Winter Viruses, Not Asthma, Culprit Behind Sleep-Disordered Breathing in Children

Pediatric sleep medicine includes the practice of evaluating and treating children with sleep related breathing disorders like obstructive sleep apnea.  This disorder, according to new research, may have a seasonal variation that worsens significantly during the virus season.  Dr. Susarla

Winter Viruses, Not Asthma, Culprit Behind Sleep-Disordered Breathing in Children

A new study reveals that during the winter and spring months, viruses alone — not allergies or asthma — can lead to an increased risk for sleepbreathing disorders in children that can impair their mental and physical development.

Over time, sleep-disordered breathing in children can cause stunted growth, heart disease, and neurocognitive problems associated with poor academic performance, impaired language development, and behavioral problems.

Until now, researchers believed that asthma, allergies, and viral respiratory infections, such as the flu, contributed to disorders that affect children’s breathing during sleep.  Now, however, they have found that viruses alone contribute to these breathing problems.

Lead researcher Dr. Riva Tauman and her colleagues at Tel Aviv University say the study has broad implications for the treatment of sleep-breathing disorders in children.

“We knew from research and clinical practice that sleep-disordered breathing in children gets worse during the colder months,” Tauman said. “What we didn’t expect is that the trend has nothing to do with asthma or allergies.”

During the study, researchers statistically analyzed data of more than 2,000 children and adolescents who were referred to the sleep center to be tested for suspected sleep-disordered breathing between 2008 and 2010.

The researchers found that pediatric sleep-disordered breathing is worse in the winter months than in the summer. The seasonal variability is most apparent in children less than five years old, they found.

The researchers also found that wheezing and asthma do not contribute to these problems.  Based on their findings, the researchers speculate that viral respiratory infections — which are more common in younger children during colder months — are the main reason behind the seasonal variability found in pediatric sleep-disordered breathing.

The researchers estimate that seven percent fewer children would have been diagnosed with sleep-disordered breathing if all the tests had been done in the summer.

“Our study suggests that if a child comes into the sleep laboratory in the winter with a mild case, I may consider not treating him. I can assume he will be better in the summer,” said Tauman.

“But if he has only mild symptoms in the summer, I can assume they are more severe in the winter.”

Read article here.

Autism resources

Resources

Wrightslaw -- Special Education law website
http://www.wrightslaw.com

The Council of Parent Attorneys and Advocates
http://www.copaa.net

Disability Rights Texas
http://disabilityrightstx.org/

The Autism Society of America
http://www.autism-society.org

The Brain Connection -- Excellent autism resource
http://brainconnection.positscience.com

Families for Early Autism Treatment
http://www.feat.org

Tony Attwood site -- Excellent information on Asperger's Syndrome.
http://www.tonyattwood.com.au/

Future Horizons -- World leader in Autism/Asperger's Syndrome Publications
http://www.fhautism.com/

The National Learning Disabilities Association
http://www.interdys.org/

The International Dyslexia Association
http://www.interdys.org/index.jsp

The ARC
http://www.thearc.org

The Williams Syndrome Association
http://www.williams-syndrome.org/

Children and Adults with Attention Deficit/Hyperactivity Disorder
http://www.chadd.org/

The Texas Education Agency Special Education Website
http://www.tea.state.tx.us/special.ed/

The Office of Special Education and Rehabilitative Services
http://www.ed.gov/about/offices/list/osers/osep/index.html?src=mr

PBIS website. Information on Positive Behavioral Supports
http://www.pbis.org/

American Music Therapy Association
http://www.musictherapy.org

Travel Training Information
http://tinyurl.com/yghnwau

The Texas Organization of Parent Attorneys and Advocates
http://www.topaa.org

The law offices of Purcell and Saucedo
http://www.purcellsaucedo.com

The law offices of Dorene Philpot
http://dphilpotlaw.com

Focus Initiative:  Assisting individual’s with ASD’S, with social cognitive differences
http://www.asdfocus.com

ASPIE of Houston: Asperger's Syndrome parent-Professional Information exchange
http://www.aspieinfo.com

Having bronchiolitis in infancy, a wheezy illness associated with viral infections, seems to leave its footprint in the lungs for years to come including adulthood.  Dr Susarla

Infant Wheezing Episodes Impact Lungs Later

BARCELONA -- Children who suffer through a bout of bronchiolitis can end up with lungs early in adulthood that look like those of patients with chronic obstructive pulmonary disease (COPD), researchers reported here.

