Resources

Transition

Hewson M, Mischler E, Tuthill P, Baroni M, Dreier C, Green C, Kraus C, Becker C, Feenan L, Sondel S, Shuster S, Wolf T. Comprehensive team care. Maternal and Child Nursing. 1993;18:198-205.

A common type of transition for children with special health care needs is from youth to adult care. Learn more at this site:
American Academy of Pediatrics National Center of Medical Home initiatives
http://www.medicalhomeinfo.org/tools/trans.html

Wisconsin Medical Home Toolkit:
http://www.wimedicalhometoolkit.aap.org/toolkit/index.cfm
(Click on Support Adolescent Transitions in the right hand toolbar)

UWPPC Website:
http://www.uwppc.org/resources/
(Click on Informational Booklets)

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Children with Special Health Care Needs

Association for Maternal and Child Health Programs (AMCHP)
http://www.amchp.org
(click on Maternal and Child Health Topics: Listings A-G: CYSHCN in the left hand toolbar)

National Survey of Children with Special Health Care Needs
http://mchb.hrsa.gov/chscn/index.htm

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Asthma

Definition
Asthma is a chronic lung condition characterized by ongoing inflammation of the airways. In a person with asthma the airways are hyper-responsive to a variety of environmental stimuli, or triggers, including specific inhalant antigens, infectious agents, cold air, tobacco smoke, aerosolized chemicals, dust, cockroaches, strong aromas, foods, and exercise. Such airway hyperactivity, characterized by bronchial smooth muscle contraction, increased mucus secretion, and edema with inflammation, results in obstruction of the airways.

Clinical Findings
The predominant clinical features of asthma are wheezing (a musical, high-pitched, largely expiratory sound), coughing, and shortness of breath. Although asthma can occur at any age, typical onset is within the first five years of life. The clinical spectrum of asthma varies considerably. Some children with asthma may have occasional, mild symptoms while others experience severe, life threatening attacks every few months, but otherwise remain symptom free. Still others have daily symptoms that interfere with their life-style.

The severity of asthma has been classified by the National Heart, Lung and Blood Institute (NHLBI) into the four categories of mild intermittent, mild persistent, moderate persistent, and severe persistent. The illness usually improves during mid-childhood and adolescence, although asthma can continue into adulthood. In many children and adolescents with asthma, pulmonary functions are normal when they are symptom-free. However, there is a subset of asthmatics who have chronic hyperinflation and/or decreased pulmonary flow rates, even in the absence of symptoms.

Treatment and Management
The goals of therapy for asthma are to prevent the development of symptoms and to reverse the symptoms when they occur. Achieving these goals requires appropriate pharmacologic therapy along with appropriate measures of environmental control. The pharmacotherapy of children with asthma may include a variety of drugs that can be used simultaneously. The two major categories of medications are relievers and controllers.

Relievers are used to treat acute symptoms of coughing, wheezing and shortness of breath. They are usually short acting inhaled bronchodilators used on an as needed basis. Any form of persistent asthma requires treatment with controller medications that are long-term daily maintenance medications used to control asthma symptoms and avoid exacerbations. Long-acting inhaled and oral anti-inflammatory agents, inhaled and oral bronchodilators and oral leukotriene modifiers are the most common classes of drugs currently used to control asthma symptoms.

Care Coordination
Asthma is among the leading causes of acute and chronic illness in children. It is estimated that up to 10 per cent of American children have asthma during childhood. The disease is the most frequent admitting diagnosis in children’s hospitals.

A child may be treated by a variety of practitioners in a variety of settings. Often, primary care physicians will diagnose and manage asthma. Some children are seen frequently in the emergency department and may need hospitalization. Other children are partially managed in the school setting by school nurses. Allergists or pulmonologists who often have the support of an interdisciplinary team may treat those children who are more difficult to manage.

The NHLBI Guidelines specify which medications are appropriate for a given level of severity. An action plan that is unique to each patient should be developed by the clinician to guide the family in the response to the inevitable exacerbations. Any therapy should fit the family setting to improve adherence to therapy, provide the ability for normal exercise and daily function, and minimize hospitalizations/emergency room visits.

References

There are several good websites regarding asthma. One of them is the American Lung Association’s site: http://www.lungsusa.org (Click on diseases A-Z and search for asthma)

American Academy of Allergy, Asthma, & Immunology, American Academy of Pediatrics, National Education and Prevention Program, National Heart Lung and Blood Institute. Pediatric Asthma: Promoting Best Practice. Guide for Managing Asthma in Children. (2004). Milwaukee, WI.
AAAAI web-site: http://www.aaaai.org

Lasley, M.V. (2003). New treatments for asthma. Pediatrics in Review, 24(7), 222-232.

National  Heart, Lung, and Blood Institute. (2002). Expert panel report 3: Guidelines for the diagnosis and management of asthma. National Asthma Education and Prevention Program. (NIH Publication No. 08-4051). Bethesda, MD: US  Department of Health and Human Services. http://www.nhlbi.nih.gov

National  Heart, Lung, and Blood Institute. (2007). Expert panel report 3: Guidelines for the diagnosis and management of asthma summary report 2007. National Asthma Education and Prevention Program. (NIH Publication No. 08-5846). Washington DC: US Government Printing Office. http://www.nhlbi.nih.gov

 

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