Pediatric Annals

If You Want to Know More

Jacob Hen, JR, MD

Abstract

In rebruary 1986, Pediatrie Annals devoted an issue to pediatrie asthma - the most common chronic illness in primary care pediatrics - which affects nearly 3 million children and adolescents in the United States today. This issue received so positive a response from its readers that, within 1 year, The American Journal of Asthma & Allergy for Pediatricians was created to update the primary care pediatrician on current aspects of allergy and asthma evaluation and management.

The Editors of Pediatrie Annals, which has a much larger readership, decided to publish a few of the many excellent articles from TKe American Journal of Asthma & Ailergy for Pediatricians as a pediatrie asthma update to refine your skills and knowledge base since the 1986 issue.

The first article, by Bennie McWilliams, MD, William Kelly, PharmD, and Shirley Murphy, MD, of the University of New Mexico, Albuquerque, provides us with a current approach to the "Management of Acute Severe Asthma" in the acute care setting and the intensive care unit.

While practicing pediatrie pulmonary medicine and critical care pediatrics, I have had to become a nose and sinus specialist in order to take care of children with asthma, for many children and adolescents with allergic rhinitis, chronic sinusitis, and postnasal drip as well as hyperactive airways disease, it is often impossible to quiet down the nose and sinuses. Alien D. Adinoff, MD1 and Nancy P. Cummtngs, MD, of the National Jewish Center for Immunology and Respiratory Medicine in Denver, Colorado, describe this often unrecognized relationship and how to approach treatment to achieve control of symptoms for both nasal problems and asthma, in their article titled, "Sinusitis and Its Relationship to Asthma." Where does bronchiolitis end and asthma begin? How are viral respiratory infections related to hyperactive airways disease in children? How can the primary care pediatrician treat the infant and child with a viral infection and wheezing? Norman J. Lewiston, MD, from Children's Hospital at Stanford in Palo Alto, California, reviews this common clinical problem and provides us with a practical approach to treatment, in his article titled, "What is Wheezy Bronchitis?"

For many children with asthma, providing environmental control is as important as medical therapy. James P. Kemp, MD, and Eli O. Meltzer, MD, from the University of California, San Diego, outline a simple approach to this often overlooked aspect of therapy, in "Gaining Control of the Allergic Child's Environment ."

Do you use steroids routinely in managing your patients with asthma? Are we over-using bronchodilators? Could the overuse of bronchodilators and the avoidance of medications that prevent the early and late phases of asthma, such as cromolyn sodium, or medications that cut down on the late phase of asthma, such as steroids, be resulting in the increased morbidity and mortality that we are seeing in pediatrie asthma? Manon Brenner, MD, of the National Jewish Center for Immunology and Respiratory Medicine in Denver, Colorado, discusses a reasonable approach to the safe "Use of Steroids in Pediatrie Asthma."

If you read Time or the New York Times, you are aware that the asthma death rate has not decreased, or may even be increasing, despite new medications; that prominent people have had to leave their jobs due to asthma, as in the case of the previous police commissioner of New York City; and that prominent people have even died from asthma, including the previous New York City chancellor of education. Can asthma morbidity and mortality be prevented? NoIaJ. Attaway, MD, and Roben C. Strunk, MD, of St. Louis Children's Hospital, Missouri, review the data, in "Death Due to Asthma in Children: What the Pediatrician…

In rebruary 1986, Pediatrie Annals devoted an issue to pediatrie asthma - the most common chronic illness in primary care pediatrics - which affects nearly 3 million children and adolescents in the United States today. This issue received so positive a response from its readers that, within 1 year, The American Journal of Asthma & Allergy for Pediatricians was created to update the primary care pediatrician on current aspects of allergy and asthma evaluation and management.

The Editors of Pediatrie Annals, which has a much larger readership, decided to publish a few of the many excellent articles from TKe American Journal of Asthma & Ailergy for Pediatricians as a pediatrie asthma update to refine your skills and knowledge base since the 1986 issue.

The first article, by Bennie McWilliams, MD, William Kelly, PharmD, and Shirley Murphy, MD, of the University of New Mexico, Albuquerque, provides us with a current approach to the "Management of Acute Severe Asthma" in the acute care setting and the intensive care unit.