Thirty years after being hospitalized for bronchiolitis when they were younger than 2 years of age, 11% of the patients exhibited lung function that fell below the 0.7 FEV (forced expiratory volume in one second)/FCV (forced vital capacity) ratio that is threshold for the definition of COPD, said Katri Backman, MD, a researcher in pediatrics at Kuopio University Hospital in Finland.

"We found that [about] 30 years after first being hospitalized for bronchiolitis, many of these patients exhibited irreversible airway obstruction -- even though [they] were 28 to 31 years of age," Backman told MedPage Today. She reported her results in a late-breaking poster abstract session at the annual meeting of the European Respiratory Society.

"Irreversible airway obstruction is present 30 years after infantile bronchiolitis for more than 20% of former bronchiolitis patients, suggesting permanent structural changes in airways," Backman said.

Backman and colleagues determined that these patients' airways had been permanently damaged by performing lung function tests before and after administration of bronchodilating medications. But there were no differences in lung function among the bronchiolitis patients, compared with controls or with patients who had been hospitalized with pneumonia in childhood.

"The lack of effect among the bronchiolitis patients of these medicines leads us to believe that the disease has irreversibly damaged their lungs," she said.

In the study, Backman and colleagues identified 83 children hospitalized for bronchiolitis and 44 who were hospitalized for pneumonia at Kuopio University Hospital in 1981-82. All the children in the study were under 2 years of age. "All these children had viral infections in their lungs," she said. "What differentiates bronchiolitis and pneumonia is that the bronchiolitis children have their illness accompanied by this wheezing."

In 2010, the researchers tracked down 47 of the bronchiolitis patients and 22 of the pneumonia patients and compared them with controls who had avoided hospitals as youths. The researchers also recruited 138 healthy, matched controls. All the subjects then underwent multiple lung function tests, such as forced vital capacity, FEV1, the FVC-FEV-1ratio and the FVC/FEV1-ratio % of predicted (FEV%).

They found irreversible airway obstruction that could be considered COPD in five of the bronchiolitis patients (P=0.012); in one of the pneumonia patients (P=0.360), and in two of the controls. "I think that if we had more pneumonia patients, then that number would be statistically significant too. These are both serious diseases in infancy."

Irreversible airway obstruction -- defined as an FEV % of less than 88% -- was observed in 21% of bronchiolitis patients (P=0.001); in 9% of pneumonia patients (P=0.247), and in 4% of controls.

Backman said making comparisons between the bronchiolitis patients and pneumonia patients was difficult because there were few pneumonia patients.

"These findings are similar to what we are finding in our children," Guilia Cangiano, MD, resident in pediatrics at Sapienza University in Rome, told MedPage Today. "Our children have reached the age of 6 and we are seeing these kinds of long-term problems." She did not participate in Backman's study.

Read article here.

Non-pharmacological sleep interventions for youth with chronic health conditions

In children with chronic health problems, sleep problems are common, UNRECOGNIZED by most professionals and have a negative IMPACT on recovery.

Many sleep problems can  treatable with non-pharmacologic means. 

Bottom line: If your child has a sleep problem, parents should seek the help of a SPECIALIST (e.g neurologist or pulmonologist) who is knowledgeable in sleep disorders to maximize treatment and recovery. 

JR

Non-pharmacological sleep interventions for youth with chronic health conditions: A critical review of the methodological quality of the evidence

July 2013, Vol. 35, No. 15 , Pages 1221-1255 (doi:10.3109/09638288.2012.723788)

• HTML
• PDF (794 KB)
• PDF Plus (795 KB)
• Reprints
• Permissions

Cary A. Brown¹, Melissa Kuo¹, Leah Phillips², Robyn Berry¹, Maria Tan¹

¹Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta,

Edmonton, Alberta

, Canada

²Department of Public Health, Faculty of Professional Education, Concordia University College of Alberta

Correspondence: Cary A. Brown, FHEA, PhD, Associate Professor, Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta,

Edmonton, Alberta

, Canada. T6G 2G4. Tel: (780) 492–9545. Fax: (780) 492–4628. E-mail: cary.brown@ualberta.ca

