Focusing on childhood asthma: the childhood asthma management program (CAMP)

Assessing respiratory function in young children: Developmental considerations

The purpose of this review is to provide practitioners and clinical investigators with an update on methods of assessing respiratory function in young children. The importance of this topic is presented in light of the natural history of asthma, as well as maturational changes that occur early in life in terms of airway development. Models of disease are cited to support the concept that injury of the mammalian airway early in postnatal life might have far-reaching consequences in terms of control of airway caliber and responsiveness. The methods currently available to measure respiratory function in our younger patients are outlined. The ability of children to perform the maneuvers necessary for this testing is considered as a function of age. Areas in which research and development are needed are highlighted.

Parents' perspectives of asthma crisis hospital management in infants and toddlers: an interpretive view through the lens of attachment theory

Interpretive phenomenology and attachment theory were used to discover the underlying concerns of parents and children during children's hospitalization for asthma. Home interviews were conducted with families of low income and with Latino and African-American infants and toddlers with severe persistent asthma. Narratives revealed that asthma crises were fearsome situations for parents and children. Hospital procedures escalated fear in children. Parents, agonized by their children's suffering, were embarrassed by feelings of helplessness. Results imply that effective, efficient care depends on addressing parents' fears, being aware of their sensitivity to the suffering of their children, and supporting their desire to alleviate it.

Development of specific immunoglobulin E in coughing toddlers: a medical records review of symptoms in general practice

The aim of this study was to study whether young children, originally immunoglobulin E (IgE) negative and who became sensitized to specific inhalation allergens, presented more frequently to their general practitioner (GP) with other allergy- and asthma-related symptoms than children who remained IgE negative. It was also investigated whether asthma was diagnosed more often in children who developed IgE to inhalant allergens. Coughing children, 1-5 years of age, visiting the participating GPs, were tested for IgE antibodies to mites, dogs, and cats by using radioallergosorbent testing (RAST). All IgE-negative (RAST < 0.2 IU/ml) children were re-tested after 2 years. The medical records of 162 children were reviewed on asthma- and allergy-related symptoms and on prescribed medication. After 30 months, 27 of the 162 children (17%) had become IgE positive for one or more allergens. Most children (93%) had visited their GP for treatment of respiratory symptoms during this period. However, the children who had become IgE positive had visited their GP more often than the children who remained IgE negative. Differences in visits were seen for: shortness of breath (52% IgE-positive vs. 19% IgE-negative children, respectively), wheeze (37% vs. 17%), allergic rhinitis (33% vs. 16%), and pneumonia (22% vs. 8%), but not for coughing (89% vs. 88%). The IgE-positive children were more frequently diagnosed by their GP as having asthma (48%) than were the IgE-negative children (23%). In a multivariate analysis, indicators of becoming IgE positive were: a visit for shortness of breath (odds ratio [OR] = 6.9; 95% confidence interval [CI] = 2.1-23.1) and two or more visits for wheeze (OR = 6.0; 95% CI = 1.9-19.2), adjusted for breast-feeding, age, and asthma or allergy in the family. The positive predictive value (PPV) of being IgE positive with a diagnosis of asthma was 90% (whereas the negative predictive value was 48.0%) for a child attending their GP for treatment of wheeze. For recurrent coughing (six or more visits) and shortness of breath, the PPVs were 73% and 71%, respectively. The development of sensitization to common inhalant allergens is associated with specific allergy and asthma-related symptoms in young children. IgE-positive children were more frequently diagnosed as having asthma by their GP. This implies that in general practice it is possible to detect children at high risk for developing allergic asthma early in life by their respiratory symptoms and by subsequent testing for specific IgE to inhalant allergens.

Challenges in assessing outcomes for pediatric asthma

Although progress has been made in understanding asthma, much remains unknown; as a result, diagnosis and treatment are not optimal. Information is still needed about the natural history of asthma to better understand which patients are at risk of inflammation and at what point during their disease that inflammation occurs. In the case of children, a greater understanding of the disease's natural history is needed to establish criteria for early diagnosis and to evaluate progressive aspects of the disease so that appropriate measures of progression can be defined. The safety of various medications used as long-term controllers must also be evaluated. The growing information about medication effects on asthma provides unique opportunities to design studies that will guide improvement in asthma care. A number of disease outcomes can be used as surrogate markers of clinically significant endpoints, and a number of adverse effects may serve as surrogate markers. The consequences of poor control of pediatric asthma can be observed in a variety of clinical markers, including clinical features of the disease that worsen as it progresses, pulmonary function deterioration, lung hyperexpansion, and inflammation increases. The Childhood Asthma Management Program is an ongoing clinical trial designed to improve the diagnosis and treatment of asthma in children. Its hypothesis is that anti-inflammatory treatment of childhood asthma will not only relieve morbidity but will also improve lung growth.

Differences between adult and childhood asthma

During the last 2 decades, we have gained new insights into the pathogenesis of asthma; consequently, new therapeutic agents and approaches to therapy have emerged. Nevertheless, significant gaps remain in our understanding of this disease. Important new treatment issues affect childhood (the usual time of asthma onset), and researchers have recently described increases in asthma incidence in children. Yet, most clinical studies have been performed with adults, and our knowledge about major determinants of childhood asthma remains incomplete. Major challenges in pediatric asthma include methods of easily assessing lung function and noninvasive methods of assessing asthma's inflammatory nature. Research that addresses the mechanisms responsible for disease onset is also critical to decrease the prevalence of asthma. What we know about adult asthma cannot be used in the treatment of children without further study, but it is now clear that effective treatment should begin during childhood.