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    Pediatric Asthma: An Update for Pharmacists

    In this month's peer-reviewed article, learn more about the illness affecting millions.


    Asthma is a chronic illness that affects the airways of the lungs. Uncontrolled asthma can lead to asthma attacks where the individual experiences coughing, trouble breathing, wheezing, and/or pain in the chest.1

    Uncontrolled asthma leads to exacerbation of the disease, hospitalizations, impaired quality of life, and death. According to the CDC, an estimated 39.5 million people in the United States—12.9% of the population—have been diagnosed with asthma in their lifetime. Children particularly have a high incidence of asthma with 10.5 million (14%) having received a diagnosis for asthma in their lifetime, with 7.1 million (9.5%) with active asthma.2

    Uncontrolled asthma leads to preventable morbidity and increased health-care utilization. Asthma costs the United States $56 billion each year. In 2009, there were 479,300 asthma-related hospitalizations, 1.9 million asthma-related emergency department visits and 8.9 million asthma-related doctor visits.1 It cost an average $1039 per year to care for a child with asthma in 2009.1

    Pathophysiology, Diagnosis, and Triggers

    Asthma is a disease with many variations, but it is usually characterized by common airflow obstruction, bronchial hyper-responsiveness, and airway inflammation.3 Two key defining features assist in diagnosing asthma: a history of respiratory symptoms such as wheezing, shortness of breath, chest tightness, and cough that vary in time and intensity; and evidence of variable expiratory airflow limitation, which is measured by one of two methods, peak expiratory flow (PEF) rates or spirometry.3-4 When a patient exhibits symptoms of asthma, a detailed history and physical examination can help further define the type of asthma and its triggers, and comorbid conditions that can contribute to disease severity.4 The diagnosis of asthma in children should be made based on the history of symptoms as well as evidence of variable airflow limitation.3-4

    PEF rate is the most commonly used method of testing lung function. If the average daily PEF rate variability is greater than 13%, it suggests a diagnosis of asthma in children.2 Spirometry measures the forced vital capacity (FVC), which is the maximum volume exhaled after taking a deep breath in, and the forced expiratory volume in one second (FEV1). These are measured at baseline and after administration of a short-acting bronchodilator to test for reversibility. When FEV1 increases by more than 12% from baseline/predicted value, this is evidence of bronchodilator reversibility. In pediatric patients, the FEV1/FVC ratio is normally greater than 0.9. If the result is less than this value, it is usually suggestive of airflow limitation.4 The greater the variation, the more confidence a health-care professional can have in diagnosing asthma.4

    Portia N. Davis, PharmD
    Assistant Professor of Pharmacy Practice Texas Southern University College of Pharmacy and Health Sciences Clinical Pharmacy Specialist, ...
    Blanca Guerra, PharmD
    Community Pharmacy Resident Texas Southern University College of Pharmacy and Health Sciences
    Abreah Ash
    PharmD. Candidate, 2018 Texas Southern University College of Pharmacy and Health Sciences


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