Asthma, Pediatric



  • 2.7 million children (<18 yr) affected annually in the U.S.
  • 850,000 ED visits per year in the U.S.
  • Inflammatory events, usually viral, lead to bronchoconstriction:
    • Compounded by hyperreactivity of airways
    • Mediators of the inflammatory cascade exacerbate symptoms
  • Airway obstruction produces increased airway resistance and gas trapping:
    • Mucosal edema
    • Bronchospasm
    • Mucous plugging
  • Infants more vulnerable to respiratory failure:
    • Increased peripheral resistance
    • Decreased elastic recoil with early airway closure
    • Unstable rib cage
    • Mechanically disadvantaged diaphragm
  • Family history of allergy
  • Medical history of early injury to airway (bronchopulmonary dysplasia, pneumonia, intubation, croup, reflux, passive exposure to smoking), reactions to foods and drugs, other allergic manifestations
  • Environmental exposures such as pets, smoke, carpets, or dust may trigger or exacerbate


Precipitating/Aggravating Factors
  • Infection:
    • Viral
    • Bacterial
  • Allergic/irritant:
    • Environment: Pollens, grasses, mold, house dust mites, and animal dander
    • Occupational chemicals: Chlorine, ammonia – food and additives
    • Irritants: Smoke, pollutants, gases, and aerosols
    • Exercise
    • Cold weather
    • Emotional: Stress, phobia
    • Intoxication: β-blockers, aspirin, NSAIDs

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