All About Asthma – PediaCast 147


  • Preparing For Adolescence
  • Internet Risks For Teen Girls
  • Transcutaneous Vaccines
  • Asthma Incidence Following WTC 911 Terrorist Attacks
  • All About Asthma – Interview With Dr Kevin Murphy



Announcer: Bandwidth for Pediacast is provided by Nationwide Children's Hospital. For every child, for every reason.


Announcer: Welcome to PediaCast, a pediatric podcast for parent. And now, direct from Birdhouse Studios, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone. And welcome to PediaCast. It is episode 147 for June 8th, 2009. This is Dr. Mike coming to you from Birdhouse Studio. And today we are going to talk about asthma. In fact the title of this program is "All About Asthma… and that's because we have an interview coming up with a pediatric pulmonologist.


And guess what, we are going to talk about asthma. Now if you don't have a child with asthma or you have no interest in asthma, don't fret, we have a news section at the beginning of the show. And actually that is not all about asthma. So I guess the show should really be called "All about Asthma if we have news stories without asthma…, I don't know. Maybe I put too much spot in the title.

Anyway, we do have some interesting news stories for you coming up. But first, the last couple of episodes sort of started out with the movie review and I know it's not a movie podcast but it's a parenting podcast. And one of the things that I really enjoy is, the one with my wife and the kids to the movies.


I think back to my own childhood I really enjoyed going to movie theaters and even though things come out on DVD much sooner than they ever did before, It's still fun to see it on the big screen. And we went with the family a couple of weeks ago, it's a week and a half ago or so, and saw the Disney Pixar movie "Up…. And I have to tell you, I think this is one of my favorite Pixar movies after the Toy Story series of course. But, Up is really good. It's a moving story. I'm sure that there were several people in the theater with tears in their eyes cause it's a moving story of love, commitment, adventure. It's a really great family movie I think. And Ed Asner does a great job. Haven't heard his voice in a while, as the main character. So I highly recommend you see this one with your kids. Definitely two thumbs up for the movie Up, the Disney Pixar movie. Really good one, really, really good.


And not just a fun movie, really there was a message there. So one of those kind of shows that afterward you can kind of talk to you kids about it. See what they got out of it, what you get out of it. Just sort of have a post movie meet up with the family. And speaking of meet ups for the family, I wanted to tell you one other thing. Those of you who have pre- teens at home, it comes a question, what can you do to prepare your child and yourself for the tumultuous teen years that are going to be coming up. And one idea is a weekend getaway with one of the parents. And my wife and daughter did this when Katie was about 12 year old or so. And the basic gist is you go away somewhere fun for a weekend and you do something that you're really going to have a great time doing, that you enjoy together for instance, maybe a fishing trip, shopping trip, going to a theme park or water park.


You just do something really fun for a weekend with your pre-teen. But as part of that weekend, and again this is one on one, one kind, one parent, so two people, not the whole family. And as part of that weekend you discuss expectations for the teen years. You talk about self-esteem issues, peer pressure issues, the whole sex, drugs, rock and roll, you get the picture. How do you that in a natural and unintimidating way. Well, Karen and Katie used a CD series by Dr. James Thompson from Focus on the Family called Preparing for Adolescents. They listen to the CD where they listen to one of the CD's and then they have a discussion then go have some fun. In the evening they get back and listen to another one of the CD's, again have a little discussion, go have some fun. The next day basically do the same thing. So you're not sitting there for hours listening to CD's. You really mix it in with doing something fun, one on one really make it a weekend to remember.


And I mentioned all these because my turn is coming up later this month. My 12 year old son, Nick and I are having a boys weekend and we are going to go through the Preparing for Adolescence series. And to have a great time at a certain Central Florida resort. But this sort of experience is new to me, I'll be sure to let you know how it goes after all is said and done. It went very well for my wife and daughter. So I'm hoping to have an excellent weekend as well. If you're interested in learning more about the Focus of the Family series on Preparing for Adolescence, I'll have a link for you in the show notes so you can look it up yourself and purchase it through the site.

