Carers' perception of childhood asthma and its management in a selected Pakistani community.

AIMS: To gather information on the level of disease awareness among the carers of asthmatic children and to determine whether it can help us draw inferences about the possible impact of prevailing perceptions on the management of asthma? METHODS: Subjects were children's parents/guardians visiting the asthma clinic, Children's Hospital, Islamabad. The questionnaire included items on general understanding of asthma, its triggers, and management. RESULTS: Two hundred carers of asthmatic patients participated. Thirty six per cent thought that asthma is a communicable disease. Rice and oily foods were blamed for asthmatic exacerbations in up to 57% of cases; 82% felt that inhalation therapy is effective in controlling asthma symptoms. CONCLUSIONS: Asthma awareness is inadequate. The majority of the carers unnecessarily blamed and withheld many nutritious foods. Social stigmata can undermine the self esteem of growing asthmatics. Lack of awareness is not significantly related to the socioeconomic or educational background. Awareness raising strategies are needed in the community.     

Accuracy of symptom perception in childhood asthma

Children's reports of their asthma symptoms are used as important data in the assessment and management of pediatric asthma, but little is known about the accuracy of such reports. Children's subjective perception of the level of asthma symptoms was correlated with peak expiratory flow rate measures on average of 34 observations for 37 children with asthma. Subjective/objective correlations for a given child varied from 0.86 to -0.16. The children's perceptual accuracy was not related to age or sex, or to duration or severity of asthma. Implications for clinical practice are discussed.     

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??Objective To explore the change of exhaled nitric oxide ??eNO?? in children from community and its importance in asthma management. Methods The study was conducted from October 2011 to December 2011. Totally 133 non-asthmatic children and 94 asthmatic children aged 7~12 years old from elementary schools in Beijing Xicheng District were included in the study. The eNO?? skin prick test ??SPT???? lung function and physical examination were carried out and information of medical history was collected in all children. The eNO level between non-asthmatic children and asthmatic children?? and its association with atopy?? rhinitis?? lung function and asthma control were analyzed. Results eNO levels of non-asthmatic children and asthmatic children were 11.63±1.88 ppb?? and 19.68±2.31 ppb respectively and the difference between them was statistically significant ??P<0.01??. In non-asthmatic children?? the level of eNO in children with rhinitis was significantly higher than in children without rhinitis ???17.49±2.02??×10-9 vs. ??10.42±1.76??×10-9?? P<0.01?? and eNO level in atopic children was higher than non-atopic children ???23.06±2.18??×10-9 vs. ??9.60±1.66??×10-9?? P<0.01??. In asthmatic children?? the difference in eNO level was not significant in children with rhinitis and without rhinitis ???19.58±2.34??×10-9 vs. ??20.09±2.25??×10-9??? but the eNO levels in atopic children ??23.06±2.18??×10-9 was significantly higher than non-atopic children ???8.75±1.86??×10-9?? P<0.01??. The level of eNO of uncontrolled asthmatic children was significantly higher than controlled asthmatic children ???25.09±2.31??×10-9 vs. ??17.21±2.22??×10-9?? P<0.05??. There was no significant difference in eNO level between children who used and those who did not use inhaled corticosteroid. The eNO level was not related to lung function parameters either in non-asthmatic or in asthmatic children. Conclusion The eNO level increases significantly in children with asthma or rhinitis and is associated with asthma control status. Atopy is an important factor on eNO level as well. Measuring eNO level would help improve the diagnosis of asthma and atopy and management of asthma and rhinitis in children from community.     

Advances in the management of childhood asthma

For children with daily asthma symptoms, the most effective preventative therapy is inhaled corticosteroids (ICS). Most children experience good symptom control on relatively low doses (<400 μg/day). If frequent symptoms persist despite treatment with ICS 400 μg/day, beneficial add-on therapies include long-acting beta-2 agonists, leukotriene receptor antagonists and slow-release theophyllines. These should be tried sequentially before the dose of ICS is increased.Non-atopic children with episodic viral-triggered wheezing are extremely unlikely to respond to regular ICS. They might best be treated with ‘when-required’ high-dose beta-2 agonists with or without oral steroids.Children with frequently recurrent or chronic non-specific coughing are unlikely to have asthma. However, a clear response of symptoms to a trial of inhaled steroids and relapse when stopping therapy remains useful in identifying those with true cough-variant asthma.It remains to be seen how effective anti-IgE antibody therapy will be.     