Purpose: Restorative sleep is clearly linked with well-being in youth with chronic health conditions. This review addresses the methodological quality of non-pharmacological sleep intervention (NPSI) research for youth with chronic health conditions. Method: The Guidelines for Critical Review (GCR) and the Effective Public Health Practice Project Quality Assessment Tool (EPHPP) were used in the review. Results: The search yielded 31 behavioural and 10 non-behavioural NPSI for review. Most studies had less than 10 participants. Autism spectrum disorders, attention deficit/hyperactivity disorders, down syndrome, intellectual disabilities, and visual impairments were the conditions that most studies focused upon. The global EPHPP scores indicated most reviewed studies were of weak quality. Only 7 studies were rated as moderate, none were strong. Studies rated as weak quality frequently had recruitment issues; non-blinded participants/parents and/or researchers; and used outcome measures without sound psychometric properties. Conclusions: Little conclusive evidence exists for NPSIs in this population. However, NPSIs are widely used and these preliminary studies demonstrate promising outcomes. There have not been any published reports of negative outcomes that would preclude application of the different NPSIs on a case-by-case basis guided by clinical judgement. These findings support the need for more rigorous, applied research.

Implications for Rehabilitation

• Methodological Quality of Sleep Research
• Disordered sleep (DS) in youth with chronic health conditions is pervasive and is important to rehabilitation therapists because DS contributes to significant functional problems across psychological, physical and emotional domains.
• Rehabilitation therapists and other healthcare providers receive little education about disordered sleep and are largely unaware of the range of assessment and non-pharmacological intervention strategies that exist. 
  An evidence-based website of pediatric sleep resources can be found at http://www.SleepRight.ualberta.ca

The current research on non-pharmacological sleep interventions (NPSI) for youth with health conditions is methodologically weak. 

However, consistently positive outcomes reported in the literature demonstrate that pragmatic interventions such as:

•  bright light therapy, 
• activity, 
• massage and 
• behavioral interventions are promising areas. 

• No studies found reasons that a trail of a NPSI matched to the youth’s context and condition should not attempted. More rigorous clinically relevant study of pragmatic non-pharmacological interventions appropriate for therapists’ and parents’ needs is required.

Read More: http://informahealthcare.com/doi/abs/10.3109/09638288.2012.723788

New Biomarkers for Asthma on the Horizon

A biomarker is any measurable substance used to measure the state or presence of a disease.  A typical source for such a test might be a patient's blood or urine.  For asthma, markers of disease are being measured in exhaled breath condensate, which is the air you breathe out into a specialized collection device.  One known biomarker in asthma is exhaled nitric oxide, which can easily be measured in the doctor's office.  Other markers are being researched for use in the future. Dr. Susarla

Asymmetric Dimethylarginine in Exhaled Breath Condensate and Serum of Children With Asthma

Background:  Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor and uncoupler of nitric oxide synthase. By promoting the formation of peroxynitrite, ADMA is believed to contribute to several aspects of asthma pathogenesis (ie, airway inflammation, oxidative stress, bronchial hyperresponsiveness, and collagen deposition). The aim of the present study was to compare this mediator in healthy children and children with asthma using the completely noninvasive exhaled breath condensate (EBC) technique.

Methods:  We recruited 77 children with asthma (5-16 years of age) and 65 healthy children (5-15 years of age) who underwent EBC collection and spirometry. Serum ADMA levels and fractional exhaled nitric oxide levels were measured on the same day in a subgroup of children with asthma. EBC was collected using the Turbo-Deccs (Medivac). ADMA levels were measured using the ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) technique.

Results:  ADMA could be detected in the EBC of 71 subjects with asthma and 64 healthy subjects. ADMA levels in the EBC of children with asthma were significantly higher than in the healthy control subjects (median, 0.12 [interquartile range, 0.05-0.3] vs 0.07 [0.05-0.12]; P = .017), whereas no difference emerged between the children with asthma who were or were not receiving inhaled steroid treatment. No correlation was found between serum and EBC ADMA levels (P > .5).

Conclusions:  We measured ADMA in EBC by UPLC-MS/MS, a reference analytical technique. Higher ADMA levels were found in children with asthma, supporting a role for this mediator in asthma pathogenesis. This oxidative stress-related mediator also seems to be scarcely affected by steroid therapy. We speculate that ADMA might be a target for new therapeutic strategies designed to control oxidative stress in asthma.

Read abstract here.

Houston Area Seizure Action Plans for Children With Epilepsy

Make sure your child has an action plan...please contact me with a link if I missed your school. 