All right, last episode we resurrected the Research Round Up and this week we're going to resurrect the Interview. We haven't done one of those in a very long time. In fact it will be the first interview in the new Birdhouse Studio here in Central Florida. And our interview topic is asthma, as I mentioned in the beginning of the show. All about asthma with pulmonologist Dr. Kevin Murphy, that's coming up in just a little while.


Other topics, we're going to talk about internet risks for teenage girls and also a new type of vaccine. A trans cutaneous vaccine. Which means theres no needles. You just rub the vaccine material on the skin, how well does that work. So we're going to discuss that. And then there is asthma story in the news but this is kind of interesting one. There are more kids with worst asthma because of the 9-11 World Trade Center attack. So there was a research project on that. We're going to discuss it as well in the news section.

Don't forget if there is a topic that you would like to discuss, all you have to do is go to and click on the Contact Link, you can get a hold of me that way. Or you can email or call the voice line at 347-404-KIDS, which translates into 5437. I do have a little bit of a back log on voice mail messages.


So coming up here in a show soon, we will get to several of those voicemail messages. And also there have been a lot of email messages and through the website too. Lots of questions, I'm getting a lit bit behind on them. Keep them coming, we're going to pick the best and we're not going to answer any questions this show but next week show, we will. And this show should start coming once a week again here folks, fingers crossed. They're not crossed to make so I don't have to do it, crossed for hope.

Don't forget the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health be sure to call your doctor and arrange a face to face interview and hands on physical examination. Also your use of this audio program is subject to PediaCast Terms of Use Agreement which you can find at And with that in mind we will be back with News Parents Can Use right after this short break.



Our News Parents Can Use is brought to you in conjunction with news partner Medical News Today, the largest independent health and medical news website. You can visit them online at

A new study demonstrates why parents need to know how their teenager daughters present themselves online. The study published in the June issue of the Journal of Pediatrics, shows that teen girls who would depict themselves online in a provocative way and teen girls with a history of child abuse are more likely to receive online sexual advances and then meet those individuals offline.


Moreover, 40% of all 173 teenage girls in the study reported experiencing online sexual advances and 26% reported meeting someone in person who they first met online. Let me repeat those numbers for you, 40% of teen girls in the study reported experiencing sexual advances and 26% reported meeting someone in person who they first met online. Now parents I know you're thinking, "Nah, not my daughter…, but 40%, yeah it's your daughter.

The importance of parental monitoring of adolescent internet use cannot be understated says Dr. Jennie Noll, a Psychologist at Cincinnati Children's Hospital Medical Center and the study's main author. This is particularly important given that 55% of adolescent internet users have or are currently using social networking websites.


Dr. Noll studied girls between the ages of 14 and 17, each was asked to create an avatar, an electronic image to represent herself and complete a questionnaire regarding her computer and internet usage, sexual attitude and activities, substance use, involvement with peers, and presence of maternal and paternal care givers. The avatars they created were evaluated based on previously defined categories spanning a continuum from conservative to provocative depending on such factors as bust and hips size, upper body clothing, lower body clothing, and piercings. Those who depicted themselves as provocative in terms of body and clothing choices were more likely to have had online sexual advances. In addition to choosing a provocative avatar, other risk factors for online sexual advances includes substance abuse and being preoccupied with sex and sexual thoughts.


Associating with high risk peers was an additional risk factor for in person encounters. The proteus effect, where the idea that one's presentation of oneself can affect the behavior or the presenter as well as the receiver has important implications in this age of wide reliance on internet use, where users can portray themselves in a multitude of fashion said Dr., Noll. Self presentation can change the way internet users interact in a manner that increases the risk for online sexual advances. Your behavior can change based on how you present yourself to the world. It isn't just naïve kids who are vulnerable, those who chose to present themselves as sexually sophisticated are particularly vulnerable to those who would choose to be exploitive of such self-descriptions. The presentation of oneself in a provocative manner however is not necessarily limited to websites that rely on avatar as the primary interface. For female adolescents in particular, self-presentation such as compilation of photographs and narrative descriptions of networking sites such as Facebook and My Space might also increase their vulnerability according to Dr. Noll.


