___________________________________________________________ Asthma: Diagnosis and Management
THE PEDIATRIC POPULATION Asthma remains an important influence on pediatric health. As noted, 6.7% of individuals younger than 18 years of age were reported to have current asthma in 2023, including 7.6% of boys and 5.7% of girls [2; 17]. Childhood asthma contributes considerably to school absenteeism in the United States. In a typical year, school-age children miss 13.8 million school days due to asthma [22]. One study found that among elementary students 5 to 11 years of age in California, approximately 50% reported missing at least one day of school due to asthma. Additionally, it was found that 11% of elementary students met the criteria for excessive absenteeism (defined as 9 to 18 missed school days during the school year) as a result of their asthma [23]. Asthma is the most common chronic disease of childhood, making it a significant threat to pediatric health. RACE AND GENDER In 2023, 11% of women in America had asthma, compared with 6.8% of men [18]. The higher incidence of asthma among women may produce additional health consequences during pregnancy and/or childbirth. The CDC has found that the asthma rate is 13.3% among individuals with multiple non- Hispanic race/ethnicity, 9.8% among American Indian/Alaska Natives, and 11.7% among non-Hispanic Black individuals. Among Hispanic individuals, the rates are 6.2% for Mexican/ Mexican Americans and 7% for people with other Hispanic heritage. Non-Hispanic White individuals have an asthma prevalence of 8.9%, and Asian Americans have an asthma prevalence of 4.9% [18]. RISK FACTORS Although experts have been unable to definitively identify the cause or causes of asthma, there are several factors that increase the risk of developing the condition in one’s lifetime. The following are some of the most common risk factors and will be addressed throughout this course [8; 15]: • Environmental allergens (e.g., mold, dander, pollen, dust mites) • Skin or food allergies • Overweight/obesity • Genetic predisposition/family history • Low birth weight • Respiratory infections in childhood • Vitamin D deficiency • Living in an urban area • Exposure to secondhand smoke • Exposure to occupational triggers (e.g., chemicals used in farming, hairdressing) • Gastroesophageal reflux disease (GERD)
OVERWEIGHT AND OBESITY There have been many studies illustrating a link between obesity and asthma in adults and children. Research indicates that being overweight or obese significantly increases the risk of developing asthma, worsening asthma symptoms, and poor asthma control [15; 19]. The obesity rate among adults with asthma was significantly higher than the rate among adults without asthma (38.8% vs. 26.8%) [19]. One meta- analysis involving more than 300,000 adults in the United States with asthma found that the prevalence is 7.1% in lean adults, compared with 11.1% in obese adults. In addition, the prevalence of asthma in women with obesity was found to be nearly double that of lean women (14.6% vs. 7.9%). Interestingly, men did not have a statistically significant dif- ference in comorbid overweight/obesity asthma [20]. Patients who are excessively overweight place an additional burden on their bodies, especially on their heart and lungs, decreasing both functional residual capacity (the amount of air left in the lungs after exhalation) and tidal volume. These decreases were associated with several factors, including changes in lung development and chronic systemic inflammation, that may affect, induce, or exacerbate asthma symptoms. However, weight is a modifiable risk factor, and researchers have found that total weight loss of 5% or greater significantly improves lung function and asthma control [20]. Unless contraindicated, moderate exercise is encouraged for all people with asthma, as it strengthens the lungs and improves respiratory function. Patients whose asthma is triggered by activity may be advised to take a short-acting beta 2 agonist or other bronchodilator 30 minutes to one hour prior to exercising. Regular aerobic activity is essential for any person with asthma, taking into consideration contraindications or complications. Asthma and obesity present a unique problem in pediatric patients. Similar to adults, children with obesity are sig- nificantly more likely to develop asthma than other children. This is of particular concern in the United States as nearly one in five children is obese. In addition, studies have found correlation between maternal obesity and weight gain during pregnancy and the development of asthma beginning in utero, with estimates showing that 15% to 30% of children born to mothers with obesity later develop asthma; however, it is important to note that asthma is a heterogenous disease and maternal obesity as a single cause is unlikely [19; 20]. GENETIC PREDISPOSITION/FAMILY HISTORY A genetic predisposition to develop immunoglobulin E (IgE) antibodies has been shown to increase the incidence of allergy and asthma. However, since the mapping of the human genome has been completed, more than 100 susceptibility genes contributing to the development of asthma have been recognized. The first gene associated with asthma susceptibil- ity and airway hyper-responsiveness, ADAM33, was mapped
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