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Childhood Asthma

When it comes to childhood asthma management, there is not a lot of new information available. However, there are some slight changes in guidelines. “There are a couple of simple recommendations for patients with mild persistent asthma that we may not need to use corticosteroids all the time, maybe just during exacerbations,” says Dr. Jamshed Kanga, chief of the Division of Pediatric Pulmonology at the University of Kentucky. Doctors are encouraged to stay on top of making a plan to deal with asthma since the issue does not seem to be improving among the nation’s population. “We know that childhood asthma is on the rise and kids are getting sick and we are still not treating them adequately, so they are getting hospitalized and going to the emergency room,” says Kanga.

Influential institutions set the rules in terms of protocol. “We follow the National Institutes of Health guidelines and hope to improve asthma care so children will be able to be normal, run, play and not get sick or be hospitalized,” says Kanga. He goes on to note that there is a lot families can control. “Families need to provide their children with a clean, smoke-free environment, which is one of our biggest problems in Kentucky where we continue to hear about kids being sick and families continuing to smoke despite our counseling.”

Nevertheless, there is hope for asthma sufferers. “There are good treatments and good environments we can control with good medications so kids can be perfectly normal with asthma and do sports and just about anything.” Asthma is a treatable disease, and Dr. Kanga says, “It just requires the family to be aware of the things that contribute to the child’s asthma.” Unfortunately asthma is genetic and many kids have a family history of asthma and allergies. This is why it is so important to use asthma medications as directed by the doctor and for researchers to continue on their quest of “always trying to find new types of drugs.”

No two kids with asthma have an identical experience. “The thing we are now beginning to understand is that not all asthma is the same and there may be different types,” says Kanga. “There are some types that kids are likely to outgrow; there are some types where patients have more persistent problems into adulthood; and there are certain types that are responsive to treatment or that do not respond. Some kids have it for a year or two and some get better whereas some may not, so the thing is that it is difficult to predict what type of asthma a child will have.”

What can doctors do? Dr. Kanga urges them to be more proactive. “Many of our families and children are not diagnosed and doctors keep saying they have bronchitis, a cough or a lot of wheezing and they are not treated appropriately for asthma.” If they are not treated adequately, naturally they will have flares which are another issue. “I find that primary care physicians are a little reluctant to diagnose asthma and I wish they would refer these kids earlier or make the diagnosis earlier,” says Kanga. The biggest message that pulmonologists want to relay is directed to the primary care doctors: “I want them to think asthma when they see a child or even adult with chronic respiratory problems and make sure they are on appropriate treatment.”

Do not be hesitant to manage your patient. Kanga warns, “A lot of primary care doctors are timid about using inhale corticosteroids which are the standard of care for asthma, so we have to make sure the patient is educated on management of asthma and other things like smoking cessation and environmental control measures.” When all else fails, see a specialist. “If they continue to have problems we are more than happy to see the child to do some further evaluation and treatment.”

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