Some adolescents include content on their social networking pages that is alarmingly provocative and revealing and this are the snap shots that are revealed publicly for all to see. Those adolescents who may be unaware of how their appearance might be perceived, may not from a developmental perspective possess the social sophistication necessary to field and ward off sexual advances in ways protect them from sexually explicit suggestions, she says, this maybe in particularly important lesson to conveyed a female adolescence who are especially vulnerable to exploitive and victimization. Such as those who have been victims of childhood abuse. Parents can play an important role in preventing exposure to online sexual solicitations according to Dr. Noll who found the care giver presence was associated with significantly fewer reports by adolescence of online solicitations.


For example, she says, parents should emphasize to adolescence ways to ward off sexual advances and explain to them how virtual self-representations can influence behaviors and perceptions. Primary care physicians too should consider asking teen patients about their internet use as an aspect of comprehensive care. Not enough people are talking about how teens are being pro-active and putting themselves out there for public consumption. Dr. Noll says, in any respects, reacting to normal or just in curiosity about sex is a large part of normative adolescent development but doing so via virtual personas or provocative self-describers in social networking worlds may not be the healthiest or most safe avenue by which to explore.

Moving on, an experimental vaccine applied to the surface of the skin appears to protect against certain type of ear infections, Scientist from the Research Institute at Nationwide Children's Hospital in Columbus, Ohio reported their findings at the 109th General Meeting of the American Society for Micro Biology in Philadelphia.


"Our data is the first to show that trans cutaneous immunization is an effective way to prevent experimental ear infections and lays the foundation for an effective and yet simple, inexpensive, and potentially transformative way to deliver vaccines… says Laura Novotny, one of the study researchers. Nontypeable haemophilus influenza is one of the three main bacterial causes of otitis media, an infection or inflammation of the middle ear. Otitis media is one of the most significant health problems for children in the United States costing approximately $5 billion annually. It is estimated 83% of all children will experience at least one ear infection prior to 3 years of age. Currently infections are managed with antibiotics. However, the emergence of antibiotic resistant microorganisms is of concern. Surgery to insert tubes to the tympanic membrane relieves painful symptoms but the procedure is invasive and requires the child to be under general anesthesia which has risks thus it is necessary to develop different ways to treat or preferably prevent this disease.


"We've designed several vaccine candidates which targets proteins on the outer surface of this bacterium. Previous works in our labs showed that after immunization by injection, each of the three vaccine candidates prevented the experimental ear infections caused by nontypeable haemophilus influenza. In this study we now wanted to test an alternative but potentially equally effective method to deliver a vaccine", says Novotny. The method known as transcutaneous immunization involved placing a droplet of each vaccine on to the ear and rubbing it on to the skin. In this study four groups of chinchillas were immunized with one of the three vaccine candidates and the fourth group received a placebo. Each vaccine was placed on the ears of the chinchillas once a week for three weeks, all animals were then inoculated with nontypeable haemophilus influenza through the nose and directly to in the middle ears.


Animals that had received the vaccines, the transcutaneous vaccines were able to very rapidly reduce or completely eliminate nontypeable haemophilus influenza from the nose and the ears, the animals that received the placebo did not.

So there's really hope here for development of transcutaneous vaccines that do not require needles, that would just be fantastic, wouldn't it.

Research conducted seven years after the terrorists attack on the World Trade Center in New York City found that children attending the socio economically and ethnically homogenous elementary school closes to ground zero have high rates of self-reported asthma, an airway obstruction. This research was presented in May at the American Thoracic Society's 105th International Conference in San Diego. Our Stoney Brook team found that the children who lived near the World Trade Center and were present at the time of 2001 attacks had a higher rates of self-reported asthma than those living further and ethnically matched controls from New York City, says the author, Dr. Anthony Zima, who is Assistant Professor of Medicine and Surgery at the State University of New York, Stoney Brook School of Medicine.


