John Prpich II, MD discusses kids and asthma and what parents need to know to keep their kids healthy.
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Kids and Asthma
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Learn more about John Michael Prpich II, MD
John Prpich II, MD
John Michael Prpich II, MD was born at St Joseph’s Women’s Hospital in Tampa, Florida. Staying local, he grew up in Brandon, attending Nativity Catholic School and Jesuit High School. He received his undergraduate degree from Loyola University in New Orleans. Dr Prpich continued with the Jesuit theme, receiving his medical degree from Loyola University, Chicago. He returned to Florida to do a residency in general pediatrics, including a year as chief resident, at the University of Florida, Jacksonville. Following this, he completed a fellowship in pediatric pulmonology at the University of Colorado in Denver with 2 years as a research associate at National Jewish. Dr. Prpich is board certified in general pediatrics and pediatric pulmonology. He has presented internationally and lectured extensively on topics as diverse as asthma, interstitial lung disease, viral associated lung disease, developmental disorders of the lung, and pediatric sleep disorders.Learn more about John Michael Prpich II, MD
Transcription:
Kids and Asthma
Melanie Cole (Host): Welcome. I’m Melanie Cole and today, we’re discussing kids and asthma. Joining me is Dr. John Prpich. He’s a pediatric Pulmonologist with BayCare. Dr. Prpich, I’m so glad to have you with us and what a great topic. Tell us a little bit about asthma and what’s the burden of asthma in kids? How prevalent is this?
John Prpich II, MD (Guest): Sure, so asthma is really a big umbrella. I think a lot of times people think of asthma as one thing or they think of it as something very specific but really, asthma encompasses a wide range of symptoms and a wide range of kind of presentations and it’s very different in kids than it is in adults. I think one of the first things that I get asked is if there’s a test to make sure that there’s a – that their child has asthma. And there really isn’t a test. It’s based on symptoms that the children are having. And it happens in about seven to seven and a half percent in the general population. But there is a big variability among different racial groups, there’s a big differential between different genders as well. So, there is a lot of variability with kind of more asthma in our African American population, more asthma in our Puerto Rican population as well but in general, about seven percent.
Host: Well thank you for that. So, let’s talk about how you diagnose it. Can it be something that comes and goes? When do we consider it chronic?
Dr. Prpich: Absolutely. And so I think that’s one of the most important things about asthma when I’m seeing a family for the first time, is that in general, these symptoms need to be happening over a period of time. So, if they come in and their child has had one episode of wheezing, their child has had one episode of increased work of breathing when they are sick; it’s very hard to make that diagnosis of asthma because it really is a chronic condition. And it can change a lot with time and that can often confuse people and really in terms of the different types of asthma, there’s a lot of kids that have recurrent coughing and wheezing and symptoms when they are very young usually when they are sick with different viruses and that may seem like it goes away or it goes into remission or they even outgrow it but then there’s other children that have symptoms that seem like they go away and they come back later in adulthood. There are patients that have asthma symptoms just in their adolescence especially with exercise or activity. There’s people that only have asthma when or symptoms of asthma when they are pregnant and then there are elderly individuals who develop asthma. So, there really is a wide range in terms of the timing of the symptoms as well and that often will confuse people.
Host: So, then let’s talk about parents identifying it and the triggers for inflammation and symptoms. Are there things that could masquerade as asthma like seasonal allergies? Speak about those triggers and how we can sort of tell the difference.
Dr. Prpich: Absolutely. That’s a very important question because so much of the variability or the differences from asthmatic to asthmatic really come down to what it is in that person that is triggering the symptoms. And so, very often in our younger children, by far and away our most common trigger for asthma symptoms is going to be viruses. So many of our younger kids have episodes of viral triggered cough, viral triggered wheezing and then when they are not sick and in between episodes, they really are asymptomatic. And then as they get a little bit older in some kids, allergies then often will develop and then allergies are kind of our number two in terms of triggers for asthma. And so what someone’s allergic to can be very variable. You develop allergies as you get older, usually we’re talking about the environmental allergies. So, like grass and pollen, trees, weeds, dog, cat, cockroach, dust mite, those types of things in our environment in certain individuals who are allergic to them will trigger symptoms.
And then the third probably most common trigger that we see is exercise or activity. There are people though that can be triggered by the temperature of the air or air quality, perfumes, or colognes, of course cigarette smoke and so there really are a lot of other things in the environment that can potentially trigger symptoms but really viruses, allergies and exercise are our most common triggers for asthma.
