Showing posts with label respiratory difficulties. Show all posts
Showing posts with label respiratory difficulties. Show all posts

Wednesday, March 18, 2015

To Air Is Human: New Tools In At Home Asthma Treatment

By: Kathleen Walsh  MD, MS; Editorial Board Memeber
      When I ask my adolescent daughter about her asthma care goals, she replies “I don’t have any,” with a sarcastic tone and a charming, braces-filled grin.  However, I know her goals include placing well in cross country races, passing her taekwondo tests, and getting good grades in school.
       All of these require excellent control of her asthma.  When she was a baby, my goals for her asthma were to minimize exacerbation frequency and duration both for her happiness and so I could finish residency.  While achieving my goals for my daughter’s asthma care has always been my primary motivation for adhering to her treatment, only recently have our goals become a part of our discussions with her clinicians.
       In this week’s Pediatrics, the MyAsthma intervention described by Fiks et al. (doi: 10.1542/peds.2014-3167) takes an important early step toward parent and physician shared decision making regarding asthma treatment at home.  MyAsthma is a portal-based intervention, where parents enter information about their child’s asthma, including their goals and their child’s current symptoms, several times a month.  The portal uses evidence-based protocols to support decisions by the family and clinician about when they need to communicate further and when to change the home treatment plan.
      Although the study was relatively small, with twenty-six children in the treatment arm and a 57% participation rate, the authors found statistically significant improvements in some outcomes.  Specifically, children in the treatment group had significantly larger improvements in ACT scores over the study period compared to controls.  In addition, parents in the treatment group reported significantly less missed work than controls.  While other portal-based asthma interventions exist, this is the first to ask parents about their asthma management goals.
      The identification of family care goals is a key step in the parent and clinician co-management of chronic disease.  The portal-based intervention described by Fiks provides decision support for asthma management when and where the patient needs it- at the family’s convenience and at home.  It also enables a partnership between families and clinicians through goal setting, enhanced communication, and early identification and mitigation of changes in health status.  The spread of promising interventions such as this one will provide the necessary support so that families and clinicians can collaborate to improve chronic disease outcomes.  For pediatricians, this is the kind of collaborative care we would like to provide to all of our patients and their families.  

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Monday, March 2, 2015

Pneumonia Effects in Childhood on Adult Respiratory Status: The Lung and Winding Road

          We are certainly aware that young children predisposed to lower respiratory illnesses in infancy and toddlerhood are often the ones who go on in childhood to experience some problems with lung function and develop illnesses such as asthma.  But what happens when these same children become adults?  Do they continue to experience problems with lung function? 
      Chan et al. (doi: 10.1542/peds.2014-3060)  explore these questions by following a cohort of children diagnosed with and without lower respiratory illnesses in the first 3 years of life and then followed with spirometry at ages 11,16,22, and 26 years of age along with information on asthma and wheezing obtained at 8 different time intervals between ages 11 and 29.  If a child experienced early pneumonia, the risk of experiencing asthma into adult life and being predisposed to developing adult chronic obstructive pulmonary disease was greater than if pneumonia had not been present in infancy and toddlerhood. 
      Understanding how early infection might trigger this life-long challenge with impaired airway function makes for an interesting discussion.  So take a deep breath and learn more about this longitudinal cohort, and how the findings in this study might apply to your own young patients with lower respiratory illness as they get older.

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Tuesday, December 9, 2014

RSV: Risk of Death

By: Lewis First, MD, MS; Editor-in-Chief 

With respiratory syncytial virus (RSV) season upon us, we know that our youngest and tiniest patients can experience significant morbidity with this virus in their system, but how fatal is it?

Byington et al.  (doi:10.1542/peds.2014-2151) looked at this question by using two large national databases to examine the past decade’s worth of hospitalizations for RSV, and in turn, the mortality associated with these hospitalizations.

The good news is that RSV deaths are extremely uncommon, although as you might expect, are most associated with infants with complex chronic conditions, making it tougher for them to deal with this respiratory infection.

Just what conditions are associated with increased RSV mortality awaits your reading of this useful description of a huge number of RSV admissions to determine the low prevalence of mortality reported. Take a deep breath and read this study to learn more that may help you reassure most families and perhaps be even more vigilant and supportive in your care of your more complex infants who succumb to RSV.

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