Childhood Asthma

by Szefler; Stanley J

• ISBN13: 9780824727352
• ISBN10: 0824727355
• Format: Hardcover
• Copyright: 2005-09-26
• Publisher: CRC Press

Summary

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.

Table of Contents

Introduction	iii
Claude Lenfant
Preface	v
Contributors	vii
Part I: Natural History of Asthma
1. The Epidemiology and Burden of Pediatric Asthma
David A. Stempel
I. Introduction	1	(1)
II. Working Definitions of Asthma	2	(2)
III. International Study of Asthma and Allergies in Childhood	4	(2)
IV. The Underdiagnosis of Pediatric Asthma	6	(4)
V. Morbidity of Pediatric Asthma	10	(2)
VI. Burden of Pediatric Asthma	12	(2)
VII. Summary	14	(1)
References	14	(3)
2. Developmental Regulation of Immune Functions and Risk for Allergy and Asthma	17	(26)
Susan L. Prescott and Patrick G. Holt
I. Introduction: The Importance of Early Immune Events in the Subsequent Development of Allergic Disease	17	(1)
II. Current Concepts of Immune Dysregulation in Allergic Disease	18	(1)
III. Evidence of Early Immune Dysregulation in Allergic Infants	19	(3)
IV. The Significance of Perinatal Immune Responses	22	(5)
V. How Perinatal Immaturity Leads to Excessive Postnatal Responses in Atopic Children	27	(1)
VI. The Relationship Between Atopy and the Development of Organ-Specific Disease	27	(3)
VII. Factors That May Influence Early Immune Development	30	(2)
VIII. Conclusion	32	(1)
References	33	(10)
3. Origins of Asthma	43	(28)
J.O. Warner
I. Introduction	43	(1)
II. Atopy and Asthma	44	(1)
III. The Atopic Immune Response and Pregnancy	45	(1)
IV. The Hygiene Hypothesis	46	(1)
V. Genetic Polymorphisms and Allergy	47	(1)
VI. Ante-natal Origins of Allergic Sensitization	48	(1)
VII. Early Life Origins of Remodeling	49	(4)
VIII. Embryology of the Lung	53	(2)
IX. Genetic Polymorphisms and Airway Structure	55	(2)
X. Fetal Programming	57	(2)
XI. Early Infection and Asthma	59	(1)
XII. Conclusions	60	(1)
References	61	(10)
4. Developmental Features of Airway Remodeling	71	(28)
Meri K. Tulic, Céline Bergeron, Patrick Daigneault, and Qutayba Hamid
I. Introduction	71	(2)
II. Epithelial Changes	73	(4)
III. Subepithelial Fibrosis	77	(1)
IV. Inflammation	78	(1)
V. Mucus Overproduction	79	(3)
VI. Smooth Muscle Changes	82	(1)
VII. Microvascular Changes	83	(2)
VIII. Cartilage Changes	85	(1)
IX. Clinical Significance of Airway Remodeling	85	(2)
X. Recent Advances	87	(2)
References	89	(10)
5. Asthma in Children and Adults—Natural Course of the Disease	99	(26)
Ronina Covar and Joseph D. Spahn
I. Introduction	99	(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