ASSESSMENT OF CHRONIC ASTHMA

Assessment of Chronic Asthma

Assessment of Chronic Asthma

Introduction

Asthma is currently the most common chronic disease among children, affecting almost 5 million children in the United States and accounting for almost 200 000 hospitalizations for children in Texas each year.,2 Asthma mortality has been increasing nationally and in Texas, with a disproportionate rise among minority and urban populations. Between 1980 and 1998, the asthma mortality rate nearly doubled in all age groups in Texas, with a 1998 asthma mortality rate higher among black children (3. of 100000) than white (1. of 100000) or Hispanic (0. of 100000) children.

The impact of asthma on families and health care providers is substantial. The National Cooperative Inner-City Asthma Study phase I found high rates of morbidity and functional limitation among inner-city asthmatic children. Although only 17% had =1 hospitalizations for asthma in the previous year, 66% had unscheduled urgent care visits. There were an estimated 4 million asthma exacerbations in 2000, resulting in 728000 emergency department (ED) visits, 214000 hospitalizations, and 223 deaths among children aged 0 to 17 years.

Age Factor for the Patient of Chronic Asthma

In most children, asthma develops before age 5 years, and, in more than half, asthma develops before they age 3 years.

Among infants, 20% have wheezing with only upper respiratory tract infections (URTIs), and 60% no longer have wheezing by age 6 years. Many of these children were called "transient wheezers" by Martinez et al.14,15 They tend to have no allergies, although their lung function is often abnormal. These findings have led to the idea that they have small lungs. Children in whom wheezing begins early, in conjunction with allergies, are more likely to have wheezing when they are aged 6-11 years. Similarly, children in whom wheezing begins after age 6 years often have allergies, and the wheezing is more likely to continue when they are aged 11 years.

Clinical History of the kid Suffering from Chronic Asthma

The updated guidelines from the National Asthma Education and Prevention Program highlight the importance of correctly diagnosing asthma.16 To establish the diagnosis of asthma, the clinician must establish the following: (1) episodic symptoms of airflow obstruction are present, (2) airflow obstruction or symptoms are at least partially reversible, and (3) alternative diagnoses are excluded. Thus, obtaining a good patient history is crucial when diagnosing asthma and excluding other causes.

Questions that need to be addressed include, but are not limited to, the following:

* Symptoms

o Wheezing

o Cough

o Cough at night or with exercise

o Shortness of breath

o Chest tightness

o Sputum production

* Pattern of symptoms

o Perennial, seasonal, or both

o Continuous or intermittent

o Daytime or nighttime

o Onset and duration

* Precipitating and/or aggravating factors

o Viral infections

o Environmental allergens

o Irritants (eg, smoke exposure, chemicals, vapors, dust)

o Exercise

o Emotions

o Home environment (eg, carpets, pets, mold)

o Stress

o Drugs (eg, aspirin, beta blockers)

o Foods

o Changes in weather

o Other conditions (eg, thyroid disease, pregnancy, menses, gastroesophageal reflux disease [GERD], sinusitis, rhinitis)

* Development of disease and treatment

o Age at onset and diagnosis

o Progression of symptoms (better or worse)

o Improvement with bronchodilators

o Use of oral ...