/7/ WISC :. ICAAI Symposium Highlights of Airway Diseases Pediatric Asthma in India Dr.H. Paramesh MD, FAAP(USA), FIAP,FIAMS, FIAA, FCAAI Director. Pulmonologist, Environmentalist, Lakeside Hospital, Bangalore Chairman I.A.P Resp Chapter (Past) Best Chapter Awardee Founder Chairman I.A.P. Environment and Child Health group Founder Chairman I.A.P Allergy and Applied Immunology Chapter Member National Task Force on Asthma Member International Consensus on (ICON) Pediatric Asthma - Flow of Talk Need for ICON on Asthma Magnitude of the problem - Historic, Asia Pacific - Indian and Bangalore Urban and Rural Children Age Distribution Gender Distribution Presenting Symptoms Co morbidities Challenges Conclusion Need for ICON in Childhood Asthma Many guidelines/consensus documents vary in scope/methodology/focus/exclusivity in pediatric Asthma Pediatric asthma presents challenges not seen in adults: Pathophysiology Developing immune system Natural history Variable response to medications Developing respiratory system Uncertainty in diagnosis Lack of good evidence Adolescent rage of age International Collaboration of Asthma, Allergy and Immunology (ICALL) was formed under EAACI, AAAAI, ACAAI and WAO to critically review the existing guidelines globally World-Wide Increasing Prevelence of Airway Allergies in Children ALLERGIC RHINITIS 89 8. cases over 9years (John Bostock) around -% ASTHMA 9. PREVALENCE -%. PREVALENCE -% United airway concept Asthma in Asia Pacific Area Singapore.% (97) % (99) Goh D.Y. et al. Thailand.% () Vanhyonond et al Indonasia (Sabang) 9.% () Sundaru.H Malaysia yrs.8% () Yousuf.M.O Wiqar.A. Shaikh Priniples and Practice of tropical. All. And Asthma, Philippines yrs 8.% () Roa.CC et al Prevelence Studies on Childhood Asthma in India Cities Year Age Prevelence Author Patna 9-9.% Viswanathan et al New Delhi 998 -.9% Chhabra et al Cities 997-8% I S A A C Chandigarh 9 -.% (B) Gupta et al.9% (G) Chennai < 8% Chakravarthy et al Lucknow 7.% Aswathi et al.% Bangalore to % Paramesh. H Bangalore < 8.7% Paramesh. H Sunil K. Chhabra. Ind.J. of Pediatrics SS.No : S - Paramesh. H Ind.J. of Pediatrics SS.No :. S.
/7/ Trends in Asthma Prevalence in Bangalore 9.%.7%.%.% Prevalence of Persistent Asthma 9%.% 8.% 8.%.% 9.%.7% *.% 9 9%.% 979 98 989 99 9 H. Paramesh; Indian Journal of Pediatrics; Special Issue, * H Paramesh International Conf on Environment and health Intermittent Asthma Persistent Asthma Dr. H. Paramesh, Indian Journal of Paediatrics: Special Issue * H.Paramesh International Conf on Environment and health Persistent Asthma Grades and Prevalence Asthma urban / rural children & semi rural children Age - years Urban children suffer more asthma than rural H.Paramesh. Ind. J. Ped * H.Paramesh International Conf on Environment and health H. Paramesh Ind. J. of Ped * Dr. H. Paramesh, E Cherian International Conf on Env & health Prevalence of Asthma In Children Under yrs Children of heavy traffic school areas suffer more from asthma it further increases in low socioeconomic children.% No.7 (.%).%.%.%.%.% No. (.%) No.7 (9.%).% H. Paramesh. Ind. J. Ped H. Paramesh Bhaves Textbook of Adolescent medicine.% Schools in low traffic regions Schools in heavy traffic regions P. Value I, II & III <.. H. Paramesh, Indian Journal of Pediatrics Schools in heavy traffic with low socio economic status
