Childhood Asthma

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ISBN: 9780824727352 | 0824727355
Cover: Hardcover
Copyright: 9/26/2005

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National Jewish Medical and Research Center, Denver, CO. Presents the latest studies on the development, diagnosis and treatment of childhood asthma and discusses special populations such as inner-city children, adolescents, and competitive athletes. For clinicians wanting to keep pace with the rapid advances in this area.

Introduction

iii

Claude Lenfant

Preface

Contributors

vii

Part I: Natural History of Asthma

1. The Epidemiology and Burden of Pediatric Asthma

David A. Stempel

I. Introduction

(1)

II. Working Definitions of Asthma

(2)

III. International Study of Asthma and Allergies in Childhood

(2)

IV. The Underdiagnosis of Pediatric Asthma

(4)

V. Morbidity of Pediatric Asthma

(2)

VI. Burden of Pediatric Asthma

(2)

VII. Summary

(1)

References

(3)

2. Developmental Regulation of Immune Functions and Risk for Allergy and Asthma

(26)

Susan L. Prescott and Patrick G. Holt

I. Introduction: The Importance of Early Immune Events in the Subsequent Development of Allergic Disease

(1)

II. Current Concepts of Immune Dysregulation in Allergic Disease

(1)

III. Evidence of Early Immune Dysregulation in Allergic Infants

(3)

IV. The Significance of Perinatal Immune Responses

(5)

V. How Perinatal Immaturity Leads to Excessive Postnatal Responses in Atopic Children

(1)

VI. The Relationship Between Atopy and the Development of Organ-Specific Disease

(3)

VII. Factors That May Influence Early Immune Development

(2)

VIII. Conclusion

(1)

References

(10)

3. Origins of Asthma

(28)

J.O. Warner

I. Introduction

(1)

II. Atopy and Asthma

(1)

III. The Atopic Immune Response and Pregnancy

(1)

IV. The Hygiene Hypothesis

(1)

V. Genetic Polymorphisms and Allergy

(1)

VI. Ante-natal Origins of Allergic Sensitization

(1)

VII. Early Life Origins of Remodeling

(4)

VIII. Embryology of the Lung

(2)

IX. Genetic Polymorphisms and Airway Structure

(2)

X. Fetal Programming

(2)

XI. Early Infection and Asthma

(1)

XII. Conclusions

(1)

References

(10)

4. Developmental Features of Airway Remodeling

(28)

Meri K. Tulic, Céline Bergeron, Patrick Daigneault, and Qutayba Hamid

I. Introduction

(2)

II. Epithelial Changes

(4)

III. Subepithelial Fibrosis

(1)

IV. Inflammation

(1)

V. Mucus Overproduction

(3)

VI. Smooth Muscle Changes

(1)

VII. Microvascular Changes

(2)

VIII. Cartilage Changes

(1)

IX. Clinical Significance of Airway Remodeling

(2)

X. Recent Advances

(2)

References

(10)

5. Asthma in Children and Adults—Natural Course of the Disease

(26)

Ronina Covar and Joseph D. Spahn

I. Introduction

(1)

II. Question #1: Will All Young Children with Recurrent Wheezing Proceed to Have Asthma?

100

(6)

III. Question #2: Do Children "Outgrow" Their Asthma?

106

(1)

IV. Question #3: Does Asthma Follow a Uniform Pattern Over Time?

107

(1)

V. Question #4: Can We Predict Which Infants and Young Children Are Likely to Develop Persistent Asthma?

108

(2)

VI. Question #5: Are There Risk Factors for Persistent Asthma from Childhood to Adulthood?

110

(2)

VII. Question #6: Is Silent BHR a Risk Factor for Subsequent Asthma?

112

(1)

VIII. Question #7: Can We Predict Who Will Undergo an Asthma Remission?

113

(1)

IX. Question #8: Does the Lack of Symptoms Equate to Resolution of the Pathophysiologic Processes Associated with Asthma?

