Articles from prior issues of The Advocate

January/February 2000

Evaluating Children With Asthma
Presented by Andrew Liu, M.D.
by Judy Nesbitt, Illinois DDS

WHAT IS THE MOST COMMON chronic disease of childhood, affects five million U.S. children, and is the fourth leading cause of disability in childhood? Most adjudicators familiar with childhood listing 103.3 would readily agree the answer to this question is asthma. Asthma is the leading cause of missed school days and the leading cause of hospitalization during childhood. The United States is on the higher end of childhood asthma incidents as other modernized countries also show greater cases of asthma. Dr. Lin reports that onset of asthma occurs in early childhood, greater in male children rather than girls. Primary development is in the 1st four years of life. Only fourteen percent of children with asthmatic symptoms in early childhood will go on to have persistent problems in later years; but these symptoms are also found to decrease in later years. Basic hallmarks of asthma include airway obstruction, airway inflammation, “twichy” lungs. There is a wide spectrum of childhood asthma severity. Fifty percent of cases are mild with symptoms less that three times a week and no prolonged episodes. Moderate symptoms are shown in approximately forty percent of childhood asthma patients and only 105 have severe symptoms. Any asthmatic child can have life threatening episodes but U.S. mortality rate from asthma is 4 in 100,000 cases. Adjudicative evaluation of childhood asthma should include severity, reoccurrence of daily symptoms, consideration of daily bronchodilator use, limitation in play activities and percentage of missed school days. Questions should be asked in sleep disturbances and amount of prolonged episodes requiring ER care. Persistent symptoms should always be addressed with emphasis on persistent wheezing between attacks and the amount of steroids needed. Dr. Lin states that the childhood asthma listing does a good job in listing the criteria necessary in evaluating this disability. The listing had done a very complete job in giving description of how to measure spirometry in childhood asthma cases. Dr. Lin observes that in children under age six that use of PFT should be avoided. He observes that usually children under six years old can not blow out enough to make the testing effective. Children of younger age should be evaluated on wheezing episodes, hospitalizations and other extensive treatment and chronic symptoms. Consideration of growth impairments, neurological and mental involvement may have a direct impact from a serious asthmatic condition. Dr. Lin’s concluding remarks in evaluating children with asthma is that the asthma listing (103.3) is comprehensive. Severe asthmatic children can meet the listing by the following: severe lung impairments, severe recurrent attacks over one year, severe persistent disease and frequent or routine systemic steroid use and growth impairments. He questioned some gray areas such as repeated wheezing in young children being true asthmatic cases. Asthma is a reversible obstructive airway disease and usually can be taken care of with medication.