/7/ Changing Seasonal Pattern of Asthma Episodes.8% 9.7% 8.8% 99 P Value. P Value. Summer Season Dr. H. Paramesh: Asthma in children: Seasonal Variation Intl Jour of Env Health 8 Vol, nos / E.R visits for Wheezing During (Light) Festival increased by % P Value :. H Paramesh th Intnl conft env & health So levels ( in ppm ) - Mean Changes in So Levels (ppm) Before During After Before During After Ambient SO levels reached values times above the safety limits recommended by WHO Ventilation & Asthma no - 8 Cigarette Smoking Parents V/s Asthma Prevelence in Children no - 8 The prevelence of asthma in ill ventilated house is nearly times more % P=<. % Nearly fold increase in asthma in a home with tobacco smoking parent % 8% % %.8% P=<. % 8.% P.8 P. WELL Ventilated ILL Ventilated Smoking Non Smoking Paramesh H Cherian E th International Conference on Environment and Childrens health Paramesh H Cherian E th International Conference on Environment and Childrens health Cooking Fuel V/s Prevelence of Asthma in Children Asthma v/s Dietary Habits No 8 % % % % % % % % % % % 8.8% 7.8%.% No 8 There is nearly times more asthma with the use of non commercial cooking fuel. 8.%.%.% 8 8.% 7.9% 9 P<. Dung Cakes P<. Agri Waste P<.... Firewood Kerosine Gas Electricity Veg P<.8 Non veg P<. Paramesh H Cherian E th International Conference on Environment and Childrens health H. Paramesh
Toddler School Pre Schooler /7/ Gender/Asthma M:F =.8-. % Asthma / Indoor air pollution rural children Year, No 9, Age - yrs, Ratio M:F :. Symptoms of Asthma 9% 9.% 8.% 7% 7.%.% 8.%.%.%.8% % %.%.%.%.% %.% Total Boys Girls Source - H. Paramesh, E. Cherian. Ind. Joul of Pediatr Cough Wheeze Vomiting Abdominal pain Chest pain H.Paramesh Ind. J. of Pediatric. Aero-biologicals Dust mite - % /g Cockroach -.% Fungi Pollens - 7.% Pets -.% ().7% () Viruses -.% Respiratory Allergy Triggers o RSV o Para influenza o Corono o Adeno o Rhino Food - 9.9% Cigarette smoke o 99 -.% o - 7.% o - 7.9% Mosquito Coil -.% - 7.9% Other smokes Formaldehyde Irritants Volatile organic compounds H. Paramesh Indian Journal of Pediatrics, 9 8 7 Allergic Rhinitis: Magnitude. 99 7. Non Asthmatics Asthmatics 7 8.7 99. H Paramesh Prevelence of Snoring/OSAS Sleep disorder breathing (SDB) & Causes 8 7 7 8%.% No = 9 Age = -7yrs...7 No = 9 8% of children had SDB Adolescent 7.9 Allergic Rhinitis = 8% Adenoid Hypertrophy = % Asthma = % Adenoid Hypertrophy = 7.9% &Asthma Adenoid Hypertrophy, =.% AR & Asthma Primary Snoring OSAS H Paramesh. Pankaj Sharma OSAS and DNB thesis Study S l e e p D i s o r d e r e d b r e a t h i n g H Paramesh. Pankaj Sharma OSAS and DNB thesis Study
/7/ Challenges in Managing Asthma (ICON) Under Yrs Difficulty in Diagnosis No objective proof Breathlessness, short of breath, congestion, difficult to breath are not reliable to wheeze Consider other causes for wheeze Efficacy safety of drugs Delivery system Difficult to predict response to a specific drug Symptoms may change with age Adolescents Non Compliance Girls hesitate to take inhalers marriage, mother in-law Psychosocial problem suicidal tendency Restrict sports activity Conclusion: Pediatric asthma is a major challenging health burden After a steady increase in prevelence for decades there is slight decrease for the past yrs However there is increase in persistent and persistent severe asthma High prevelence is noted in urban children, and in children from ill ventilated houses, heavy traffic schools, poor indoor air pollution, non vegetarians, and low income group Our aim should be for primary prevention and controlling the disease, while adopting the guidelines for the local needs. A Healthy Breath will always bring Healthy life Each one Teach one and Plant one tree