While practicing pediatrie pulmonary medicine and critical care pediatrics, I have had to become a nose and sinus specialist in order to take care of children with asthma, for many children and adolescents with allergic rhinitis, chronic sinusitis, and postnasal drip as well as hyperactive airways disease, it is often impossible to quiet down the nose and sinuses. Alien D. Adinoff, MD1 and Nancy P. Cummtngs, MD, of the National Jewish Center for Immunology and Respiratory Medicine in Denver, Colorado, describe this often unrecognized relationship and how to approach treatment to achieve control of symptoms for both nasal problems and asthma, in their article titled, "Sinusitis and Its Relationship to Asthma." Where does bronchiolitis end and asthma begin? How are viral respiratory infections related to hyperactive airways disease in children? How can the primary care pediatrician treat the infant and child with a viral infection and wheezing? Norman J. Lewiston, MD, from Children's Hospital at Stanford in Palo Alto, California, reviews this common clinical problem and provides us with a practical approach to treatment, in his article titled, "What is Wheezy Bronchitis?"

For many children with asthma, providing environmental control is as important as medical therapy. James P. Kemp, MD, and Eli O. Meltzer, MD, from the University of California, San Diego, outline a simple approach to this often overlooked aspect of therapy, in "Gaining Control of the Allergic Child's Environment ."

Do you use steroids routinely in managing your patients with asthma? Are we over-using bronchodilators? Could the overuse of bronchodilators and the avoidance of medications that prevent the early and late phases of asthma, such as cromolyn sodium, or medications that cut down on the late phase of asthma, such as steroids, be resulting in the increased morbidity and mortality that we are seeing in pediatrie asthma? Manon Brenner, MD, of the National Jewish Center for Immunology and Respiratory Medicine in Denver, Colorado, discusses a reasonable approach to the safe "Use of Steroids in Pediatrie Asthma."

If you read Time or the New York Times, you are aware that the asthma death rate has not decreased, or may even be increasing, despite new medications; that prominent people have had to leave their jobs due to asthma, as in the case of the previous police commissioner of New York City; and that prominent people have even died from asthma, including the previous New York City chancellor of education. Can asthma morbidity and mortality be prevented? NoIaJ. Attaway, MD, and Roben C. Strunk, MD, of St. Louis Children's Hospital, Missouri, review the data, in "Death Due to Asthma in Children: What the Pediatrician Can Do" to have a positive affect on this frightening aspect of pediatrie care.

If you are not using "spacer devices" for your children old enough to use metered-dose inhalers (and you can teach most 4 year olds to use them!), then you are probably behind the times. Tom Plaut, MD, from Amherst, Massachusetts, reviews the commonly used spacers, or "Holding Chambers for Aerosol Drugs," and includes instructions for the use of each.

The following list of asthma resources can provide you with more information on topics in this issue and others of importance to the practitioner who treats children with asthma. I recommend that you read trie books and provide this list to your patients with asthma and their families, as well as school nurses and teachers.

RESOURCE LIST '

Books

Children with Asthma: A Manual for Parents, Thomas F. Plaut, MD 291 pages, 1988, $12.95 including shipping, Pedipress, Ine 125 Red Gate Lane Amherst, MA 01002. For quantity discount, call 800344-5864.

Acclaimed as the "asthma bible" by parents and physicians alike. Beautifully lucid illustrations, first-person stories by parents and clear descriptions of the basics of asthma, how medicines work, and when to call for help. Thirty drawings, 20 tables and forms provide instructions for parents, teachers, and babysitters.

A Parent's Guide to Asthma, Nancy Sander, 291 pages, 1989, $17.95, Doubleday.

A special message from Nancy Sander, founder of Mothers of Asthmatics, whose child has severe asthma. If you learn asthma and work with a doctor who is up-todate, your child can lead a fully active life. The road may be long and hard, but the results are worth it. Includes many practical tips.

Teaching Myself About Asthma, G. Parcel, K. Tiernan, P. Nader, and L. Weiner, 152 pages, 250 illustrations by Mark Weakley, 1989, $9.95, Asthma & Allergy Foundation of America, 1717 Massachusetts Ave, NW, Washington, DC 20036.