114

(2)

X. Question #9: Are Children with Severe Asthma Different from Adults with Severe Asthma?

116

(1)

XI. Question #10: Are There Phenotypic Differences Between Adults with Early-Onset vs. Late-Onset Asthma?

116

(2)

XII. Question #11: Is Asthma Progression a Consequence of Airway Remodeling, Are All Asthmatics Affected, and Can Controller Medications Affect Disease Progression?

118

(3)

XIII. Summary

121

(1)

References

121

(4)

6. Growth and Development of the Child with Asthma

125

(28)

David B. Allen

I. Introduction: Perspectives on Growth and Asthma

125

(1)

II. Normal Growth

126

(1)

III. Effects of Chronic Disease on Growth

127

(2)

IV. Effects of Severe Asthma on Growth

129

(2)

V. Effects of Asthma on Pubertal Development

131

(1)

VI. Effects of Glucocorticoids on Growth

131

(4)

VII. Growth of Asthmatic Children Treated with Oral Glucocorticoids

135

(1)

VIII. Growth of Asthmatic Children Treated with Inhaled Corticosteroids (ICS)

136

(7)

IX. Effects of Other Asthma Medications on Growth

143

(1)

X. Summary

144

(1)

References

145

(8)

Part II: Altering the Course of Asthma

7. Viral Respiratory Infections and Asthma

153

(34)

James E. Gern and Robert F. Lemanske

I. Introduction

153

(1)

II. Do Early Infections with Viruses Such as RSV Cause Asthma?

154

(2)

III. What Is the Role of Common Cold Infections in Causing Acute Exacerbations of Asthma?

156

(1)

IV. How Do Viral Infections Cause Bronchospasm and Plugging, Leading to Airway Obstruction and Wheezing?

157

(5)

V. What Are the Genetic, Environmental, and Immunological Risk Factors for More Severe Respiratory Infections in Childhood?

162

(4)

VI. Treatment of Virus-Induced Wheezing and Asthma

166

(7)

VII. Future Directions 172 References

173

(14)

8. Controlling the Environment of Asthmatic Children: Benefits and Limitations

187

(26)

Andrea J. Apter and Peyton A. Eggleston

I. Introduction

187

(1)

II. Allergic Environmental Triggers

188

(3)

III. Nonallergic Environmental Triggers

191

(5)

IV. Limiting Exposure to Allergens: Primary and Secondary Prevention of Allergic Asthma

196

(7)

V. Conclusion

203

(1)

References

203

(10)

9. Early Pharmacologic Intervention of Asthma: How Early and What Treatment?

213

Søren Pedersen

I. Introduction

213

(14)

II. Which Patients?

227

(1)

III. Which Study Designs?

228

(4)

IV. Interventions

232

(2)

V. Studies Addressing Early Intervention

234

(8)

VI. Summary

242

(1)

VII. Discussion

243

(1)

References

244

(9)

Part III: Advancing Technology

10. Measuring Pulmonary Function in Young Children

253

(34)

Wayne Morgan, Theresa Guilbert, and Gary L. Larsen

I. Introduction

253

(1)

II. Resistance Measurements

254

(14)

III. Comparison of Techniques in Young Children

268

(6)

IV. Spirometry in Young Children

274

(3)

V. Summary

277

(2)

References

279

(8)

11. Inflammatory Mediators of Asthma in Children

287

(16)

Peter G. Gibson and Jodie L. Simpson

I. Introduction

287

(1)

II. Key Issues

288

(2)

III. Induced Sputum

290

(3)

IV. Exhaled Nitric Oxide

293

(3)

V. Exhaled Breath Condensate

296

(2)

VI. Conclusion

298

(1)

References

298

(5)

12. Imaging in Pediatric Asthma

303

(16)

Talissa A. Altes and Alan S. Brody

I. Introduction

303

(1)

II. Technical

304

(2)

III. Clinical Care

306

(3)

IV. Research Applications and Future Directions

309

(5)