Host: Then tell us a little bit about the management of asthma in kids as asthma can come along with comorbid conditions that you are also dealing with and can contribute even to symptoms. Tell us what therapies are available for kids.
Dr. Prpich: Absolutely. I think it’s important to understand when we’re talking about asthma, really there’s three main things that happen in the airway. So, when someone is having an acute attack, often they’re having episodes of what we call bronchospasm. So, there’s muscles that are wrapped around the airway and they constrict, or they squeeze or get tight in response to an acute trigger and they make that airway narrow and it’s hard to breathe. But then over time, especially if the asthma is more chronic, and they have more frequent symptoms; there’s inflammation that builds up. So, the walls of the airway become thickened, they become kind of almost edematous and that also narrows the airway and makes it harder to breathe. And then our asthmatics often have much more mucus production in response to triggers but even at baseline, they have more mucus. And the reason why I bring that up is because our treatments really target those components of that asthmatic response.
And so if someone has mild asthma that really is asymptomatic in between episodes and really symptoms are fairly mild and easy to control; often the bulk of those symptoms are due to that bronchospasm and so albuterol which is what everyone’s very familiar with usually with asthma, it really addresses that bronchospasm. It’s going to relax those muscles, open up those airways and make it easier to breathe. It works very quickly but it only lasts for a few hours. It’s our rescue medicine. But in our patients that are having more chronic symptoms, or in our patients that when they do get sick or exposed to the trigger have very severe episodes and end up in the emergency room and have a lot of inflammation even acutely; we have inhaled steroids that we use to help control and prevent that inflammation. And they are very powerful in the sense that they are able to prevent and control that inflammation in very small doses and very safe ways and so that our patients with asthma are able to be around the things that might trigger their symptoms and they don’t build up that chronic inflammation.
And then we have medicines that can also control inflammation but also prevent bronchospasm chronically. And those are our combination medicines that have both long acting versions of albuterol as well as inhaled steroids. And then of course, comorbid conditions often go along with our asthmatics especially our older asthmatics that often have allergies and so we have a whole cadre of allergy medicines that we use, the antihistamines, and other medicines like leukotriene modifiers to help control the allergy driven inflammation.
Host: That was a very comprehensive answer, Dr. Prpich, thank you so much and now while we know exercise induced asthma is a bit different, back in the day, kids with asthma were not supposed to exercise or run around at recess or gym. What are we doing now for kids as far as psychosocial and going along with their friends and what do you tell parents about the day to day for a child with asthma?
Dr. Prpich: That’s actually a very important question too because our goal in clinic really is to help manage the symptoms and help educate the family so that our asthmatics can participate and do the things that they want to do. I don’t want my asthmatics sitting out of physical education at school. I don’t want my asthmatics to not be able to participate in sports and we really have a wide range of medicines. I just sort of broadly talked about classes we have several different medicines within all those classes that really are very powerful in terms of helping us control these symptoms. And so I have asthmatics that are trying out for running in the Olympic Games. I have semipro hockey players. I have families and children that are really are playing at a high level of athletics and they have asthma. And we have excellent medicines to control them. And so really, through education, both around identifying the symptoms, identifying the triggers but also education on the way that we use the medicines, that’s very important as well. Our goal really is that they should be able to participate. They should be able to do the things that they want to do.
And that’s important because if we find that if we are using our medications correctly and if we’re using them when we are supposed to and we’re identifying the symptoms and we’re still having issues; then that’s all of when we start to think are there other things that may be mimicking our asthma. Are there other things that may be kind of contributing to our symptoms? And I think one of the most important asthma kind of masqueraders if you will is something of a vocal cord dysfunction or exercise induced laryngospasm. And I just bring that up only because it’s about as prevalent as asthma. It’s about seven percent of the population but most people have never heard of it and it can show up also as exercise induced acute shortness of breath, difficulty breathing and act a lot like exercise induced asthma. And so it’s an important thing to be looking for that treatment response to help make sure that what you’re treating is – that your asthma is responding to treatment.
Host: So, tell us about some therapies that might be in the pipeline that can help prevent asthma possibly, and what’s the focus on current asthma research?
Dr. Prpich: Absolutely. So, we really feel like every year and as years go on, our toolbox continues to expand in terms of the medications that we have available. Our mainstays have always been aimed at controlling inflammation with our inhaled steroids which are very effective, but they have a very nonspecific action in the sense of their control of inflammation. We now have a whole new cadre of medications that are really more like scalpels that go into these inflammatory cascades and knock out specific pathways. It’s a whole bunch of what we call monoclonal antibodies that are given via injection but not very often. Sometimes once a month, sometimes every other month, sometimes every two weeks but these new therapies really go in and are able to isolate and knock out specific pathways, inflammatory pathways that are really responsible for a lot of that inflammation and asthmatic symptoms and they have been life changing.
