Curbside Consultation in Pediatric Asthma 49 Clinical Questions

Dedication

Acknowledgments

About the Editor

Contributing Authors

Preface

Foreword by Gabriel G. Haddad, MD

Section I Asthma Epidemiology

Question 1 How Big of a Problem Is Childhood Asthma?

Robert A. Heinle, MD

Question 2 Who Is at Risk for Developing Asthma?

Robert A. Heinle, MD

Question 3 Which Groups of Children Are Most Impacted by Childhood

Asthma?

Robert A. Heinle, MD

Question 4 The Asthma of Most of My Patients Seems Very Mild. Do Children

Really Die From Asthma?

Robert A. Heinle, MD

Question 5 Do Children Outgrow Asthma? What Is the Evolution of Asthma

Throughout Childhood?

Robert A. Heinle, MD

Section II Asthma Pathophysiology

Question 6 What Causes Asthma? Is It Due to Genes, the Environment, Infection, or Some Combination of These?

Kather.ine A. King, MD

Question 7 What Is the Role of Airway Inflammation in Asthma?

Katherine A. King, MD

Question 8 What Is the Differential Diagnosis of Pediatric Asthma?

Natalie M. Hayes, DO

Question 9 How Do I Know It Is Asthma That Is Causing My Patient’s

Symptoms?

Anita Bhandari, MD

Section III Asthma Therapy

Question 10 What Are the Common Classes of Asthma Medication and How Do

They Work?

Lisa Forbes, MD and Jonathan M. Spergel, MD, PhD

Question 11 What Is the Role of Immunotherapy or Allergy Shots in Managing

Asthma?

Lisa Forbes, MD and Jonathan M. Spergel, MD, PhD

Question 12 What Other Medications Might I Use to Treat My Patients With

Asthma?

Lisa Forbes, MD and Jonathan M. Spergel, MD, PhD

Question 13 Do Any Alternative Therapies for Asthma Have Proven Efficacy?

Natalie M. Hayes, DO

Question 14 What Medication Delivery Devices Are Used in the Medical

Management of Asthma and How Do They Work?

David E. Geller., MD

Section IV Environmental Influences

Question 15 What Are the Most Important Allergic Asthma Triggers?

Stephen J. McGeady, MD

Question 16 Is Environmental Tobacco Smoke Really That Bad for My Patients

With Asthma?

Aaron S. Chidekel, MD and Sheela Raikar., MD

Question 17 What Is the Role of Viral Infections in Pediatric Asthma?

Joel D. Klein, MD, FAAP and Jennifer. LeComte, DO

Question 18 Are There Other Infections That Are Important?

Joel D. Klein, MD, FAAP and Jennifer. LeComte, DO

Question 19 What Do Patients With Asthma Need to Know About Environmental

Control, and What Is the Evidence to Support These Instructions?

Stephen J. McGeady, MD

Section V Asthma Outpatient

Question 20 How Is Asthma Diagnosed in Infancy and Childhood?

Alia Bazzy-Asaad, MD

Question 21 I Am a Busy Pediatrician. How Can I Integrate Effective Asthma

Management Into My Practice?

Amy Renwick, MD

Question 22 What Are the Most Current Asthma Guidelines From the National

Institutes of Health and What Do I Need to Know About Them?

Alia Bazzy-Asaad, MD

Question 23 What Is an Asthma Action Plan and How Can One Be Individualized

for My Patients?

Aaron S. Chidekel, MD

Question 24 What Is Exercise-Induced Asthma?

Brad Bley, DO, CSCS and Aaron S. Chidekel, MD

Question 25 What Is Nocturnal Asthma?

Holger Link, MD

Question 26 My Patient’s Asthma Is Not Getting Better. What Treatment Options

Do I Have?

Anita Bhandari, MD

Question 27 How Should I Deal With Asthma Exacerbations in My Office?

Amy Renwick, MD

Question 28 How Can I Deal With Asthma Symptoms Over the Telephone Safely

and Effectively?

Concettina (Tina) Tolomeo DNP, APRN, FNP-BC, AE-C

Question 29 What Is Intermittent Asthma?

Aaron S. Chidekel, MD

Question 30 What Is Persistent Asthma?

