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Pediatric Pulmonology, Allergy, and Sleep Medicine

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Department of Pediatrics

Asthma Management and Education
For appointments or to contact us, call 914-493-7585

Our center assists referring physicians in confirming a diagnosis of asthma for children with recurrent symptoms and for treating children who have asthma that is difficult to control.

Our pediatric pulmonologists and allergies evaluates patients for factors that make asthma hard to control, develops an individualized asthma action treatment plan including state of the art pharmacologic therapies and advises environmental controls.

We provide education and the resources necessary to help patients and their families self manage their asthma.  This includes helping to identify what may be triggering their child’s asthma symptoms and what they may do to control asthma.  Continuing assessment of asthma control occurs at every visit and treatment plans are adjusted accordingly.

Childhood asthma has increased by epidemic proportions in the Hudson Valley and the Pediatric Pulmonology, Allergy and Sleep Medicine Division at the Maria Fareri Children’s Hospital and New York Medical College is by far the largest provider of care for these children and their families.

STATISTICS:

  • Between 20 and 30 new patients a week with asthma are referred for evaluation.

  • We cared for over 10,000 children with asthma in 2009.

  • Asthma and related conditions is the #1 one reason for children to miss school, the #1 reason for children to see their pediatrician, the #1 reason to need the emergency room, and the #1 reason for children to be hospitalized.

  • Children with asthma are transferred on a daily basis to the Maria Fareri Children's Hospital at Westchester Medical Center via ambulance and helicopter from throughout the Hudson Valley.

  • Our asthma specialists not only care for hospitalized children and children in the emergency room, we staff eight outreach offices throughout the Hudson Valley in addition to our main offices near Westchester Medical Center.

  • We have ten pediatric pulmonologists and two pediatric allergists dedicated to caring for children with asthma and related conditions. The entire group are on the faculty of New York Medical College as well as on the medical staff of the Maria Fareri Children’s Hospital at Westchester Medical Center.

  • Our asthma specialists are dedicated to education.  As part of that mission, we regularly give lectures and speak to a wide variety of audiences, including community groups, medical students, nurses, residents, and fellows.

BACKGROUND:

  • The prevalence of asthma steadily increased over the last forty years, though there is some evidence to suggest that rates have leveled off over the last few years.

  • This increase has occurred throughout the developed world, and since genetics do not change this quickly, it must be related to our environment (broadly speaking.)

  • The statistics on asthma significantly underestimate the scope of the problem, since for a variety of reasons it is difficult to diagnose asthma in very young children

  • While around 10% of the population have life-long asthma, about one third of all children today will wheeze in the first few years of life.1,2  This is a huge and very expensive problem for families and society.

  • Some of those children have life-long asthma and some seem to “grow out of it.”  There are now a number of “asthma predictive indices” that are very good at predicting who will have life long asthma.3

  • Almost all people with life long asthma started before 6 years of life (though many don’t realize it, or have forgotten.)

  • Asthma is a nonspecific sensitivity of the bronchial tubes.  Any thing in the air in sufficient quantity can trigger coughing and wheezing.  So eliminating one or two environmental irritants will not solve the problem

    • Almost all asthma attacks in the early childhood are related to viral respiratory infections.

    • Chronic exposure to low levels of environmental irritants upregulate airway inflammation and therefore result in increased response to infections. 

  • Common environmental triggers:  environmental tobacco smoke, air pollution from traffic and factories (smog and soot) allergens, including dust, cockroaches, mold, etc.

  • Key point:  while all of the triggers above trigger symptoms of asthma, it is not known if exposure to these triggers can actually make you an asthmatic.  This is a hugely important area for research: The interaction between our environment and our genes.

  • The most common theory for the asthma epidemic is known as the “hygiene hypothesis,” which briefly suggests that the regulation of our immune system is altered by environmental exposures in the first few years of life.

    • In summary, asthma is a clinical syndrome caused by a dysregulation of our immune system.

  • A relatively recent suggestion is that the asthma epidemic is in part related to the increasing problem of vitamin D deficiency.  This is a subject of intense study right now.

    • We should not lose sight of the fact that the other essential part of the “environment” that may play a role in the asthma epidemic is what we eat.

      • This area urgently needs more research, but the diets of young children may be very important.

  • Clearly, the key is to focus on the first few years of life.  That is when asthma begins.  (Actually the problem probably starts in utero.)

  • While we have traditionally focused on outdoor air, infants and toddlers spend almost all of their time indoors.  If the problem is related to the environment of infants and toddlers, than the focus must shift to indoor air.