Clearly written and wellillustrated, this workbook is geared to the reading abilities of children 9 to 12 years of age. Learning activities are suggested, which demonstrate the basics of breathing, the causes, prevention, and treatment of asthma, and the child's role in asthma management. Parent and child can read the book together.

Winning Over Asthma, Eileen Dolan Savage, 32 pages, 1989, $7.95 including shipping, Dolan Press, 1645 Gales Court, Forest Grove, OR 971 16.

This picture book presents a number of asthma facts, while telling the story of 5-year-old Graham. It describes the asthma reaction, mentions several triggers and medicines, and emphasizes teamwork between parents and physician. Illustrates that childhood asthma can be controlled.

Luke Has Asthma Too, Alison Rogers, 32 pages, illustrated, 1987, $6.95, Waterfront Books, 98 Brookes Avenue Burlington, VT 05401.

This book will make for good reading with your child whether or not he or she has asthma. The narrative conveys the feeling that asthma can be managed in a calm fashion. This is an important message for the more than 2 million families that have children with asthma.

Comp/ete Book of Children's Auergies, B. Robert reidman, MD with David Carroll, 352 pages, 1989, $17.95, Times Books.

This truly is a complete guide for the parents of allergic children. The evaluation and treatment of allergy problems is reviewed in a no-nonsense fashion. Ten comprehensive yet readable sections on specific allergic conditions, including asthma, chronic rhinitis, hives, insect stings, and food allergies.

Living With Asthma Part 1: Manual for teaching patents the selfmanagement of childhood asthma. Part 2: Manual for teaching children the self-management of asthma. Thomas L. Creer, 773 pages, 1986, $40.00, The Asthma Project, Christine Krutzsch, National Heart, Lung, and Blood Institute NIH Building 31, Room 4A-21 Bethesda, MD 20092, 301496-4236.

This outstanding resource for parents' support groups provides accurate information, illustrations, and handouts for parents. Detailed instructions guide the leader through two sessions on the basics of asthma and medications. Six sessions provide extensive discussion of the early warning signs and triggers of asthma, positive reinforcement of desired behavior, and problem-solving techniques. The second volume is designed for a concurrent children's program.

Peak Performance: A Strategy for Asthma Self Assessment, Guillermo Mendoza, MD 64 pages, $15.00, Order from Mothers of Asthmatics, Ine, 10875 Main Street, Suite 210, Fairfax, VA 22030.

An extremely helpful guide to peak flow monitoring. Essential reading for those who want to go beyond the basics in learning this important technique for the control of asthma.

Manual of Probiems In Asthma, Allergy and Related Disorders, Don A. Bukstein, MD, and Robert C. Strunk, MD, eds, 293 pages, $18.95, Little, Brown and Co, 1984.

A collection of short, sophisticated summaries of common clinical problems in asthma and allergy, covers triggers, infections, psychological considerations, exercise- induced asthma, pregnancy, surgery, as well as excellent descriptions of the common drugs used to treat asthma. An annotated list of medical references accompanies each section.

Asthma; The Complete Guide To Self-Management Of Asthma And Allergies For Patients and Their Families, Alan M. Weinstein, MD, 350 pages, $17-95, McGrawHiIl, 1987.

This excellent book focuses on the problems of adults. The basics of asthma and allergies and the medications used to treat them are described in a clear fashion. Dr Weinstein includes 1 1 sample programs for managing mild, moderate, and severe asthma. There is a 17-page chapter on children with asthma.

Newsletters

Asthma Update, David Jamison, Editor, 123 Monticello Ave, Annapolis, MD 21401.

Quarterly newsletter for parents and adult patients. Includes annotated abstracts from current medical journals and perspectives on asthma by health professionals. Fbur to six pages per issue, $10.00 per year.

MA Report, Nancy Sander, Editor, 10875 Main Street, Suite 210, fciirfax, VA 22030.

"A support system in a newsletter" published by Mothers of Asthmatics, Inc. Practical and positive information for parents of asthmatic children, $15.00 for 12 monthly issues.

Video Tapes

Asthma and Auergies in the School: The Importance of Cooperative Care, Twelve minutes.

