Virtual International Pediatric Pulmonary Network (VIPPN)

Editor’s Choice, November 2018

Andres Carrion, MD FAAP

Asthma

Acute respiratory infections with RSV, and other viruses, is one of the risk factors most strongly and consistently associated with recurrent wheezing in children and risk for later development of asthma. Turi et al, describe the immune-response during RSV infection and association with risk of recurrent wheezing with some insights into mechanisms of asthma development. (4)

Children with frequent asthma attacks and allergies are more vulnerable to reduced lung function later in life, especially if they also become adult smokers. Bui et al, mention that childhood risk factor profiles are useful to predict long-term lung function and COPD, and emphasized the importance of preventing smoking exposure in children. (2)

Both under- and overdiagnosis of asthma may be associated with inappropriate treatment. Underdiagnosis occurs when the physician has attributed the patient’s respiratory symptoms to a condition other than asthma. Risk factors that challenge the diagnosis of asthma include: the patient’s poor perception of symptoms, poor diagnostic sensitivity of spirometry, and low socioeconomic status. Failure to use objective tests at the time of diagnosis, sustained clinical remission, and obesity are some of the factors that falsely may increase the prevalence by overdiagnosing asthma. Aaron et al, explore the prevalence and burden of these factors, and describe potential solutions to these issues. (1)

Poor health literacy is a stronger predictor of a person’s health status than age, economic status, education, race, or ethnicity. Understanding of a condition may sometimes be limited by physical or emotional status, stress, fatigue, or health system complexity. Myers et al, discuss that low health literacy is associated with poor longitudinal asthma outcomes. Communication is a powerful tool in the delivery of healthcare and adherence to therapy. (3)

  1. Aaron SD, Boulet LP, et al. Underdiagnosis and overdiagnosis of asthma. Am J Respir Crit Care Med. 2018 Oct 15;198(8).

  2. Bui DS, Walters HE, et al. Childhood respiratory risk factor profiles and middle-age lung function: A prospective cohort study from the first to sixth decade. Ann Am Thorac Soc. 2018 Sep;15(9).

  3. Myers L and Murray RK. Overcoming health literacy barriers to improve asthma inhaler therapy adherence. Ann Am Thorac Soc. 2018 Oct. doi: 10.1513/AnnalsATS.201805-338PS.

  4. Turi KN, Shankar J, et al. Infant viral respiratory infection nasal immune-response patterns and their association with subsequent childhood recurrent wheezing. Am J Respir Crit Care Med. 2018 Oct 15;198(8).