This may potentially indicate that the higher rates of new cases of asthma following the World Trade Center attack persisted, suggesting that the plum immediately following the attack precipitated chronic respiratory ailments. The same researcher found that on year following the World Trade Center attacks, asthmatic children ages 5 to 12 years old who were living near ground zero at the time of the attacks show clinical signs of worsening asthma including reduced peak expiratory flow rates, increased number of asthma medications for child and more asthma clinic visits. Additionally, they have found new cases of asthma among children increased 50% in the wake of the disaster. For the most recent study, Dr. Zima, along with colleagues from the New York State Department of Environmental Conservation in Stonia Brooke medical students, collected questionnaires and spirometry data on 202 children who had lived and attended school in the area at the time of and since the attacks.


Dr. Zima's team took ear samples to investigate the level of current urban ambient pollution including 2.5 micron particulate matter as a surrogate for diesel exhaust. And also levels of dust mites allergen and other indoor aero allergens at an elementary school near Ground Zero. The researchers also found high levels of PM 2.5, that's the 2.5 micron particulant matter, measured on the roof of the schools, indicating unacceptable high levels of urban ambient air pollution. Surprisingly, indoor aero allergen exposure to rat, cockroach, dust mites antigen, cat and dogs were essentially negligible. Exposure to these indoor aero allergens as well as parental smoking cannot account for acute exposure leading to airway obstruction in these kids.


Our estimates of asthma incidents are open to the criticism that we lack evidence of reversibility of airway obstruction, acknowledges Dr. Zima, but our data do show that China Town asthma rates are still higher than among other groups. 29% versus the New York City reference rate of 13%. Our study raises the possibility that high air pollution levels may account for increased asthma incidence. It is possible that exposure to various toxins released by the World Trade Center attacks accentuated the effects of subsequent exposure to urban air pollution. Future directions for this research, continuing to assess this and other control populations further away in Queens by utilizing impedance oscillometry as a more sensitive gauge of airway obstruction for long term follow up. Short cuppings or yet to be addressed issues may be clarified by further exploration.


So, really when you think about this, the kids who live near Ground Zero have a 29% incidence of asthma compared to 13% for the rest of New York City. So there is definitely more asthma in the group around Ground Zero. Now, when they said that one of the criticisms is that they lack evidence of reversibility of airway obstruction, all that means is, OK, so there is a higher percentage of asthma but did we really prove that it's worse asthma than is elsewhere. Cause we didn't really do that. Of course it was all by self-report. So if the kid or the parent said they have asthma, they took that as yes they have asthma, so it didn't necessarily have to be diagnosed by a doctor. But I think this is all interesting as we learn more about asthma and what sort of things contribute to it. And do certain exposures when you're young, of course they may make you wheeze at that time but do they make it more likely that you'll have chronic asthma compared to other kids or is that all just a genetic thing.


And this is showing that the environment that you're in when you are young may have an effect on long term, whether you'll have asthma or not, not just genetic, so. I think it's an interesting study. Speaking of asthma, we are going to take a short break here and we will be back with Dr. Kevin Murphy, a pediatric pulmonologist, and we are going to talk all about asthma and that's going to happen right after this short break.




All right, today we are joined by Dr. Kevin Murphy, a pediatric pulomologist, and Director of Allergy, Asthma and Pulmonary Research at Boys Town National Research Hospital in Omaha, Nebraska. He also serves as Clinical Professor at Pediatrics at the University of Nebraska Medical Center and Crayton University School of Medicine in Omaha. Dr. Murphy is the Founding Board member, Chairman of the Medical Review Board and current Vice president for Attack on Asthma Nebraska, which is a non-profit organization that provides comprehensive asthma and allergy awareness, education and medical treatment to schools. He also authored multiple published manuscripts including a program that place life saving asthma medications in every school in Nebraska. And a newly published children's book aimed at teaching kids with asthma more about their disease. Today, Dr. Murphy joins us in PediaCast to discuss the ins and outs of pediatric asthma, welcome to the program, Dr. Murphy.

Dr. Kevin : Thank you very much. Glad to be here.

Dr. Mike Patrick: Great. So let's jump right into it and just talk about, what exactly is asthma?