I’ve had patients who have been intubated multiple times in the ICU on ventilators really severe asthma at very young ages and we’ve been able to get their asthma under control where they are not in the hospital at all. They’re not nearly at risk. And I think that just brings up an important thing, when we are talking about asthma control, our goals are to minimize symptoms. We don’t want to see a patient having symptoms daily, weekly or even monthly. We don’t want to see them having that kind of impact, but we also want to minimize risk. We do not want our asthmatics in the emergency room. We don’t want our asthmatics to be in the hospital or in the ICU. And so really, those are the two major domains when we’re looking at therapies and as we’re making decisions.
Are we having symptoms frequently that we need to prevent? Or do we have severe episodes that we really need to minimize as well because the patients are more at risk.
Host: So, as we wrap up, Dr. Prpich, and what a great topic and you’re giving us really great information. Very encouraging as well for parents with children that have asthma. Wrap it up with your best advice. If your child has asthma, what would you like parents to know about caring for that child, helping them to thrive, and the options that are available at BayCare.
Dr. Prpich: Absolutely. So, I think the early recognition of symptoms, really picking up especially in those younger children. There’s a large population of kids that are having episodes every time they are sick, they are coughing, they are wheezing, they’re having difficulty and so that early recognition, that well this is happening a lot and probably is more symptoms than I should be seeing; talk to the pediatrician, talk to them about maybe whether this could be symptoms of kind of childhood asthma that needs to be addressed. Early recognition I think is very important.
But you’re right, it is very encouraging because even if we identify asthma in those younger age groups, it’s not a – it doesn’t mean that this is going to be something lifelong. I mentioned that these things change over time and so really don’t be scared or discouraged if your child does have a diagnosis of kind of either childhood asthma or even later on in terms of asthma. The symptoms are – we have excellent tools to get them under control and there’s no real reason to be worried or kind of scared. It’s important to talk to the pediatricians about that and I think within BayCare, we have a lot of excellent tools right across our hospital. We have a standardized method for the way that we evaluate our asthmatics in the emergency room. We have a standardized symptom based approach in terms of the medications that we use. So, if you walk into a BayCare hospital, whether it’s our main children’s hospital there at St. Joseph’s in Tampa or if it’s any of our other BayCare hospitals, there’s a bar that we’ve set. Your child is going to receive the best and the most standard of care in terms of asthma management.
And then when we – also if we get admitted, the same thing. We’ve got a very regimented, very standardized treatment approach to our asthmatics that includes education for the children, education for the parents and then of course, we also have available testing while in the hospital if we need it both spirometry where we can measure air flows as well as allergy testing if we need it. And so I do feel like – I feel comfortable that if you come into a BayCare hospital, you’re going to receive the most comprehensive and up to date care for your asthma that’s currently available.
Host: Wow. What a great segment. Dr. Prpich, thank you so much for joining us today and sharing your incredible expertise. To learn more about BayCare’s Children’s Health services, please visit www.baycare.org. And that concludes this episode of BayCare HealthChat. Please remember to subscribe, rate and review this podcast and all the other BayCare podcasts. For more health tips and great advice, like you heard today please follow us on your social channels. I’m Melanie Cole.
Kids and Asthma
Melanie Cole (Host): Welcome. I’m Melanie Cole and today, we’re discussing kids and asthma. Joining me is Dr. John Prpich. He’s a pediatric Pulmonologist with BayCare. Dr. Prpich, I’m so glad to have you with us and what a great topic. Tell us a little bit about asthma and what’s the burden of asthma in kids? How prevalent is this?
John Prpich II, MD (Guest): Sure, so asthma is really a big umbrella. I think a lot of times people think of asthma as one thing or they think of it as something very specific but really, asthma encompasses a wide range of symptoms and a wide range of kind of presentations and it’s very different in kids than it is in adults. I think one of the first things that I get asked is if there’s a test to make sure that there’s a – that their child has asthma. And there really isn’t a test. It’s based on symptoms that the children are having. And it happens in about seven to seven and a half percent in the general population. But there is a big variability among different racial groups, there’s a big differential between different genders as well. So, there is a lot of variability with kind of more asthma in our African American population, more asthma in our Puerto Rican population as well but in general, about seven percent.
