Hewson M, Mischler E, Tuthill P, Baroni M, Dreier C, Green C, Kraus
C, Becker C, Feenan L, Sondel S, Shuster S, Wolf T. Comprehensive team
care. Maternal and Child Nursing. 1993;18:198-205.
A common type of transition for children with special health care
needs is from youth to adult care. Learn more at this site:
American Academy of Pediatrics National Center of Medical Home initiatives
Wisconsin Medical Home Toolkit:
(Click on Support Adolescent Transitions in the right hand toolbar)
(Click on Informational Booklets)
Children with Special Health Care Needs
Association for Maternal and Child Health Programs (AMCHP)
(click on Maternal and Child Health Topics: Listings A-G: CYSHCN in the left hand toolbar)
National Survey of Children with Special Health Care Needs
Asthma is a chronic lung condition characterized by ongoing inflammation of
the airways. In a person with asthma the airways are hyper-responsive to
a variety of environmental stimuli, or triggers, including specific inhalant
antigens, infectious agents, cold air, tobacco smoke, aerosolized chemicals,
dust, cockroaches, strong aromas, foods, and exercise. Such airway hyperactivity,
characterized by bronchial smooth muscle contraction, increased mucus secretion,
and edema with inflammation, results in obstruction of the airways.
The predominant clinical features of asthma are wheezing (a musical, high-pitched,
largely expiratory sound), coughing, and shortness of breath. Although asthma
can occur at any age, typical onset is within the first five years of life.
The clinical spectrum of asthma varies considerably. Some children with asthma
may have occasional, mild symptoms while others experience severe, life threatening
attacks every few months, but otherwise remain symptom free. Still others
have daily symptoms that interfere with their life-style.
The severity of asthma has been classified by the National Heart, Lung and
Blood Institute (NHLBI) into the four categories of mild intermittent, mild
persistent, moderate persistent, and severe persistent. The illness usually
improves during mid-childhood and adolescence, although asthma can continue
into adulthood. In many children and adolescents with asthma, pulmonary functions
are normal when they are symptom-free. However, there is a subset of asthmatics
who have chronic hyperinflation and/or decreased pulmonary flow rates, even
in the absence of symptoms.
Treatment and Management
The goals of therapy for asthma are to prevent the development of symptoms
and to reverse the symptoms when they occur. Achieving these goals requires
appropriate pharmacologic therapy along with appropriate measures of environmental
control. The pharmacotherapy of children with asthma may include a variety
of drugs that can be used simultaneously. The two major categories of medications
are relievers and controllers.
Relievers are used to treat acute symptoms of coughing, wheezing and shortness
of breath. They are usually short acting inhaled bronchodilators used on an
as needed basis. Any form of persistent asthma requires treatment with controller
medications that are long-term daily maintenance medications used to control
asthma symptoms and avoid exacerbations. Long-acting inhaled and oral anti-inflammatory
agents, inhaled and oral bronchodilators and oral leukotriene modifiers are
the most common classes of drugs currently used to control asthma symptoms.
Asthma is among the leading causes of acute and chronic illness in children.
It is estimated that up to 10 per cent of American children have asthma during
childhood. The disease is the most frequent admitting diagnosis in children’s
A child may be treated by a variety of practitioners in a variety of settings.
Often, primary care physicians will diagnose and manage asthma. Some children
are seen frequently in the emergency department and may need hospitalization.
Other children are partially managed in the school setting by school nurses.
Allergists or pulmonologists who often have the support of an interdisciplinary
team may treat those children who are more difficult to manage.
The NHLBI Guidelines specify which medications are appropriate for a given
level of severity. An action plan that is unique to each patient should be
developed by the clinician to guide the family in the response to the inevitable
exacerbations. Any therapy should fit the family setting to improve adherence
to therapy, provide the ability for normal exercise and daily function, and
minimize hospitalizations/emergency room visits.
There are several good websites regarding asthma. One of them is the
American Lung Association’s site: http://www.lungsusa.org (Click on diseases A-Z and search for asthma)
American Academy of Allergy, Asthma, & Immunology, American Academy
of Pediatrics, National Education and Prevention Program, National
Heart Lung and Blood Institute. Pediatric Asthma: Promoting Best Practice.
Guide for Managing Asthma in Children. (2004). Milwaukee, WI.
AAAAI web-site: http://www.aaaai.org
Lasley, M.V. (2003). New treatments for asthma. Pediatrics in Review, 24(7),
National Heart, Lung, and Blood Institute. (2002). Expert panel report 3: Guidelines for the diagnosis and management of asthma. National Asthma Education and Prevention Program. (NIH Publication No. 08-4051). Bethesda, MD: US Department of Health and Human Services. http://www.nhlbi.nih.gov
National Heart, Lung, and Blood Institute. (2007). Expert panel report 3: Guidelines for the diagnosis and management of asthma summary report 2007. National Asthma Education and Prevention Program. (NIH Publication No. 08-5846). Washington DC: US Government Printing Office. http://www.nhlbi.nih.gov
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