Dr. Kevin : Asthma is an entity where there is reocurring multiple symptoms that parents and any physicians can easily recognize which is shortness of breath, cough, wheezing, exercise intolerance. Those symptoms are caused by narrowing of the airways which is typically a result of airway inflammation. And in children with asthma, one of the definition is those symptoms and narrowing of the airways is reversible. And so we commonly think of asthma as reversible obstructive airway disease or ROAD. And so what we think about children with asthma, they have narrowing of their airways caused by various precipitants that is reversible either by changing their environment, avoiding allergic triggers or using very good supplements and simple state medications.


Dr. Mike Patrick: Right. Now at what point do you call it asthma? A lot of parents, you have a child who's wheezed a couple of times and maybe they've used medicine to reverse it. At what point do you actually call it asthma? I say this because a lot of parents if you asked them, did your child have asthma, and they don't know how to answer that question.

Dr. Kevin : Well, a very important question and what I'd like to help families and physicians with this. That asthma is just not one picture. So if you're just having an occasional episode of cough or wheezing, that typically is not asthma. Because asthma is reoccurring, wheezing cough, short breaths and exercise intolerance. And if you're having re-occurring symptoms or chronic cough especially at night, it is more than likely, I bet you have asthma and there may be other reasons for those symptoms. You need to make sure that there is not an infection or other triggers of those symptoms. But if you're having re-occurring symptoms, especially those reoccurring symptoms that are very responsive to asthma medications, then that defines for a child with asthma.

Dr. Mike Patrick: OK. Now, tell us what exactly is happening in the airways with asthma. What causes this obstruction?

Dr. Kevin : Well, there is in the airways inflammation. And that's the inflammatory cells that individuals who have this disease causes airways swelling and because of inflammation, in the same way that if we have swelling around our joint, you could easily see that inflammatory cells going into your wrist through your hand. You would actually see the swelling that occurs. We can't see this because it's in the airways but we know that in children that there is this airway inflammation, and the inflammation results in airway swelling and then because the swelling occurs you have narrowing to the airway passages and then again the symptoms that we've talked about, re-occurring wheezing, cough and shortness of breath.

Dr. Mike Patrick: Sure. And what causes this inflammation in the airways?


Dr. Kevin : Multiple cause for inflammation. One is that certain individuals, and it's very common in children have a genetic predisposition to have airway inflammation. And then you can make your list of common causes that makes this inflammation worse. Allergies are very high on the list. Infections, specific triggers including exercise, irritants such as dust and wind are also triggers that can affect the airway inflammation and cause swelling of the airways.

Dr. Mike Patrick: OK. Now, once you have the swelling there, how do you go about making the swelling go away and treating the symptoms.

Dr. Kevin : Well, there is a couple of ways to do that. And there are two general classes of medication that help the symptoms. The first is, we refer to as quick relief bronco dilators, which work best to treat the wheezing and the shortness of breath when they occur with an allergic exposure or with exercise. And that's the acute relief. The important part about asthma treatment is the long term maintenance medications, which included corticosteroids which help prevent or reduce the airway inflammation that results in the swelling. So there is two approach, this one is quick relief when you're having symptoms and a very important corner stone if you will, the treatment and that's the use of anti-inflammatory therapy directed to the airway inflammation and the corner stone of that will be inhaled corticosteroids.


Dr. Mike Patrick: OK. Now the bronchodilators that you are talking about, things like albuterol and Xopenex, so those don't actually decrease inflammation? How do those work?

Dr. Kevin : That is a very important distinction because those medications, the quick relief medications such as albuterol and and Xopenex, those are just medicines that take down the swelling and they're quick relief medications and they don't directly affect the inflammation. And so thus the term quick relief, they will decrease the swelling in the airway but it's not long lasting.

Dr. Mike Patrick: Right.

Dr. Kevin : It's not a long term medication. And I always sort of use the term that airway inflammation is the quite part of asthma and that for the long term care and treatment of asthma that anti-inflammatory therapy inhaled corticosteroids directs, is directly at the inflammation and the airway swelling to take down a relief that over the long term as compared to the quick relief bronchodilators that you mentioned.

Dr. Mike Patrick: Sure. This is a really important distinction for parents, isn't it? Because if they don't understand that, they just grab the inhaler and they happened to be corticosteroid, and their kids is having a bad asthma attack, that can be disastrous.

