. 18.33; P < .001))indicating better asthma control.They also required less number of emergency visits due to asthma exacerbation and less use of oral or injectable steroids(0 vs. 1; P < .001).) ,higher number of good control of asthma by GINA guideline(41 vs. 10; P < .001).)
Spirometry parameters,throat swab culture ,FeNO reports and adverse events were not much different between two groups.
The benefits of Azithromycin was not different whether the child was suffering from eosinophilic or non eosinophilic asthma.
The study was published in CHEST.
CONCLUSION and BOTTOM LINE: Azithromycin in the dose of 10mg/kg,thrice weekly for 3 months may be added in treatment for children who could not achieve good control of asthma with standard therapy
REFERENCES:: Ghimire JJ, et al. Chest. 2022;doi:10.1016/j.chest.2022.02.025.
WATCH DR.DK.JHA,M.D.,Pediatric Pulmonologist and Respiratory intensivist ,Delhi, moderating a Panel discussion by international experts on Asthma in children with or without COVID 19
The most common chronic respiratory disease from which children all over the world suffer is ASTHMA.
Please click to know more for the better care of asthmatic children.