As a child neurologist / specialist in epilepsy, I fill out may of these forms.  Schools should be aware and prepared. JR

Selected Houston Area Seizure ACTION Plans for Schools

Houston ISD Seizure and Asthma action Plans

Katy ISD

• Seizure action Plan  http://www.katyisd.org/healthservices/Seizures/Seizure%20Action%20Plan%20.pdf
• Parent Questionnaire  http://www.katyisd.org/healthservices/Seizures/Parent%20Questionnaire%20-%20Seizures.pdf

Fort Bend ISD ( Sugar Land, Stafford ) Seizure, Asthma and Allergy ACTION PLAN

Spring Branch ISD ACTION PLAN for seizures, asthma, allergies & Diabetes

Conroe ISD ( The Woodlands)  Seizure information form 

Lamar Consolidated ISD ( Richmond Rosenberg Fulshear Pleak Greatwood Weston Lakes Simonton ) ACTION PLAN

Generic Forms from the EPILEPSY FOUNDATION

Why might this be? Children with allergies and asthma are known to have elevated risk of sleep disturbance, which could manifest with snoring in those with allergies, increased cough and respiratory symptoms during sleep for poorly controlled asthma. And finally, poor sleep quality can lead to symptoms of ADHD. Dr. Susarla

Children With Allergy, Asthma May Be at Higher Risk for ADHD

 The number of children being diagnosed with attention-deficit disorder (ADHD), allergy and asthma is increasing in the United States. And according to a new study, there might be a link between the growth of these three conditions.

The study, published in the August issue of Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI), found there is an increased risk of ADHD in boys that have a history of allergy or asthma.

"ADHD, a chronic mental health disorder, is most commonly found in males, while asthma is also more common in young boys than girls," said Eelko Hak, lead study author. "We found there is an increased risk of ADHD in boys with a history of asthma and an even stronger risk associated with milk intolerance."

Researchers in the Netherlands and Boston studied 884 boys with ADHD and 3,536 boys without the disorder. Of the children with ADHD, 34 percent had asthma and 35 percent had an allergic disorder. The study suggests medications used to treat these conditions may be associated with an increased ADHD risk.

"Further research is needed to understand why there appears to be an increased risk of developing ADHD in children with allergy and asthma," said Gailen Marshall, MD, editor-in-chief of Annals of Allergy, Asthma & Immunology. "Medications for these conditions far outweigh the risks, and can be life-saving in some conditions. Treatment should not be stopped, unless advised by a board-certified allergist."

According to the ACAAI, allergy and asthma often run in families. If both parents have an allergy a child has a 75 percent chance of being allergic. If neither parent has allergy, the chance of a child developing an allergy is only 10 to 15 percent. Allergists also know allergies and asthma are linked. An estimated 60 to 80 percent of children with asthma also have an allergy. While the cause of ADHD is unknown, this disorder is also thought to run in families
.

Read article here.

There is undoubtedly a role for non-pharmacologic treatment of asthma and other kinds of respiratory disorders.  While they may not replace medication per se, a well conditioned, exercised lung probably manages inflammation and other forms of impairment better than an under utilized, poorly conditioned lung. Dr. Susarla

Really? Breathing Exercises Can Relieve Asthma

THE FACTS

Breathing exercises are among the most popular alternative therapies for asthmatics. But do they work?

According to a recent report by the Agency for Healthcare Research and Quality, the answer depends on the technique. Some appear effective in reducing asthma severity, but there is little evidence to support others.

In the exhaustive, 219-page report, researchers examined 22 randomized studies of breathing techniques. Among the most common are hyperventilation-reduction techniques like the Buteyko method, which instructs asthmatics to breathe shallowly and slowly through the nose when short of breath. The report also looked at yoga breathing exercises and so-called inspiratory-muscle training, which involves exercises and devices that make inhaling more difficult in order to strengthen muscles.

The researchers found the most robust body of evidence supported hyperventilation-reduction breathing techniques, which achieved “medium to large improvements in asthma symptoms and reductions in reliever medication use of approximately 1.5 to 2.5 puffs per day.”

Looking at inspiratory training approaches, the researchers could not find enough credible research to draw any firm conclusions. They did find some evidence for yoga exercises, which typically require deep breaths — usually through the nose — with extended exhalation. But most of the evidence came from studies in India, where yoga exercises are more intensive and frequent than in the United States.

Still, the authors said, “Patients with asthma who are students of yoga and willing to undertake intensive training may find benefits of asthma-targeted practice with a trained yoga practitioner.”

