Dyspnea interfering with feeding or speaking 2nd acute asthma attack following release from ER Persistent vomiting associated with severe cough Co Morbidities: Chronic allergy All infants and children with asthma should have GERD considered in their differential diagnosis. If their history is suggestive of GERD, swallowing disorders, aspiration, or congenital defects e. If further workup is required, hour esophageal pH monitoring and bronchoscopy may be necessary.
See Treatment and Medication for more detail. Background Asthma is a chronic inflammatory disorder of the airways characterized by an obstruction of airflow, which may be completely or partially reversed with or without specific therapy.
Airway inflammation is the result of interactions between various cells, cellular elements, and cytokines. In susceptible individuals, airway inflammation may cause recurrent or persistent bronchospasm, which causes symptoms that include wheezing, breathlessness, chest tightness, and cough, particularly at night early morning hours or after exercise.
Airway inflammation is associated with airway hyperreactivity or bronchial hyperresponsiveness BHRwhich is defined as the inherent tendency of the airways to narrow in Pediatric astham to various stimuli eg, environmental allergens Pediatric astham irritants.
The prevalence of asthma is increasing, especially in children. Annually, the World Health Organization WHO has estimated that 15 million disability-adjusted life-years are lost andasthma deaths are reported worldwide.
In the United States, asthma prevalence, having increased from toshowed a plateau at 9. Each year, an estimated 1. Pathophysiology Interactions between environmental and genetic factors result in airway inflammation, which limits airflow and leads to functional and structural changes in the airways in the form of bronchospasm, mucosal edema, and mucus plugs.
Airway obstruction causes increased resistance to airflow and decreased expiratory flow rates. These changes lead to a decreased ability to expel air and may result in hyperinflation.
The resulting overdistention helps maintain airway patency, thereby improving expiratory flow; however, it also alters pulmonary mechanics and increases the work of breathing. Hyperinflation compensates for the airflow obstruction, but this compensation is limited when the tidal volume approaches the volume of the pulmonary dead space; the result is alveolar hypoventilation.
Uneven changes in airflow resistance, the resulting uneven distribution of air, and alterations in circulation from increased intra-alveolar pressure due to hyperinflation all lead to ventilation-perfusion mismatch.
Vasoconstriction due to alveolar hypoxia also contributes to this mismatch. In the early stages, when ventilation-perfusion mismatch results in hypoxia, hypercarbia is prevented by the ready diffusion of carbon dioxide across alveolar capillary membranes.
Thus, patients with asthma who are in the early stages of an acute episode have hypoxemia in the absence of carbon dioxide retention. Hyperventilation triggered by the hypoxic drive also causes a decrease in PaCO2. An increase in alveolar ventilation in the early stages of an acute exacerbation prevents hypercarbia.
With worsening obstruction and increasing ventilation-perfusion mismatch, carbon dioxide retention occurs. In the early stages of an acute episode, respiratory alkalosis results from hyperventilation.
Later, the increased work of breathing, increased oxygen consumption, and increased cardiac output result in metabolic acidosis. Respiratory failure leads to respiratory acidosis. Fatigue is also a potential contributor to respiratory acidosis.
Role of inflammation Chronic inflammation of the airways is associated with increased BHR, which leads to bronchospasm and typical symptoms of wheezing, shortness of breath, and coughing after exposure to allergens, environmental irritants, viruses, cold air, or exercise.
In some patients with chronic asthma, airflow limitation may be only partially reversible because of airway remodeling hypertrophy and hyperplasia of smooth muscle, angiogenesis, and subepithelial fibrosis that occurs with chronic untreated disease.
New insights in the pathogenesis of asthma suggest that lymphocytes play a role. Airway inflammation in asthma may represent a loss of normal balance between two "opposing" populations of T helper Th lymphocytes.
Two types of Th lymphocytes have been characterized: The hygiene hypothesis The current "hygiene hypothesis" of asthma illustrates how this cytokine imbalance may explain some of the dramatic increases in asthma prevalence in Westernized countries. Evidence suggests that the prevalence of asthma is reduced in children who experience the following events: Certain infections Mycobacterium tuberculosis, measlesor hepatitis A Rural living Exposure to other children eg, presence of older siblings and early enrollment in childcare Less frequent use of antibiotics, including in the first week of life [ 7 ] Early introduction of fish in the diet [ 7 ] Furthermore, the absence of these lifestyle events is associated with the persistence of a Th2 cytokine pattern.
Under these conditions, the genetic background of the child, with a cytokine imbalance toward Th2, sets the stage to promote the production of immunoglobulin E IgE antibody to key environmental antigens eg, dust mites, cockroaches, Alternaria, and possibly cats.Children’s National established the Severe Asthma Clinic as a resource for patients and families who have experienced an asthma emergency.
Sickle Cell Pulmonary Clinic Children's National has one the largest and most active pediatric sickle cell programs in the country. Asthma Overview. Asthma is a chronic disease involving the airways in the lungs. These airways, or bronchial tubes, allow air to come in and out of the lungs.
Childhood asthma (pediatric asthma) is the most common serious chronic disease in infants and children; yet is often difficult to diagnose. In infants and children, asthma may appear as: Some children have symptoms only when exercising or playing a sport.
This is called exercise-induced bronchospasm. Pediatric asthma. Download printable PDF. Introduction Although asthma is a common disease, it is not always recognized that asthma has become the most common chronic disease of childhood.
May 22, · Asthma, which occurs in adult and pediatric patients, is a chronic inflammatory disorder of the airways characterized by an obstruction of airflow. Among children and adolescents aged years, asthma accounts for a loss of 10 million school days annually and costs caretakers $ CDC’s National Asthma Control Program created this set of videos to help children with asthma and their families and caregivers learn how to use an asthma inhaler.
The kids in these videos have asthma.