V. Summary

314

(1)

References

315

(4)

13. Pharmacogenetics: Will It Have a Place in Managing Childhood Asthma?

319

(14)

Scott T. Weiss, Kelan G. Tantisira, Eric Silverman, Edwin K. Silverman, Stephen Lake, Brent Richter, and Ross Lazarus

I. Introduction

319

(1)

II. What is Pharmacogenetics?

319

(2)

III. How Does One Determine Pharmacogenetic Effects in a Clinical Trial?

321

(1)

IV. Methodologic Issues in Pharmacogenetic Association Studies

322

(2)

V. Particular Issues in Asthma Pharmacogenetics Relating to Children

324

(1)

VI. Do Asthma Susceptibility Genes Have Pharmacogenetic Effects?

325

(1)

VII. Previous Studies of Asthma Pharmacogenetics in Children

325

(3)

VIII. Summary

328

(1)

References

329

(4)

Part IV: Management Principles

14. Asthma Education: Translating Knowledge into Action

333

(22)

James Y. Paton

I. Introduction

333

(1)

II. Asthma Management Is a Complex Behavior

334

(3)

III. Does Asthma Education Work?—Evidence of Effectiveness

337

(1)

IV. Lessons from Research

338

(5)

V. Translating Research into Practice

343

(4)

VI. Educational Materials

347

(2)

VII. Conclusion

349

(1)

References

350

(5)

15. Managing Childhood Asthma: Evolving Guidelines

355

(18)

Allan Becker

I. Introduction

355

(6)

II. Evolving Concepts of Guidelines

361

(3)

III. Dissemination and Implementation of Guideline Recommendations

364

(5)

References

369

(4)

16. Choosing the Appropriate Asthma Medication Delivery Device

373

(30)

Myrna B. Dolovich

I. Introduction

373

(1)

II. Factors Affecting Delivery of Aerosol to Children

374

(1)

III. Types of Aerosol Delivery Devices

375

(1)

IV. pMDI + Spacer/Holding Chamber

375

(5)

V. Nebulizers

380

(3)

VI. Dry Powder Inhalers

383

(3)

VII. Measuring In Vitro Drug Delivery from Aerosol Devices: Simulating Pediatric and Adult Use

386

(2)

VIII. Measuring Drug Delivery from Aerosol Devices: In Vivo Measurements of Lung Deposition

388

(2)

IX. Summary

390

(3)

References

393

(10)

17. Anticipating and Managing Variable Response to Asthma Therapy

403

(44)

Stanley J. Sailer and Glenn Whelan

I. Introduction

403

(1)

II. Managing Asthma in Children Five Years of Age and Older

404

(5)

III. Managing Asthma in Young Children

409

(3)

IV. When Should Long-Term Asthma Controller Therapy Be Initiated in Children?

412

(5)

V. Evolution of Asthma Therapy and Potential for Future Developments

417

(1)

VI. Variable Response to Treatment and Relevance of the Asthma Phenotype

418

(3)

VII. Genetic and Pharmacogenetic Advances in Asthma Research

421

(14)

VIII. Conclusions

435

(1)

References

436

(11)

18. Role of Allergen-Specific Immunotherapy in Childhood Asthma

447

(44)

Andrew H. Liu and Harold S. Nelson

I. Introduction

447

(1)

II. Clinical Rationale for SIT in Childhood Asthma

448

(6)

III. Mechanisms of Action

454

(6)

IV. Key Parameters for Effective SIT

460

(13)

V. Alternative Routes of Administration for SIT

473

(2)

VI. Modified Allergen Extracts

475

(1)

VII. Conclusion

476

(2)

References

478

(13)

19. Inner-City Asthma

491

(20)

Meyer Kattan

I. Introduction

491

(2)

II. Access to and Patterns of Care

493

(1)

III. Adherence

493

(2)

IV. Psychosocial Factors

495

(1)

V. Outdoor Environmental Exposures

495

(1)

VI. Indoor Environmental Exposures

496

(2)