Dr. Kevin : It is a very important distinction. And I'm glad you brought that up because it really is important for parents and families to know that the quick relief medication is something that will immediately reverse the airways. But the long term maintenance medications won't. So it's very important for families and parents to know the distinction between those two medications. And also the importance of the long term maintenance medication needs to be used every day for it to be effective.

Dr. Mike Patrick: Right, even when they are not having symptoms.

Dr. Kevin : Even when they are not having symptoms and important is that it should be used everyday to avoid the need for quick relief bronchodilator or Xopenex, Proventil, Ventolin medications which is a marker, the less you use of the quick relief bronchodilator, the better controlled your asthma is, the better control of your airway inflammation is. Because you don't need the quick relief medications.

Dr. Mike Patrick: Right. The quick relief medications, the bronchodilators, there is several different ways those can be administered. Do you have any preference, metered dose inhaler versus being done with the nebulizer or the inhaler with the mask with younger kids. Do you have preferences, do you think one delivers the medicine better than another?

Dr. Kevin : Well, we know that either medicines, either nebulized or deliver via inhaler as some of the kids referred to them as their puffers, are both effective if they're used properly. I will tell you that in the younger child, coordinating the correct technique with the inhaler or as the kids referred to as their puffer. It's very important that they have the correct technique or may need to use a spacer device which is a spacer that allows you to spray the medicine into the spacer and then allows the child to then take a breath in without having to coordinate the spray and the breath at the same time. So that's another good option if a child does not have appropriate technique with their inhaler, they can use a spacer that allows them to spray the medicine into the spacer and then inhale the medicine without having to coordinate spraying and inhaling at the same time, which is another effective way to deliver a medication in children with asthma. It does allows us to have children received nebulized medications inhalers either with or without a spacer depending on their technique.


Dr. Mike Patrick: Great. Now, in terms of the chronic treatment of the underlying control of it, we talked about inhaled steroids, what about, is there any oral medications that can be used for that?

Dr. Kevin : You know there are oral medications, they're commonly referred to as second line therapies. They're very effective and they're medicines that work on the allergy cells if you will. But they're typically once or twice a day. And they are effective in children who have milder disease that are affected. But not as effective for not as preferred as the long term inhaled anti-inflammatory therapy which are the inhaled corticosteroids.

Dr. Mike Patrick: One thing that parents often asked is you hear bad things about steroids in the news and you think if my kids is going to be in this inhaled steroid for a really long period of time, are there any negative effects on that?

Dr. Kevin : We have learned so much about the long term safety, as well as long term effect of inhaled corticosteroids. It is interesting that we actually find that children over the long term actually have better outcome and regard to safety issues, particularly growth, which is often a concern, I don't want my child's growth to be stunted because they're on this inhaled corticosteroids. But what we find is that children with poorly controlled asthma as compared to children with well controlled asthma on inhaled corticosteroids. The children grow better and function much better on inhaled corticosteroids compared to those children with asthma who are not treated appropriately with inhaled steroid. So we find that inhaled corticosteroids are very safe but especially very effective in controlling airway inflammation.


Dr. Mike Patrick: Because uncontrolled asthma can affect growth as well.

Dr. Kevin : It can. It's very interesting that it can affect growth and it also can result in more frequent needs of the use of oral steroids which certainly can affect growth.

Dr. Mike Patrick: Right.

Dr. Kevin : And then, a certainly poorly controlled asthma results in a very deal of disruption in family life affecting sleep, affecting performance in school, the need for physician visits, emergency room visits or hospitalizations.

Dr. Mike Patrick: Right. Now I know one of the things that you've been really active is advocating for kids in school systems in dealing with their asthma. What is your take on that? Do you think that kids should be able to carry their own inhalers with them or is it the medicine should be available in the office, and then if you think they should them carry with them, what's the youngest age which kids can carry a metered dose inhaler and be responsible for using when it's needed.

Dr. Kevin : I think it's very, very important that the children with asthma who can use their inhaler on their own are educated about their asthma, be able to carry their medicine.


