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Nutritional issues for children with asthma
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High Incidence Rate Among:
Males
Low socioeconomic status
African Americans
Family history of asthma or allergies
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Asthma symptoms
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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
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Asthma Medications
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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
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Preventer Medications
Flovent™
Singulair™
Theophylline
Pulmicort™
Intal™
Serevent™
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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
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Rescue Medications
Albuterol™
Xopenex™
Serevent™
Alupent™
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Steroids Prednisone
Anti-inflammatory actions essential for chronicand acute asthma exacerbations
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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)
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Effects of chronic (daily or every other day) oral steroids
Slowed linear growth
Decreased bone density
Excessive weight gain
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Corticosteroids
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Asthma & Food Allergies
Food Allergies Do Not Significantly Add to Asthma Symptoms!
Research Says . . .
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Asthma & Food Allergies
ALERT!
Dawson, 1990
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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%
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Calcium & Vitamin D
Antioxidants
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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
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• 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
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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
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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
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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?
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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
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Breast feeding and the prevention of asthma in children:Is there a connection?
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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
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Nutrition interventions for asthma
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BMI or weight % ile?
Elimination of food groups?
Calcium and vitamin D intakes?
Alternative therapies?
Corticosteroid use?
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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
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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