VII. Overcoming the Barriers to Improve Morbidity

498

(1)

VIII. Interventions

499

(5)

IX. Conclusions

504

(1)

References

504

(7)

20. Asthma in Adolescence

511

(28)

Robert C. Strunk, Leonard B. Bacharier, and Gordon R. Bloomberg

I. The Myth of "Outgrowing Asthma": Natural History of Asthma from Childhood to Adolescence

512

(1)

II. The Paradox of Asthma Mortality in the Period of Wellness That Occurs in Adolescence

513

(3)

III. Changing Gender Relationships of Asthma from Preteen Years to Adult

516

(4)

IV. Factors That Increase Asthma Severity in Adolescence

520

(4)

V. Issues of Adherence and Self Care

524

(2)

VI. Conclusion

526

(1)

References

527

(12)

21. Exercise-Induced Asthma in the Competitive Athlete

539

(22)

Henry Milgrom

I. Diagnosis and Screening

540

(3)

II. Differential Diagnosis

543

(2)

III. Prevalence

545

(1)

IV. Pathophysiology of EIA

546

(2)

V. Pharmacologic Therapy

548

(4)

VI. Non-pharmacologic Therapy

552

(1)

VII. Conclusion

553

(1)

References

553

(8)

22. Comorbid Illness Associated with Childhood Asthma

561

(20)

Gail G. Shapiro

I. Asthma Comorbidities

561

(9)

II. Gastroesophageal Reflux Disease

570

(2)

III. Obesity as a Risk Factor for Asthma

572

(2)

IV. Conclusions

574

(1)

References

574

(7)

23. Improving Asthma Medication Adherence

581

(24)

Bruce G. Bender, Cynthia Rand, and Frederick S. Wamboldt

I. Introduction

581

(1)

II. Non-adherence and Health Care Cost

582

(1)

III. Why Do Patients Not Take Their Medication as Prescribed?

583

(7)

IV. Who Is Responsible for Changing Patient Behavior?

590

(7)

V. Conclusions

597

(1)

References

597

(8)

24. Potential Applications of New Drugs in the Management of Childhood Asthma

605

(46)

Peter J. Barnes

I. Introduction

605

(1)

II. Problems of Drug Development in Children

606

(1)

III. New Bronchodilators

607

(4)

IV. Mediator Antagonists

611

(4)

V. Cytokine Inhibitors

615

(3)

VI. Anti-inflammatory Cytokines

618

(2)

VII. Chemokine Inhibitors

620

(2)

VIII. New Corticosteroids

622

(1)

IX. Phosphodiesterase-4 Inhibitors

623

(2)

X. Transcription Factor Inhibitors

625

(1)

XI. Kinase Inhibitors

626

(1)

XII. Immunomodulators

627

(1)

XIII. Cell Adhesion Blockers

628

(1)

XIV. Anti-allergic Drugs

629

(3)

XV. Preventive Therapies

632

(1)

XVI. Gene Therapy

633

(1)

XVII. Conclusions

634

(1)

References

634

(17)

25. Difficult-to-Control Asthma

651

(22)

John F. Price

I. Introduction

651

(1)

II. Poor Control Unrelated to Asthma Severity

652

(5)

III. Poor Control Due to Severe Asthma

657

(4)

IV. Management of Difficult Asthma

661

(5)

V. Conclusions

666

(1)

References

666

(7)

26. Childhood Asthma Management in the Next 10 Years

673

(20)

Stanley J. Szefler and Søren Pedersen

I. Introduction

673

(2)

II. Evolving Changes in Asthma Management

675

(1)

III. Childhood Asthma—Current Management Approach

675

(1)

IV. Asthma in Young Children—New Opportunities to Make Significant Strides in Asthma Management

676

(2)

V. Potential New Directions for the Management of Childhood Asthma

678

(8)

VI. Summary and Conclusions

686

(2)

References

688

(5)

Index

693

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Childhood Asthma

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