THE BOTTOM LINE

Breathing exercises may help relieve asthma, though the efficacy varies.

Read article here.

Effects of Exercise Training on Airway Hyperreactivity in Asthma: A Systematic Review and Meta-Analysis.

Abstract

BACKGROUND:

Although physical exercise is recommended for asthmatics, evidence on the effects of exercise on clinical key factors is still missing.

OBJECTIVES:

We performed a systematic review and meta-analysis to determine the effect of exercise training (EXT) on quality of life (QoL), bronchial hyperresponsiveness (BHR), exercise-induced bronchoconstriction (EIB), lung function and exercise capacity, plus the factors affecting changes in QoL and exercise capacity in asthmatics after a period of EXT.

DATA SOURCES:

A computerized search was conducted in MEDLINE, EMBASE, and CINAHL (last search on 15 November 2012), without language restriction, and references of original studies and reviews were searched for further relevant studies.

STUDY SELECTION:

Two independent investigators screened full-text studies with asthmatic subjects undertaking EXT (defined as training for ≥7 days, ≥2 times per week, ≥5 training sessions in total) that assessed at least one of the following outcomes: QoL, airway hyperreactivity, forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), inflammatory parameters, exercise capacity, or exercise endurance. Potentially relevant studies were excluded if only respiratory muscle training, breathing exercises or yoga was performed, if asthmatic subjects with co-morbidities were investigated, if only data of mixed patient groups without separate results for asthmatics were presented, if training regimens were not sufficiently specified, if no numerical outcome data were presented, and if new long-term medication was introduced in addition to physical training. Of 500 potentially relevant articles, 13.4 % (67 studies including 2,059 subjects) met the eligibility criteria and were included for further analyses.

STUDY APPRAISAL AND SYNTHESIS METHODS:

Data extraction and risk of bias assessment was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis of all randomized controlled trials (RCTs) was performed to determine the effect of EXT on asthma symptoms, BHR, EIB, FEV1, exercise capacity and exercise endurance compared with control training. In addition, relative pre/post changes were analysed in all RCTs and controlled trials. Finally, multiple linear regression models were used to identify effects of relative changes in airway hyperreactivity (BHR or EIB), lung function (FEV1 or PEF) and training hours on QoL and exercise performance.

RESULTS:

In a total of 17 studies including 599 subjects, meta-analyses showed a significant improvement in days without asthma symptoms, FEV1and exercise capacity while BHR only tended to improve. The analysis of relative within-group changes after EXT showed, however, significant improvements in QoL (17 %), BHR (53 %), EIB (9 %), and FEV1 (3 %) compared with control conditions. Multiple linear regression models revealed that changes in airway hyperreactivity and lung function significantly contributed to the change in QoL, while mainly the changes in airway hyperreactivity contributed to the change in exercise capacity.

CONCLUSION:

EXT was shown to improve asthma symptoms, QoL, exercise capacity, BHR, EIB, and FEV1 in asthmatics and improvements in BHR explained part of the improvement in QoL and exercise capacity. Thus, physical activity should be recommended as a supplementary therapy to medication. However, more well controlled studies should be performed assessing the relationship of physical activity, QoL, airway hyperreactivity, lung function and especially airway inflammation as well as medication intake.

Read article here.

Genetic Test Could Predict Lasting Asthma Symptoms

Asthma for many, is certainly a combination of genetic risk and environmental exposure.  Tests may be available in the future to help identify risk.  Dr. Susarla

Genetic Test Could Predict Which Kids Will Have Lasting Asthma Symptoms

Half of children with asthma will continue to suffer from the respiratory disorder as adults, and a new genetic test could reveal who remains at risk past childhood.

About one in 11 children suffers from asthma, according to the Centers for Disease Control (CDC), and although half will eventually grow out of the condition, a recent CDC survey found that medical costs of asthma and its complications add up to about $56 billion each year. Improved treatment of those most likely to live with their condition longer term, say experts, could help to lower some of these costs, which include treating complications and mismanaged symptoms.

Researchers report in the journal Lancet Respiratory Medicine that a new genetic test may be able to predict a child’s risk of having asthma into adulthood, and therefore help doctors figure out which children might need more intensive care in childhood to potentially lower their risk of longer term symptoms.

