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Developmental Biology Boot Camp

Clinical Experience: Asthma

Clinical Shadowing Experience 

Paul Moore, M.D., Professor of Pediatrics and Pharmacology and the Director of Pediatric Allergy, Immunology and Pulmonary medicine, mentored me throughout my clinical shadowing experience. During this experience, I was also able to follow Dr. Rebekah Brown, a pediatric pulmonary specialist, during her clinic hours. When seeing pateints, Dr Brown asked questions like “does anyone else in your family have respiratory problems?” This question posed an interesting conclusion: it was asthma that was genetic. While many cases are childhood asthma and go away during childhood, sometimes asthma comes back in adulthood.

Dr Moore was able to provide me with an outline that he uses to diagnose a patient with asthma, which is the number one reason for Emergency Department visits.

  1. Make sure nothing is obstructing the lung
  2. Determine if there is a trigger. Most childhood asthma is reversible.

His management strategy for patient is:

  1. Score the asthma serverity on the standardized scale
    • If it is a high score, the patient will go to the ICU, otherwise they will be discharged with some help
    • Getting a spirometry may be necessary to rule out a foreign body or vocal cord disfunction.
    • Anxiety may worsen symptoms.
  2. Partnership- build a relationship with the family.
    • Patients and guardians may forget to take inhaled steroids everyday which are essential for improving the patients condition.
    • The guardian may forget to refill the prescription or use the spacer when taking the inhaled steroid.
    • Most importantly, education for the patient and parents. Making sure they understand that the cause of asthma is inflammation so it can easily be managed if prescriptions are taken properly.
  3. Determine the triggers
    • Respiratory viruses can lead to the development of asthma 30-40% after the patient has been admitted.
    • Allergies are common triggers that can be an environmental trigger.
    • If the patient is in a smoking home or is around someone that smokes. Smoke on clothing can even trigger asthma, so even if the patient is not around the individual when they are smoking, the patient can still have a reaction.
    • Perfume and cologne can cause asthma.
    • Obesity is another cause of asthma. So if the child is sedentary, by getting the child active and controlling the obesity the asthma can be controlled
    • Kids aspirating on fluids due to lack of proper muscle strength. If a parent notices a child coughing frequently while drinking, then a swallow study can be done to determine if the child is aspirating. The irritation caused by the aspiration can cause inflammation and therefore asthma.
  4. Treatment
    • Treatments often include inhaled steroids and montelukast.
    • If  a child has severe asthma, the family may consider getting biologic therapy, which includes Anti-IGE antibody to treat the asthma
      • If a child has a hard time adhering to the management plan or if they are in a smoking home this treatment is often used.

Other asthma guidelines can be found below:

NHLB Guidelines

CDC Asthma Guidelines