Difficult to Control Asthma in Children

Alfin G. Vicencio, MD Attending in Pediatric Pulmonary at: Steven and Alexandra Cohen Childrens Med Center

Difficult to Control Asthma in Children Male: Most kids who wheeze which are labeled asthmatics correctly or incorrectly can get controlled pretty easily with any type of medicines but there are some very difficult ones to manage, how would you pick them out of the crowd and how would you approach that problem? Alfin G. Vicencio: Yes, as you mentioned, probably about 90% or 95 % of children with asthma can be very, very well controlled with very simple medications but depending on which region the children are from then anywhere from 5% to 10% estimated children have disease that’s much, much more difficult to control and they don’t respond as well to traditional asthma medications. The new way of thinking is that we’re trying to define these children in specific FENO types of asthma. For example, what type of inflammation is in their airways and based on what type of inflammation in their airways there is that dictates different types of therapies that they maybe responsive to. Male: Wait a minute, you’re talking about inflammation. That means you can’t just look at the kid and listen. It means you have to look down into the lung? Alfin G. Vicencio: Well, not necessarily there are a lot of different ways that we’re trying to characterize those. Some people can do it by a variety of different means for example collection of what we call exhale breath compensate, sputum analysis. Sometimes in more difficult cases even bronchoscopy with alveolar lavage. In certain cases children are mislabeled and we sometimes do find airway abnormalities that are actually contributing to a lot of the symptoms that mimic asthma. Male: Can you mention that couple of those things that mimic asthma that are on asthmatics? Alfin G. Vicencio: There was just a child that we saw last week whose asthma had been poorly controlled and poorly responsive to medications for the past two years and we found an airway cyst in the large airway that was causing obstruction and the symptoms that were previously attributed to asthma. Male: It was removed? Alfin G. Vicencio: She already in surgery right now. Male: Okay so you would expect within a month or two after which the kid problem would be easily controlled at this point? Alfin G. Vicencio: Yes, as a matter of fact at this point in time I question whether or not she truly has asthma. Male: Okay, we will know that for sure but that’s a possibility. Alfin G. Vicencio: Right, yeah. Male: So you bring up the point and everything that wheezes is asthma? Alfin G. Vicencio: Exactly, that’s one of the things that we often times talk about where wheezing is a very generalized symptom that it’s true the majority of children who are wheezing are either going to have asthma or bronchiolitis but there are those cases that seem a little bit odd or refractory to certain medical therapies that we have to rely other types of airway abnormalities.