The new study piggy backs on so-called genome-wide association (GWAS) studies, which compare those affected by asthma to those who are not to isolate specific genetic markers that could be associated with the disease. In the 40-year long study, Duke University researchers developed a genetic risk score that was based on 15 variants gleaned from previous GWAS, and looked at how these scores matched up to physical symptoms of asthma over time among 880 participants. The genetic score reflected only individual participant’s asthma risk, independent of family history.

The kids with higher scores, which meant they were more likely to possess more of the genetic markers linked to asthma, were also more likely to have asthma symptoms as adults, based on a 38 year follow-up. Those with the higher genetic risk also tended to miss school or work or be hospitalized for their symptoms more often than those with lower genetic scores.

Family history of asthma, the researchers say, did not appear to correlate with a higher genetic risk of the disease; many of the participants with high genetic risk had no family history of asthma, and conversely, people with a strong family history of the disease showed low genetic risk. That suggests that many of the cases were caused by environmental factors such as exposure to pollution or other irritants that have been linked to respiratory problems.

That means that doctors may need to expand the criteria they use to assess asthma risk to include measures such as genetic factors, which may be more predictive of future disease than family history. “What we are discovering in GWAS and doing molecular studies of asthma, is giving us new information over and above the old fashioned way we used to evaluate the genetic risk for asthma and still are in the clinic, which is to take family histories,” says study author Dan Belsky, a postdoctoral Fellow at Duke University. “I think that we are seeing more and more genomic medicine as time goes on. It is really coming into play in cancer medicine. It is not yet there in the treatment of asthma, but I think it will be coming. This study shows some of what may be possible.”

Belsky says scientists are far from knowing which genetic factors are directly responsible for causing asthma, but GWAS are a first step toward narrowing down the field of likely candidates. Most experts believe that for conditions such as asthma, multiple genes may contribute to the disease’s symptoms, so panels such as the one discovered in the current study could help to triage patients and ultimately guide them toward the most effective treatments — both in childhood and in adulthood.

Read article here.

Take your child's word for it on asthma, study finds

Many parents may be surprised by the subtlety of their child's asthma symptoms.  This frequently leads to underestimation of asthma severity.  Dr. Susarla

Take your child's word for it on asthma, study finds

SAN ANTONIO -- Children's perceptions of living with asthma may differ significantly from their caregivers' perceptions, which means both should be interviewed when they visit the doctor's office, a new study from UT Kids San Antonio and the Center for Airway Inflammation Research (cAIR) shows.

The study analyzed the agreement between 79 children and their caregivers on health-related quality-of-life questionnaires. The children ranged in age from 5 to 17. Fifty-three were classified as having acute asthma and 26 had refractory, or treatment-resistant, asthma.

Include children

"The take-home message is that children need to be included in the communication process with health care providers, and physicians need to elicit the child's perspective on their illness, health status, asthma symptoms and what is being done to treat their illness," said senior author Pamela Wood, M.D., Distinguished Teaching Professor of pediatrics in the School of Medicine at The University of Texas Health Science Center at San Antonio.

UT Kids is the clinical practice of the Department of Pediatrics. cAIR is a newly established research center at the Health Science Center's South Texas Research Facility that focuses on controlling and preventing acute and chronic airway diseases. The director is Joel Baseman, Ph.D.

Encouragement needed

Study lead author Margaret Burks, M.D., a 2013 graduate of the School of Medicine who is now an intern at Vanderbilt University, said children should be empowered to take control of their asthma. "Encouraging an environment where children can talk freely with their caregiver is important, and can start with allowing the child to participate in the office visit," Dr. Burks said. "It is important that children feel that their response to their disease is valued, not only by their physician but by their caregiver, as well."

Children were asked to rate their own limitations on activity, while caregivers were asked to rate the effect that the children's limitations had on family activities. "Overall, children viewed themselves as less impaired, in comparison to how caregivers viewed the limitations that the asthma placed on the family," Dr. Wood said.

Overcome barriers

Parents may not want to acknowledge a lack of communication when they go to a doctor's office. "I think there is often a concern in the minds of caregivers about how they appear to the physician," Dr. Burks said. "Caregivers may not want to seem out of touch with their child's day-to-day health, and, in such fear, they may dominate the conversation at the office visit. Our study demonstrates that it is helpful to gain insight from both the caregiver and the child."

Describing life with asthma to a health care provider can be an inexact science, to be sure. "There is no gold standard," Dr. Wood said. "We can't use a thermometer to measure quality of life."

Read article here.