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.
ICS can suppress growth through a number of mechanisms, including:
The following factors may increase the risk of growth suppression by 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.
There are a number of strategies that can be used to minimize the risk of growth suppression by ICS:
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.