Host: Well thank you for that. So, let’s talk about how you diagnose it. Can it be something that comes and goes? When do we consider it chronic?
Dr. Prpich: Absolutely. And so I think that’s one of the most important things about asthma when I’m seeing a family for the first time, is that in general, these symptoms need to be happening over a period of time. So, if they come in and their child has had one episode of wheezing, their child has had one episode of increased work of breathing when they are sick; it’s very hard to make that diagnosis of asthma because it really is a chronic condition. And it can change a lot with time and that can often confuse people and really in terms of the different types of asthma, there’s a lot of kids that have recurrent coughing and wheezing and symptoms when they are very young usually when they are sick with different viruses and that may seem like it goes away or it goes into remission or they even outgrow it but then there’s other children that have symptoms that seem like they go away and they come back later in adulthood. There are patients that have asthma symptoms just in their adolescence especially with exercise or activity. There’s people that only have asthma when or symptoms of asthma when they are pregnant and then there are elderly individuals who develop asthma. So, there really is a wide range in terms of the timing of the symptoms as well and that often will confuse people.
Host: So, then let’s talk about parents identifying it and the triggers for inflammation and symptoms. Are there things that could masquerade as asthma like seasonal allergies? Speak about those triggers and how we can sort of tell the difference.
Dr. Prpich: Absolutely. That’s a very important question because so much of the variability or the differences from asthmatic to asthmatic really come down to what it is in that person that is triggering the symptoms. And so, very often in our younger children, by far and away our most common trigger for asthma symptoms is going to be viruses. So many of our younger kids have episodes of viral triggered cough, viral triggered wheezing and then when they are not sick and in between episodes, they really are asymptomatic. And then as they get a little bit older in some kids, allergies then often will develop and then allergies are kind of our number two in terms of triggers for asthma. And so what someone’s allergic to can be very variable. You develop allergies as you get older, usually we’re talking about the environmental allergies. So, like grass and pollen, trees, weeds, dog, cat, cockroach, dust mite, those types of things in our environment in certain individuals who are allergic to them will trigger symptoms.
And then the third probably most common trigger that we see is exercise or activity. There are people though that can be triggered by the temperature of the air or air quality, perfumes, or colognes, of course cigarette smoke and so there really are a lot of other things in the environment that can potentially trigger symptoms but really viruses, allergies and exercise are our most common triggers for asthma.
Host: Then tell us a little bit about the management of asthma in kids as asthma can come along with comorbid conditions that you are also dealing with and can contribute even to symptoms. Tell us what therapies are available for kids.
Dr. Prpich: Absolutely. I think it’s important to understand when we’re talking about asthma, really there’s three main things that happen in the airway. So, when someone is having an acute attack, often they’re having episodes of what we call bronchospasm. So, there’s muscles that are wrapped around the airway and they constrict, or they squeeze or get tight in response to an acute trigger and they make that airway narrow and it’s hard to breathe. But then over time, especially if the asthma is more chronic, and they have more frequent symptoms; there’s inflammation that builds up. So, the walls of the airway become thickened, they become kind of almost edematous and that also narrows the airway and makes it harder to breathe. And then our asthmatics often have much more mucus production in response to triggers but even at baseline, they have more mucus. And the reason why I bring that up is because our treatments really target those components of that asthmatic response.
And so if someone has mild asthma that really is asymptomatic in between episodes and really symptoms are fairly mild and easy to control; often the bulk of those symptoms are due to that bronchospasm and so albuterol which is what everyone’s very familiar with usually with asthma, it really addresses that bronchospasm. It’s going to relax those muscles, open up those airways and make it easier to breathe. It works very quickly but it only lasts for a few hours. It’s our rescue medicine. But in our patients that are having more chronic symptoms, or in our patients that when they do get sick or exposed to the trigger have very severe episodes and end up in the emergency room and have a lot of inflammation even acutely; we have inhaled steroids that we use to help control and prevent that inflammation. And they are very powerful in the sense that they are able to prevent and control that inflammation in very small doses and very safe ways and so that our patients with asthma are able to be around the things that might trigger their symptoms and they don’t build up that chronic inflammation.
And then we have medicines that can also control inflammation but also prevent bronchospasm chronically. And those are our combination medicines that have both long acting versions of albuterol as well as inhaled steroids. And then of course, comorbid conditions often go along with our asthmatics especially our older asthmatics that often have allergies and so we have a whole cadre of allergy medicines that we use, the antihistamines, and other medicines like leukotriene modifiers to help control the allergy driven inflammation.
