Asthma

Cite relevant scholarly literature. Asthma Case Study: Mary is an 8-year old female African American girl who presents to the clinic with a 2-day history of fever, malaise, and nonproductive cough. Her mom gave her acetaminophen and ibuprofen to control her fever. Mom stated that " a lot of other kids in her class have been sick this month." Mary states having trouble breathing this morning. At that time her mother gave her albuterol, 2.5 mg via nebulizer twice within one hour. Mary still sounded wheezy to her mother after the albuterol, and Mary stated it was "hard to breath." Mary asthma was previously well controlled. Previous clinic notes reported symptoms during the day only with active play at school or at home, with rare nighttime symptoms. Mary uses prn albuterol to help with symptoms after playing. Her assessment revealed Mary to have labored breathing, such that she could only complete four to five work sentences. She had subcostal retractions, tracheal tugging with tachypnea at 54 bpm. Her other vital sign were HR 160/min, BP 115/59, T 101F. The initial O2 SAT was 94%. Bilateral inspiratory and expiratory wheezes noted on exam. A CXR revealed hyperinflation, no infiltrate's. PMH: Asthma, last hospitalization 4 years ago, and last course of oral corticosteroids over a year ago. FH: Asthma on father's side of the family. SH: Lives at home with mother, father, and 2 siblings, both have asthma. There are 2 cats and a dog in the home. Father is a smoker, but states that he tries to smoke outside and not around the children. She is in second grade and is very active. On Exam: VS - BP 125/60, HR 120, RR 40, T 100.4F, Wt. 101 lbs., Ht.48". Medications: fluticasone HFA 44 mcg, 2 puffs bid, albuterol 2.5 mg via nebulizer q 4-6h prn for wheezing, acetaminophen 160 mg/5 mL - 10 mL 14h prn for fever, ibuprofen 100 mg/5mL - 10 mL q6h prn for fever. No allergies. PE: Alert and oriented, in mild distress with difficulty breathing, Skin: no rashes. HEENT: PERRLA, neck supple, no cervical lymphadenopathy. Chest: wheezes throughout all lung fields, still with subcostal retractions. Abd: sort, NT/ND. Extremities: no clubbing or cyanosis. Neuro: no focal deficits. Assessment: Exacerbation of Asthma. Based on the case study: Discuss the impact chronic inhaled corticosteroids may have on growth and development of the pediatric patient.

Inhaled corticosteroids (ICS) are the most effective medications for controlling asthma symptoms and reducing exacerbations. They are typically the first-line treatment for asthma in children, and they can be used safely and effectively for long-term management.

However, there is some concern that chronic ICS use may have a negative impact on growth and development in pediatric patients. This is because ICS can suppress the hypothalamic-pituitary-adrenal (HPA) axis, which is responsible for regulating the production of cortisol, a hormone that plays an important role in growth and development.

Studies have shown that ICS can cause a small but statistically significant decrease in growth velocity in children. This effect is more pronounced in prepubertal children and in children who are taking higher doses of ICS. However, the impact on final adult height is less clear. Some studies have shown a small decrease in final adult height in children who used ICS long-term, but other studies have not found this association.

Overall, the evidence suggests that chronic ICS use may have a small but measurable impact on growth and development in pediatric patients. However, the benefits of ICS in controlling asthma symptoms and preventing exacerbations outweigh the potential risks.

Mechanisms of growth suppression by ICS

ICS can suppress growth through a number of mechanisms, including:

Suppression of the HPA axis: ICS can suppress the production of cortisol, which can lead to growth retardation.
Direct inhibition of growth hormone secretion: ICS can directly inhibit the secretion of growth hormone from the pituitary gland.
Inhibition of insulin-like growth factor-1 (IGF-1) bioactivity: IGF-1 is a hormone that plays a key role in growth and development. ICS can inhibit the bioactivity of IGF-1 by decreasing its production or by increasing its degradation.
Inhibition of osteoblast activity: ICS can inhibit the activity of osteoblasts, which are the cells that build bone. This can lead to decreased bone growth and density.
Suppression of collagen synthesis: ICS can suppress the synthesis of collagen, which is the main protein in bone and connective tissue. This can also lead to decreased bone growth and density.
Adrenal androgen suppression: ICS can suppress the production of adrenal androgens, which are hormones that play a role in growth and development.

Risk factors for growth suppression by ICS

The following factors may increase the risk of growth suppression by ICS:

Younger age: Children are more sensitive to the effects of ICS on growth than adults.
Higher doses of ICS: Children who take higher doses of ICS are more likely to experience growth suppression.
Longer duration of ICS use: Children who use ICS for a longer period of time are more likely to experience growth suppression.
Prepubertal status: Prepubertal children are more sensitive to the effects of ICS on growth than pubertal children.
Concomitant use of other medications: Certain medications, such as oral corticosteroids and some anticonvulsants, can increase the risk of growth suppression when used in combination with ICS.

Monitoring growth in children on ICS

It is important to monitor growth in children who are taking ICS. This can be done by measuring the child's height and weight regularly and plotting them on a growth chart. If the child is not growing at a normal rate, the healthcare provider may recommend adjusting the dose of ICS or switching to a different medication.

Strategies to minimize growth suppression by ICS

There are a number of strategies that can be used to minimize the risk of growth suppression by ICS:

Use the lowest effective dose of ICS: It is important to use the lowest effective dose of ICS to control asthma symptoms. This can help to reduce the risk of growth suppression.
Use ICS on an intermittent basis: If possible, ICS should be used on an intermittent basis, rather than daily. This can help to reduce the overall exposure to ICS and the risk of growth suppression.
Use a spacer when using ICS: A spacer device can help to deliver more of the ICS medication to the lungs and less to the mouth and throat. This can help to reduce the risk of side effects, including growth suppression.
Monitor growth regularly: It is important to monitor growth in children who are taking ICS regularly. This can be done by measuring the child's height and weight regularly and plotting them on a growth chart.
Consider switching to a different medication: If a child is experiencing growth suppression on ICS, the healthcare provider may consider switching to a different medication, such as a leukotriene receptor antagonist or a long-acting beta-agonist.

Conclusion

Chronic ICS use may have a small but measurable impact on growth and development in pediatric patients. However, the benefits of ICS in controlling asthma symptoms and preventing exacerbations outweigh the potential risks.

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Asthma

Mechanisms of growth suppression by ICS

Risk factors for growth suppression by ICS

Monitoring growth in children on ICS

Strategies to minimize growth suppression by ICS

Conclusion

Sample Solution

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