Nutritional issues for children with asthma

High Incidence Rate Among:

Males

Low socioeconomic status

African Americans

Family history of asthma or allergies

Asthma symptoms

What happens when a child has an asthma episode?

The insides of the airways get irritated and inflamed

The linings of the airways get swollen

Irritated airways make more mucus

The muscles around the airways spasm and get tight

Asthma Medications

Preventer Medications

• Are for children who have frequent asthma symptoms (at least weekly)

• Are taken daily

• PREVENT most asthma episodes

• Help children live normal lives

Preventer Medications

Flovent™

Singulair™

Theophylline

Pulmicort™

Intal™

Serevent™

Rescue Medications

“Rescue” children when asthma symptoms appear (cough, wheeze, short of breath…)

Relieve muscle spasm but not inflammation

Inhaled: works right away

Pills and liquid take 30 minutes to act

Rescue Medications

Albuterol™

Xopenex™

Serevent™

Alupent™

Steroids Prednisone

Anti-inflammatory actions essential for chronicand acute asthma exacerbations

5 day courseacute exacerba tionsm inim a l s ide e ffec ts

D a i ly or every other daychronic use

poss ib le sys tem ic e ffec ts

O ra l Inha ledchronic use

l i ttle sys tem ic e ffec ts

C orticostero ids(stero ids, prednisone, etc)

Effects of chronic (daily or every other day) oral steroids

Slowed linear growth

Decreased bone density

Excessive weight gain

Corticosteroids

Asthma & Food Allergies

Food Allergies Do Not Significantly Add to Asthma Symptoms!

Research Says . . .

Asthma & Food Allergies

ALERT!

Dawson, 1990

Recent meta-analysis on weight and asthma in children

BMI > 85th %ile in middle childhood increases the risk of future asthma by 50%

High birthweight (> 3.8 kg) increases the risk of asthma by 20%

Calcium & Vitamin D

Antioxidants

PFT’s and PEF before and after 9 oz cow’s milk in “positive” and “negative” perceivers

No significant differences in either group

Milk does not cause or worsen mucus productionWoods, 1998

• Chronic steroid use can lead to osteoporosis

• Recent report that asthmatic children have decreased bone density regardless of steroid use

• The “milk-mucus connection” myth is widespread

• Parents often report avoiding dairy products in their asthmatic childrens’ diets

Ducharme 2003

Dawson, 1990

Age

(years)

Ca intake

(mg)

AI Peers Vit D

1- 3 890 +

244

> < NS

4-8 883 +

359

NS NS NS

9-18 973 +

517

< NS NS

Antioxidant Supplementation Study

Gave 250 mg Vitamin E & 50 mg Vitamin C

to asthmatic children in Mexico City x 18 months

Romieu et al. 2002

Antioxidant Supplementation Study

Children with moderate to severe asthma were effected less by ozone levels

Romieu et al. 2002

Protective effects of Vitamin C and E against air pollution in children with asthma?

4 recent studies (US and Australia)

At least 50% used 1 or more alternative therapy to treat asthma

HerbsVitamins

Chest massage with rubsPrayer

Shenfield, 2001

Breast feeding and the prevention of asthma in children:Is there a connection?

Many suggest that there may be benefit first 2- 3 years

Recent report found no long term protection againstallergic tendencies and asthma

Sears MR. Et al. Lancet 2002;360:901-7

Nutrition interventions for asthma

BMI or weight % ile?

Elimination of food groups?

Calcium and vitamin D intakes?

Alternative therapies?

Corticosteroid use?

BMI or weight % ile?

Elimination of food groups?

Calcium and vitamin D intakes?

Alternative therapies?

Corticosteroid use? Route & frequency

Weight control

Adjust diet

Supplement to DRIlevels

Counsel accordingly

Summary

Cystic fibrosis, BPD and asthma are chronic diseases which affect nutrition and growth in children.

Nutritional interventions are necessary to improve growth and outcome in children with pulmonary diseases