Dr. Kevin : Because when they need their medication for a relief of airway obstruction, they really need it now versus waiting to get back to the school from the playground or from gym class to the office to get their inhalers. I think it's very important. Now, it needs to be a child who is old enough, and is responsible enough and knowledgeable enough to know when to use their inhaler. And also, to be able to keep their inhaler with them and remember to have it with them. So typically, it's usually the child who is in the upper grades, certainly all high school children should be able to carry their inhaler. And I would say children in the 5th, 6th, 7th and 8th grade, one you consider with their parents and their physician and the school whether it's appropriate for them to carry their inhaler. Because there may be some young children who have been dealing with their asthma since a year or two of life and the family says if well and are very in tuned and when to use their inhaler, how to use it and those children should really carry it with them. So what I suggest is that one being availability of being able to carry your inhaler should occur in all schools. And that physicians and families in schools should work together to decide whether it's appropriate for that child to carry their inhaler.

Dr. Mike Patrick: Sure.

Dr. Kevin : But, they should all have the opportunity to have their inhaler with them.

Dr. Mike Patrick: Great. In terms of, sort of going back to the home side of it, if you are a kid with asthma and you're using your regular chronic controlled medicine and inhaled corticosteroid, what kind of things monitoring wise, at home can you do to know that you're getting ready to have an attack, maybe sort of to hit it off with the pass. What do you suggest for parents to do to monitor their kid's asthma at home.


Dr. Kevin : I suggest that and ask families who have children with asthma that they have available, what we referred to as asthma action plan. And what that is, it outlines for the family, one, their day to day medications. What the child should be taking on a day to day basis for treatment of airway inflammation and control of asthma. The second part of the asthma action plan is what the child and the family should do if the child develops worse scenes symptoms of asthma. So, on a spring day, or it is windy or rainy or there is a lot of allergy in the air. And they're playing on the playground or they're at home shooting baskets in the driveway and they developed worse symptoms of asthma, that the family and the child, they have an action plan to increase medications than using quick relief medications and having the plan to intervene to improve worsening symptoms of asthma. And that includes use of medications, someone to contact including their physicians, if they're having worsening symptoms. And if they're not responding to their action plan, then they have a plan to be seen either in their physician's office, emergency room or at the hospital.

Dr. Mike Patrick: OK.

Dr. Kevin : Very important part about that care of a child with asthma.

Dr. Mike Patrick: Do you believe in peak flow meters or do you think those are over relied on. Some of the good thing are not necessary.

Dr. Kevin : I think peak flow meters are very helpful in a select group of children. And especially children who have allergic disease, sinus disease and asthma. And who can have reoccurring episodes of cough.


Dr. Kevin : And it can be very helpful for the family to determine whether the symptom of cough is due to asthma and then their peak flow which is a measurement of airway's obstruction would be decreased. Or if their peak flow is normal, that would suggest that it is not their asthma is the reason for the cough but maybe worsening allergic of airway symptom with nasal draining. So in that group of children, it can be very helpful. The more severe asthmatic, who rapidly becomes ill. If you could monitor peak flow, it allows you to detect hours before they are having worsening symptoms of asthma. A drop in their lung function showing that their developing airway obstruction. Thus allowing the family as part of their asthma action plan to intervene early the treatment of worsening symptoms of asthma. I think in those two groups of children, they're very helpful. Otherwise, I think families are very good in identifying worsening symptoms of asthma and allows them then to use their asthma action plan to intervene.

Dr. Mike Patrick: Great. Now, you're a pediatric pulmonologists. There is a lot of kids out there with asthma who are just followed by either their regular pediatrician or maybe a family practice doctor. Do all kids with asthma need to see a pediatric pulmonologist, if not, at what point should such a referral take place?

Dr. Kevin : All children do not need to see an asthma specialist whether that's a pediatric pulmonologist or an allergist. I feel that pediatricians and family physicians do a very, very good job in monitoring and caring for children with asthma. My suggestion to families is that if your asthma is not well controlled, if you're needing to use your inhaler 3 to 4, 5 times a week, if you're needing to be seen ,


Dr. Mike Patrick: You're talking about the rescue inhaler, right?