Parents, children, and teachers talk about managing asthma and allergies in school. Supplementary written material available for parents and teachers, for free loan video, write to: Modern Talking Pictures, 5000 Park Street North, St. Petersburg, FL 33709; 813-541-5763

Organizations

American Lung Association, 1740 Broadway, New York, NY 10019.

The more than 300 local and state lung associations provide many asthma education services, including family asthma programs and "Super Stuff." Some chapters sponsor support groups and newsletters. Local affiliates are listed in the white pages under American Lung Association.

Asthma and Allergy Foundation of America, 1717 Massachusetts Ave, Washington, DC 20036, 202-265-0265.

A number of chapters throughout the country offer support groups, school programs, community workshops, and conferences.

Mothers of Asthmatics, Ine, 10875 Main Street, Suite 210, feirfax, VA 22030, 703-385-4403/703385-4404.

Nonprofit organization provides support for the parents of asthmatic children.

American Acadenry of Auergy and Immunology, 611 E. Wells St, Milwaukee, WI 53202, 414-2726071.

The AAAl offers a well-rounded packet of information, from tip sheets on asthma and its incidence to pamphlets that discuss such topics as specific types of asthma, asthma triggers, asthma medications, and outpatient treatment.

Parents of Asthmatic/ Allergic Children, 1412 Maramont Dr, Ft. Colline, CO 80524, 303-482-7395.

PA/AC founded Breathing Buddies, a local support group for asthmatic children, and provides a pamphlet on the program. In addition, the group offers Secrets of Breathing for Children with Asthma and Their Parents, an illustrated, easy-to-read manual that describes what happens during an asthma attack and includes step-by-step exercises to help relieve breathing and mucous congestion. PA/AC also has a lending library and publishes a quarterly newsletter, and Support Group Manual by Nancy Carol Sanker, a useful tool for anyone operating or considering starting a support group. One of the most difficult challenges support group leaders face is maintaining the work once it is started. This basic how-to approach is full of practical advice and resources. Suggested donation $12.00.

National Jewish Center for Immunology and Respiratory Disease, 1400 Jackson Street Denver, CO 80206, 800-222-LUNG.

Provides information on asthma and lung disease via the toll-free LUNG LINE, 800-222-LUNG. Engaged in treatment, research, and education in chronic respiratory diseases. Accepts patients through physician referral.

MOTHERS OF ASTHMATICS

The following resources are available through Mothers of Asthmatics, Inc.

MA Report (Mothers of Asthmatics)

A nonprofit organization devoted to helping families overcome the hardships of asthma through education, awareness of medical advancements, and quality resources. Membership includes a subscription to MA Report, a monthly newsletter that helps parents deal with the practical aspects of raising children with asthma or allergies. Dues are $15.00/year for membership.

Phones Across America

A support system by phone. Participants provide information, which is included in a directory that is updated every 6 months. Participants will receive a directory once their names have been included. Suggested donation $3.00

TEAM Work (Together for Effective Asthma Management)

A listing of resources for products, books, services, organizations, camps, etc. Suggested donation $3.00

The Asthma Organizer

This is one of their most popular, useful, and exciting new educational materials. It is a three-ring binder packed with quality asthma information, a daily home diary section, which is useful in tracking symptoms and early warning signals, with sections on peak flow monitoring and coping with asthma in school. The binder pockets are filled with coupons and freebies. Suggested donation $17.00

Users Guide to Peak Flow Monitoring

This useful guide helps parents with children who have asthma and adults with asthma understand the basics of peak flow monitoring. Suggested donation $3.00.

Peak Performance

By Guillermo Mendoza, MD. This is the bible of peak flow monitoring written for physicians but also helpful for patients and parents who want to know everything there is to know about peak flow management of asthma. This manual is serious reading. Suggested donation $10.00.

So YOM Have Asthma, Too By Nancy Sander.

I Have Asthma: Broofce's Story

This is a colorful book written for children from Brooke Sander's perspective at age 7. It is educational, yet lively, and stimulates conversation. It is asthma through the eyes of a child and her family. Suggested donation $3.00.

10.3928/0090-4481-19891201-06

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