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Seasonality is often overlooked in Childhood Asthma

September 17, 2015

Asthma is a commonly overlooked condition affecting 10% of the nation's children. The article below is by David Staczak from MDSpiro the nations leading provider of Spirometry products to primary care and occupational health clinics. It is critical to the management of childhood asthma that objective lung function studies be conducted. Also the use of a spacer in the provision of inhaled medication is a big help in treating these children. I have posted below a few statistics about asthma from the Asthma and Allergy Foundation. I am very interested in your thoughts on this important article.

  • Approximately 25.9 million Americans suffer from asthma (8% of adults, 10% of children), and asthma affects over 230 million people worldwide. The prevalence of asthma has been increasing since the early 1980s across all age, sex and racial groups.1
  • Asthma is the leading chronic disease among children and the leading reason for missed school days.9
  • Asthma is more common among adult women than adult men.1
  • Asthma is more common among boys than girls.1
  • Asthma is more common among children (1 in 10) than adults (1 in 12).1
  • Nearly 7.1 million asthma sufferers are under the age of 18.2
  • In 2011, the asthma prevalence rate for African Americans was 47% higher than for Caucasians.2
  • Asthma accounts for almost 2 million emergency room visits each year.3
  • Each year, asthma accounts for more than 14 million doctor visits and 439,000 hospitalizations.4
  • The average length of stay (LOS) for asthma hospitalizations is 3.6 days.5
  • Asthma is the third-ranking cause of hospitalization in children.3
  • African Americans are three times more likely to be hospitalized from asthma.6 


Why Fall is the Worst Season for Children's Asthma


Fall and winter are the worst seasons for children with asthma because they become exposed to many more respiratory viruses as school resumes and they return to classrooms, Dr. Piedimonte says.

He warns parents and other doctors that children’s asthma may flare up in late August and September because of two key factors:

1.    Viral infections are more prevalent in the community, and that continues into the fall and winter.
2.    Children return to school and are in close quarters with other students with viruses.

“The fall/winter season is when we experience a very significant increase in asthma attacks,” says Dr. Piedimonte.

“That’s because viruses become highly prevalent in the population and typically cause upper respiratory infections. This, in turn, triggers asthma attacks.”

Throughout the changes of the seasons, children may have various allergies, depending on pollination and the blooming of various flowers and grasses. Allergic reactions can also spark asthma attacks, alone or in combination with other environmental factors like viruses and indoor and outdoor pollution.

Viruses are the real culprits
However, during the summer season, there are fewer asthma attacks because children are not exposed to as many potential viral infections and spend less time in the more densely populated school setting.

While some children and adults may suffer because of higher levels of humidity and pollution in the summer, the fall/winter season remains the most challenging because of the increase in exposure to viruses, Dr. Piedimonte says. Studies show that viruses cause more than 80 percent of asthma attacks, he says.

Here’s the usual progression, according to Dr. Piedimonte:
•    For the first three to five days, a child has an upper respiratory infection (URI), with a runny nose, congestion, sneezing and, sometimes, a low-grade temperature.
•    During the URI, the virus may spread down to the lower airways.
•    That generates inflammation and triggers obstruction of the airways, which are more reactive (“twitchy”) in children with asthma.

How should you best manage the asthma?

There are several steps you can take as a parent to reduce or prevent a viral-related asthma attack.
1.    Make sure the child washes his or her hands. It’s best if they do this on a regular basis because most of the viruses that cause problems are primarily spread through contact with infected hands, e.g., rubbing the nose or the eyes.
2.    Teach children not to rub their noses, mouths or eyes with their hands. This can be a challenge, but if they can avoid rubbing, it may prevent infections through viruses on their skin.
3.    Avoid areas where there are large numbers of people. While this is not always easy and won’t totally prevent your child from getting sick, it will reduce the chances of picking up a virus outside of school.
4.    Make sure the child always has an albuterol MDI, even if he or she has mild, intermittent asthma. This is especially important at school and usually offers immediate relief for wheezing and coughing from an asthma attack.

“All of these practices are particularly important for children who have had episodes of wheezing in the past and, therefore, are predisposed to have recurrent episodes of wheezing,” Dr. Piedimonte says.

Managing more serious types of asthma
Children with mildly, moderately or severely persistent asthma require corticosteroid medication given through metered-dose inhalers (MDI) with spacers, says Dr. Piedimonte.

“Parents should discuss with their child’s physician the safety and effectiveness of any medications they give them,” he says. “But it’s also important to learn the correct way to deliver those medications.

“For example, without using a spacer device with the MDI, most of the medication will not reach beyond the child’s mouth and throat, so the therapeutic effect on the lungs will be very limited and the side effects will be magnified.”

What are the side effects of these medications?
The side effects of albuterol, used for decades to manage asthma, are similar to those of adrenaline, which has similar molecular composition.

Albuterol tends to increase the heart rate and prompt some tremor, palpitations and hyperactivity, but that is usually well-tolerated, according to Dr. Piedimonte.

Some studies show that corticosteroids, which are the most powerful medication for the control of chronic asthma to date, may inhibit a young child’s linear growth. In other words, they can slow the speed of growing taller, especially in the first year of therapy. Although children tend to catch up after that first year, their final adult height may still be slightly less than those not receiving steroids.

“With children who have moderate and severe asthma, this risk is balanced by the fact that these children need to have the anti-inflammatory therapy to reduce the frequency of their attacks, prevent a faster decline in their lung function and improve their quality of life,” Dr. Piedimonte says.

He says if asthma is not treated appropriately, it may require frequent visits to the doctor’s office or emergency department, and it can even result in hospitalizations.

“It can interfere with sleep, sport activities, school performance, and overall quality of life, and it may be followed by chronic deterioration of the child’s pulmonary function over time.”

He says it’s paramount that people understand how important it is to manage asthma in children. “It should not be forgotten that asthma is a potentially life-threatening condition,” he says.


After children head back to school, they go straight into peak virus season. If your child patients have asthma, this can exasperate the condition. It’s important to anticipate heightened symptoms and have a plan in place, says Giovanni Piedimonte, MD, Institute Chair for Pediatrics and staff physician for the Cleveland Clinic’s Center for Pediatric Pulmonary Medicine.

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