Aaron S. Chidekel, MD

Question 31 How Is Exercise-Induced Asthma Diagnosed and Treated?

Brad Bley, DO, CSCS and Aaron S. Chidekel, MD

Section VI Asthma Emergency and Inpatient Care

Question 32 What Is Status Asthmaticus? Who Is At Risk for It and What Are Its

Causes?

Jonathan E. Bennett, MD and Aaron S. Chidekel, MD

Question 33 How Should a Child Who Presents to the Emergency Room With

Wheezing Be Assessed and Treated?

Jonathan E. Bennett, MD

Question 34 What Are Some Respiratory Emergencies That Can Present Like

Asthma?

Jonathan E. Bennett, MD

Question 35 Which Patients With Asthma in the Emergency Department Need

to Be Admitted to the Hospital?

Jonathan E. Bennett, MD and Aaron S. Chidekel, MD

Section VII Asthma Education

Question 36 What Is the Standard Practice When a Patient With an Acute Exacerbation

Is Admitted to the Hospital?

Lisa B. Zaoutis, MD

Question 37 When Is My Patient With Asthma Ready to Go Home?

Aaron S. Chidekel, MD

Question 38 What Do the Parents of My Patients Need to Know About Asthma and

Its Management?

Concettina (Tina) Tolomeo DNP, APRN, FNP-BC, AE-C

Question 39 What Are Some Strategies to Enhance Asthma Education in My

Practice?

Concettina (Tina) Tolomeo DNP, APRN, FNP-BC, AE-C

Question 40 What Education Should Be Provided to All Parents of Children With

Asthma to Help With Day-to-Day Management?

Concettina (Tina) Tolomeo DNP, APRN, FNP-BC, AE-C

Section VIII Asthma Testing

Question 41 What Is the Role of Pulmonary Function Testing in Asthma?

What Testing Should Be Ordered and When?

Daniel J. Weiner., MD

Question 42 Is Office-Based Spirometry Possible? How Do I Interpret the

Results?

Daniel J. Weiner., MD

Question 43 What Other Tests Will My Patient With Asthma Need?

Natalie M. Hayes, DO

Section IX Other Management Pearls

Question 44 Why Is the Influenza Vaccine So Important for the Patient Who Is Diagnosed With Asthma and What Other Vaccines Do My Patients Need?

Joel D. Klein, MD, FAAP and Jennifer. LeComte, DO

Question 45 What Is the Role of the Upper Airway in Asthma and How Big of a

Problem Is Sinusitis and Allergic Rhinitis?

Stephen J. McGeady, MD

Question 46 How Many Chest X-Rays Are Enough? When Should I Order Imaging

Studies and Which Studies Should Be Done?

Julie Ryu, MD

Question 47 How Can I Maximize Patient Adherence to Therapy?

Concettina (Tina) Tolomeo DNP, APRN, FNP-BC, AE-C

Question 48 Are There Particular Asthma Outcomes or Quality Indicators of Which

I Need to Be Aware?

Gabriela Ramirez-Garnica, PhD, MPH

Question 49 Which of My Patients With Asthma Should See a Subspecialist?

Aaron S. Chidekel, MD

Financial Disclosures

Index

Biography

Aaron S. Chidekel, MD received his medical degree from Brown University in Providence, Rhode Island. He completed his internship and residency in general pediatrics at Yale-New Haven Hospital. He completed fellowship training in pediatric respiratory medicine in the Section of Respiratory Medicine at the Yale University School of Medicine. After completing his training, Dr. Chidekel moved to the Nemours at the Alfred I. duPont Hospital for Children in Wilmington, Delaware. He is currently Chief of the Division of Pulmonology at the Alfred I. duPont Hospital for Children and Director of the Sleep Medicine and Cystic Fibrosis Programs as well. He is an Associate Professor of Pediatrics at the Jefferson Medical College of Thomas Jefferson University. Dr. Chidekel has authored numerous scientific papers and abstracts in various aspects of clinical and basic research related to pediatric pulmonary medicine. He has contributed chapters to several textbooks and has served as a reviewer for many prestigious journals as well. He is a fellow in the American Academy of Pediatrics and has been active as an officer and board member of the Delaware Chapter, and is a member of the American Thoracic Society and the American Academy of Sleep Medicine.