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Understanding Pediatric Asthma: Prevalence, Effects, Symptoms, and Management Strategies

Pediatric asthma is a growing concern, with prevalence rates increasing since 1990. Over 10 million children aged 5-17 were estimated to have asthma, leading to significant school and parental work absences, costing approximately $726 million in lost productivity. Asthma episodes are characterized by wheezing, coughing, and chest tightness, often triggered by allergens, irritants, or emotional stress. Effective management includes preventive medications, inhalers, asthma education, and addressing psychological factors such as stress and family dynamics.

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Understanding Pediatric Asthma: Prevalence, Effects, Symptoms, and Management Strategies

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  1. Asthma October 30, 2007

  2. Pediatric Statistics • Prevalence increasing • School absences • Estimated as more than 10 million in 1990 for children between the ages of 5 and 17 • Parental work absences • Estimated to cost $726 million in 1990 • Death rate = 1.9 per 100,000 (1980-89) Weiss, Gergen, & Hodgson (1992)

  3. Respiratory System

  4. The Respiratory System

  5. Physiology of Asthma

  6. What is an Asthma Episode?

  7. Characteristics of Asthma • Episodes are variable • Episodes are reversible • Airway hyper-responsiveness

  8. Triggers of Asthma Episodes • Viral respiratory infections • Exercise • Cold air or changes in weather • Irritants • Allergens • Emotional upsets

  9. Signs of Asthma Episode • Wheezing • Chest retractions (especially with infants) • Breathing is faster • Feeling chest tightness (or heaviness) • Coughing • “Status asthmaticus”

  10. Asthma Medications • Two types of medicine • Preventive or Controller = Anti-inflammatory • Rescue = Bronchodilators • Oral steroids • Preferred delivery = Inhalation

  11. Taking Inhaled Medications • Nebulizer (with or without face mask)

  12. Taking Inhaled Medications • Metered Dose Inhaler (MDI)

  13. Taking Inhaled Medications • Spacer or chamber devices

  14. Preventing an Asthma Episode • Avoid irritants • Control allergens in the environment • Take inhaled bronchodilator PRIOR to exercise • Monitor lung functioning with peak flow meter • Use “preventer” or “controller” medicine REGULARLY

  15. Psychological Factors Affecting Asthma • Stress • Anxiety • Depression

  16. Psychological Factors Affecting Asthma • Family dysfunction • Attachment • Critical mothers • Purcell et al. (1969)

  17. Psychosocial Dysfunction Associated With… • Needing more asthma medications • Having a greater # of hospitalizations • Requiring longer hospitalizations • Dying more frequently from asthma • Not complying with asthma care regimen

  18. Medical Noncompliance • Multiple medications on multiple schedules with varying periods when symptoms are not present • As high as 90% of patients • Negative consequences • Typically “partial” in nature • Assessment of compliance

  19. Psychological Assessment • Interviews, observation, & testing • Parental functioning • Marital status & satisfaction • Employment status & functioning • Social supports & stressors • Understanding of asthma & its treatment

  20. Psychological Assessment • Child functioning • Developmental skills • Quality of peer interactions • School performance • Understanding of asthma & its treatment

  21. Psychological Assessment • Family functioning • Interaction patterns • Routines • Asthma management & family division of responsibility/supervision

  22. When should patients obtain psychotherapy? • Are markedly anxious or depressed • Demonstrate decreased capacity to manage their asthma • Have been erratic in medication use • Have poor perceived control of symptoms

  23. When should patients obtain psychotherapy? • Experience a decline in functioning in school or work • Are in frequent conflict with medical staff • Have made repeated visits to the ER • Family appears dysfunctional, disorganized, or distressed

  24. Treating Medical Noncompliance • Strategies fit into 3 categories • Educational • Organizational • Behavioral

  25. Other Approaches to Treatment • Operant procedures • Positive reinforcement • Satiation • Differential reinforcement of incompatible behavior (DRI) • Response cost • Extinction

  26. Other Behavioral Approaches to Treatment • Systematic desensitization • Biofeedback • Modeling

  27. Other Behavioral Approaches for Non-Adherence • Contracts • Family approaches

  28. Self-Management Programs • Patient education • Training in device techniques • Self-assessment of symptoms • Group & family therapy • Relaxation & stress reduction

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