The pharmacologic management of childhood asthma

Asthma treatment is based on the appropriate recognition and classification of children warranting treatment. Adequate treatment requires that children and parents have a good understanding of the disease and expectations for good control. Assessment requires a thorough history of symptoms, impairments of physical activity, past history of exacerbations, and understanding of triggering events. Therapy then must be appropriately implemented to reverse the symptoms and prevent future exacerbations. The approach in pediatrics is to be conservative, to use the safe and proven therapy, and to prevent the potential morbidity of the disease. These goals provide the rationale in childhood immunization. The literature suggests that the appropriate and conservative approach for children with persistent asthma, of any disease severity, is the use of low-dose inhaled corticosteroids that may be combined with an inhaled long-acting bronchodilator. This therapy is the most effective in reducing symptoms and exacerbations and preventing the potential mortality from the disease. It also allows children to be able to enjoy physical activity with their friends. Expectations should be high. Concerns about the potential for adverse effects should always be addressed proactively and should be balanced with the potential of adverse events from the disease.     

不断提高儿童支气管哮喘的诊治水平

支气管哮喘(哮喘)是儿童时期最常见的慢性呼吸道疾病,随着对疾病认识的不断提高,近年国际上对哮喘指南进行了较大程度的改版[1-4].中华医学会儿科学分会呼吸学组和<中华儿科杂志>编辑委员会根据儿童哮喘诊治的研究进展并结合我国的实际情况修订了<儿童支气管哮喘诊断与防治指南>,旨在促进我国儿童哮喘诊治水平的不断提高.     

东莞地区儿童哮喘社区干预模式的建立与效果评价

目的建立一套适合东莞地区的儿童哮喘社区干预模式以提高哮喘患儿及家长的认知水平和防治能力,降低社区儿童的哮喘发病率。方法通过建立社区居民动态档案,经调查访问收集68例支气管哮喘患儿,对患儿及父母实施系统化的社区干预,包括建立个人健康档案,监督患儿合理规范用药,建立哮喘患儿日常记录卡,成立社区哮喘防治小组进行健康教育等,定期随访并对干预效果进行评估。结果经过为期一年系统化的社区干预,患儿家长对哮喘知识的认知水平显著提高,规范化治疗率由68．2％升高至86．3％,人均年平均急诊次数由（3．2±0．4）次降至（1．5±0．2）次,人均年平均发病次数由（4．5±0．8）次降至（2．0±0．4）次,人均年住院天数由（8．0±2．8）d降至（5．0±1．6）d,人均住院花费由（2698±20．2）元降至（1554±30．9）元,干预前后,各项指标差异均有统计学意义（P〈0．05）。结论对哮喘儿童实施社区干预,进行长期的监测、管理和教育工作可有效地控制病情急性发作,提高诊治效率,缓解病情,降低就医成本。     

Inhaled corticosteroid-phobia and childhood asthma: Current understanding and management implications

Asthma is the most prevalent chronic disease in children. Inhaled corticosteroids (ICS) is the first-line controller therapy for children with persistent asthma, however, suboptimal compliance to ICS therapy remains as a major obstacle in paediatric asthma management. Steroid-phobia, the fear of side-effects and subsequent aversion of ICS, has been widely reported in parents of asthmatic children. The reported prevalence of steroid-phobia varies widely from 19% to 67% in different populations. The concerns about ICS frequently raised by parents include growth suppression, weight gain, bone weakness, addiction and psychiatric disturbances. Outside of growth suppression, which is statistically significant yet mild in clinical studies, the other concerns are not evidence-based and are misconceptions. Conflicting results have been reported regarding the impact of steroid-phobia on ICS compliance. In contrast, steroid-phobia has consistent and negative effects on asthma control in children. While asthma educational programmes have demonstrable benefits in general paediatric populations, the generalisability of such programmes to steroid-phobic parents remains undetermined. There is a paucity of data on specific educational programmes to clear misconceptions and reduce steroid-phobia. Given the continually raising prevalence of paediatric asthma, high-quality studies are warranted to investigate the prevalence and impact of steroid-phobia, with an ultimate goal of developing effective strategies to tackle steroid-phobia and improve asthma care in children.     

Recent advances on diagnosis and management of childhood asthma and food allergies

The epidemic of childhood allergic disorders has been associated to the decline of infectious disease. However, exposure to many triggers (airborne viruses, tobacco smoke, pollution, indoor allergens, etc.) contribute to the disease. Breast feeding practices, nutrition, dietary and obesity also play a multifaceted role in shaping the observed worldwide trends of childhood allergies. Guidelines for treatment are available, but their implementation is suboptimal. Then developed countries are slowing learning integrating the development of suitable guidelines with implementation plans. Awareness, psychosocial and family factors strongly influence asthma and food allergy control. Moreover, monitoring tools are necessary to facilitate self-management. By taking into consideration these and many other pragmatic aspects, national public health programs to control the allergic epidemic have been successful in reducing its impact and trace the need for future research in the area.