Pathophysiology and Epidemiology: Childhood Asthma

Asthma is a disease in which the sufferers airways get inflamed. It is characterized by obstruction of airflow and hyper-responsiveness that results in symptoms such as wheezing and coughing. The prevalence of childhood asthma rose gradually from the early 1980s up to the late 1990s when it became constant. In 2007 in the United States, 6.7 million children aged below 17 years were suffering from asthma, which is about 9% of the entire population. The diseases lifetime prevalence in children is about 13%. Childhood asthma is still a preventable cause of death despite the fact that mortality rates have reduced since 1999. The mortality rate stood at 2.5 children per 1 million in 2004, with an average of 186 deaths reported every year. Racial disparities are quite substantial, with prevalence rates for the disease being highest among African American and Puerto Rican children.

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A notable characteristic of asthma is inflammation of airways that is countered by various cell subtypes. The airways become hyper-responsive, eventually limiting flow of air and triggering variable symptoms. After the airway broncho-constriction, there is airway edema and intense production of mucus together with airway hyper-responsiveness. This is usually followed by remodeling of the airways. The inflammation can be countered by chemokines and cytokines whose role is chemotaxis and leukocytes activation. Cytokines are secreted by several types of cells such as eosinophils, mast cells and lymphocytes. It is believed that pro-inflammatory cytokines, secreted mainly by T-helper lymphocytes, are what causes the intense inflammation experienced in allergic asthma. An increase in Th2 activity as well as a decrease in Th1 activity is a contributor of chronic inflammatory asthma.

Protocol for Diagnosis

Most childhood asthma patients develop their initial symptoms before the age of five years. However, it can be quite difficult to diagnose the disease in children below the age of five. A child with frequent wheezes, respiratory infections or colds is likely to suffer from asthma if one or both parents have the disease, and if he or she shows signs of allergies like eczema. Other tell-tale signs include wheezing in the absence of colds or other infections, and allergic reactions to airborne allergens such as pollen.

Diagnosis for asthma includes a physical examination and a diagnostic lung function test. A physician will listen to the childs breathing and also check for symptoms of the disease such as a running nose, wheezing, allergic skin conditions, and swollen nasal passages. It is worth bearing in mind that the child can still be suffering from asthma even if he or she does not display these symptoms at the time of examination. To check lung function, a test known as spirometry is conducted to check how the childs lungs are working. The test measures the amount of air breathed in and out, as well how fast the child can blow air out.

The physician may recommend other types of tests if more information is required for a diagnosis. They include a test known as bronchoprovocation that measures how sensitive the childs airways are. An electrocardiogram (EKG) or a chest X-ray can also be carried out to figure out whether the symptoms are caused by a foreign object or some other condition. Allergy testing can be done to find out if any allergens affect the child. also, the physician can conduct tests to see if the child is suffering from another disease with symptoms similar to those of asthma.

Management

Management of childhood asthma is based on confirmation of diagnosis, assessment of the symptoms pattern and triggers, and discussion of management goals with the child and his/her parents, depending on age. It also involves selection of the initial treatment based on how old the child is and pattern of symptoms, as well as regular review and adjustment of treatment based on latest risk factors and symptom control. An ideal management plan involves dealing with comorbid conditions that affect the disease, handling flare-ups whenever they occur, and offering advice healthy eating, avoidance of smoking and tobacco smoke, physical exercise and immunization.

Follow-Up Care

Children suffering from asthma have to be scheduled for planned follow-up visits to a physician at regular intervals. This step is meant to assess their control of the disease as well as to modify treatment should it be necessary. Childhood asthma is quite variable as it is capable of changing with time, varying by situation or season, and differing from child to child. Since response to the diseases therapy also varies, regular monitoring of its control via clinical visits is crucial.

How Culture Impact Care of Children with Asthma

Parental cultural and psychological factors may impact childhood asthma in a number of ways. For instance, Hispanic and African-American parents may worry more about their childrens condition. However, they have more pressing priorities, lower expectations for symptom functionality and control, and more concerns about drug dependency and overmedication than their white counterparts. In addition, they tend to have poor compliance with preventive medications, even when health insurance coverage is not an issue to them. The same case applies to parents of south Asian descent and other minority communities.

References

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care (5th ed.).Philadelphia, PA: Elsevier.

Hagan, J. F., Jr., Shaw, J. S., Duncan, P. M. (Eds.). (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd ed.). Elk Grove Village, IL: American Academy of Pediatrics.