K. Hovnanian Children’s Hospital Pediatric Pulmonologist Perspective on Shifts from Critical Care Interventions to Prevention for Pediatric Lung Disease

Charles Dadzie, M.D., explores shifts from emergency-focused care to preventive approaches for asthma and other lung conditions

In pediatric pulmonology and critical care practice, Charles Dadzie, M.D., has observed and welcomed a shift from emergency care to preventive strategies for children and teens with asthma and other lung issues. He credits several important therapeutic shifts and keys to successful implementation.

One of the biggest shifts is nebulization available at home for all ages, including infants. This paired with at-home oxygen monitoring prevents many ED visits. It also provides quicker treatment.

“Most asthma patients wake up in the night with an issue. We now have the technology to get the oxygen level up when parents see low oxygen levels. They can call, and we’ll say whether to go to the ER,” Dr. Dadzie said.

Parent and patient education are key. Newer preventive medications, like inhaled steroids and rescue albuterol (when taken properly) are effective tools. With teens especially adherence must be closely monitored, he said. Parents need to understand the importance of continued preventive therapy once their child sees improvements, rather than taking that as an indication that treatment is no longer needed. These are education opportunities the pediatric pulmonology team should anticipate. Dr. Dadzie said when pediatric patients do warrant an ICU visit for asthma, it is commonly teens who are inconsistent with preventive medications and families without medical insurance.

Other patients who present ICU care include children without an asthma diagnosis who seek emergency care when previously mild symptoms present more strongly. Such children may have received a reactive airway or bronchitis diagnosis prior or dismissed mild chest tightness. When asthma patients do require intubation in the ICU, Dr. Dadzie said as a best practice, a chest tube is always kept at bedside and patients receive attentive monitoring because of the high risk of lung rupture with asthma.

Coughing is one of the best remedies to clear mucus. This becomes especially important in infants and children under 8 years old who have not fully developed collateral airways to depend on should main air flow pathways become plugged. He credits the advent of Pulmozyme to help break down thick mucus and allow the cilia and cough to do their job. Again, parent education, he said, is important to shift the perception of coughing as a symptom to discourage or suppress, to a productive process, which can ease parental anxiety and support the child’s recovery.

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