Dr. Kevin : Yeah, the rescue inhaler, yes. If you're needing that more frequently. If you're not sleeping well through the night. If you're having exercise and thought all of these things which point to asthma that's not well controlled. Now, I think it can be very helpful for an asthma specialist to help with the care. Because they can look at a child lung function, do an allergic evaluation if it's needed. And then help the family and the referring physician in regard to the treatment of that, that is not as well controlled, for asthma that is not as well controlled. So I think those are circumstances where it's very helpful for a specialist to be involved with the care of a child with asthma.

Dr. Mike Patrick: Great. I understand that you've written a book about asthma in children's book, is that correct?

Dr. Kevin : I shelf a book called "Breathless Bethany Buttercup…, and it was in great part and the person who deserves the credit is Nancy Sander who is the President and Founder of Allergy and Asthma Network Mothers of Asthmatics which is a wonderful support group that they have a tremendous website that I can give to you that is a great resource for families who have children with asthma. But I did helped with the medical consultation and review. But it's a very nice book for families who have children with asthma, outlining the difficulties children can have and how evaluation and treatment can really change their lives.


Dr. Mike Patrick: Is the book, is it geared toward the parents or more toward the kids or for both?

Dr. Kevin : It's for both. It is definitely geared for the kids. It's because it's a description of Bethany Rose Buttercup who loves to be active and to play like all kids do. But because of her asthma, she's not well controlled and can't do the things that she would like to. And then it proceeds to talk about how seeing her physician and being started on anti-inflammatory therapy and asthma action plan changes her life. And so it's directed at both. But clearly something children with asthma can understand.

Dr. Mike Patrick: Great.

Dr. Kevin : It's very well done by Nancy Sander and her group at Mother of Asthmatics.

Dr. Mike Patrick: Great. And is the book available through their website?

Dr. Kevin : Yes. And it's free, and it was sponsored through an educational grant by Schering Plough who is involved with this important educational piece. And through their website which is

Dr. Mike Patrick: Great. And we'll put a link to that in the Show Notes so the listeners can find it easily.

Dr. Kevin : That will be great. It's free and it's very nicely done.

Dr. Mike Patrick: Great. And the website has other things too, support information and ,

Dr. Kevin : Support information, discussions about use of medications, treatment of asthma in school, support groups. So it's a great link for families who have children with asthma.


Dr. Mike Patrick: Great. Well, Dr. Murphy, we really appreciate you stopping by PediaCast to talk about childhood asthma with us. Thanks so much.

Dr. Kevin : Listen, thank you for taking time and including this in your program and I appreciate all you do with your PediaCast.

Dr. Mike Patrick: Great. Thanks so much.

Dr. Kevin : OK. Thank you.



Dr. Mike Patrick: All right, thanks go out to Dr. Murphy, stopping by and talking with us about asthma, we really appreciated that. Also thanks to Nationwide Children's Hospital for helping us out with the bandwidth for the program today. Medical News Today, for helping us out with the news department, and of course, Vlad, at He helps us out with the artwork at the website. And most of all, thanks to you, the listener, for coming back and joining us, we really appreciate all that you do. We have had lots of people participate in PediaCast through their questions through topic suggestions. Sending us along research articles, news articles, we appreciate all of that. And also we appreciate donations. There is a lot of cost that goes into developing PediaCast. And if you'd like to support us financially, please go to and click on the donate button and it will take you a place where you can find information on how to help us out with the program.


Also I want to take the time to thank my family, because this program does take a lot of time away from the family in terms of research and putting the shows together and recording them and doing the post production and all of that business.

Reminders, don't forget iTunes reviews are helpful, if you have not taken the 30 to 60 seconds it takes to write one. If you could just go to iTunes and leave us a review that will be appreciated. We also have a listener survey at which helps us with demographics for the audience. Don't forget your questions comments topic requests are always welcome. You can find us at Contact page at or email or call the voice line at 347-404-KIDS. That's 347-404-5437. And until next time, this is Dr. Mike saying stay safe, stay health and stay involved with your kids. So long everybody.




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