Host: That was a very comprehensive answer, Dr. Prpich, thank you so much and now while we know exercise induced asthma is a bit different, back in the day, kids with asthma were not supposed to exercise or run around at recess or gym. What are we doing now for kids as far as psychosocial and going along with their friends and what do you tell parents about the day to day for a child with asthma?
Dr. Prpich: That’s actually a very important question too because our goal in clinic really is to help manage the symptoms and help educate the family so that our asthmatics can participate and do the things that they want to do. I don’t want my asthmatics sitting out of physical education at school. I don’t want my asthmatics to not be able to participate in sports and we really have a wide range of medicines. I just sort of broadly talked about classes we have several different medicines within all those classes that really are very powerful in terms of helping us control these symptoms. And so I have asthmatics that are trying out for running in the Olympic Games. I have semipro hockey players. I have families and children that are really are playing at a high level of athletics and they have asthma. And we have excellent medicines to control them. And so really, through education, both around identifying the symptoms, identifying the triggers but also education on the way that we use the medicines, that’s very important as well. Our goal really is that they should be able to participate. They should be able to do the things that they want to do.
And that’s important because if we find that if we are using our medications correctly and if we’re using them when we are supposed to and we’re identifying the symptoms and we’re still having issues; then that’s all of when we start to think are there other things that may be mimicking our asthma. Are there other things that may be kind of contributing to our symptoms? And I think one of the most important asthma kind of masqueraders if you will is something of a vocal cord dysfunction or exercise induced laryngospasm. And I just bring that up only because it’s about as prevalent as asthma. It’s about seven percent of the population but most people have never heard of it and it can show up also as exercise induced acute shortness of breath, difficulty breathing and act a lot like exercise induced asthma. And so it’s an important thing to be looking for that treatment response to help make sure that what you’re treating is – that your asthma is responding to treatment.
Host: So, tell us about some therapies that might be in the pipeline that can help prevent asthma possibly, and what’s the focus on current asthma research?
Dr. Prpich: Absolutely. So, we really feel like every year and as years go on, our toolbox continues to expand in terms of the medications that we have available. Our mainstays have always been aimed at controlling inflammation with our inhaled steroids which are very effective, but they have a very nonspecific action in the sense of their control of inflammation. We now have a whole new cadre of medications that are really more like scalpels that go into these inflammatory cascades and knock out specific pathways. It’s a whole bunch of what we call monoclonal antibodies that are given via injection but not very often. Sometimes once a month, sometimes every other month, sometimes every two weeks but these new therapies really go in and are able to isolate and knock out specific pathways, inflammatory pathways that are really responsible for a lot of that inflammation and asthmatic symptoms and they have been life changing.
I’ve had patients who have been intubated multiple times in the ICU on ventilators really severe asthma at very young ages and we’ve been able to get their asthma under control where they are not in the hospital at all. They’re not nearly at risk. And I think that just brings up an important thing, when we are talking about asthma control, our goals are to minimize symptoms. We don’t want to see a patient having symptoms daily, weekly or even monthly. We don’t want to see them having that kind of impact, but we also want to minimize risk. We do not want our asthmatics in the emergency room. We don’t want our asthmatics to be in the hospital or in the ICU. And so really, those are the two major domains when we’re looking at therapies and as we’re making decisions.
Are we having symptoms frequently that we need to prevent? Or do we have severe episodes that we really need to minimize as well because the patients are more at risk.
Host: So, as we wrap up, Dr. Prpich, and what a great topic and you’re giving us really great information. Very encouraging as well for parents with children that have asthma. Wrap it up with your best advice. If your child has asthma, what would you like parents to know about caring for that child, helping them to thrive, and the options that are available at BayCare.
Dr. Prpich: Absolutely. So, I think the early recognition of symptoms, really picking up especially in those younger children. There’s a large population of kids that are having episodes every time they are sick, they are coughing, they are wheezing, they’re having difficulty and so that early recognition, that well this is happening a lot and probably is more symptoms than I should be seeing; talk to the pediatrician, talk to them about maybe whether this could be symptoms of kind of childhood asthma that needs to be addressed. Early recognition I think is very important.
But you’re right, it is very encouraging because even if we identify asthma in those younger age groups, it’s not a – it doesn’t mean that this is going to be something lifelong. I mentioned that these things change over time and so really don’t be scared or discouraged if your child does have a diagnosis of kind of either childhood asthma or even later on in terms of asthma. The symptoms are – we have excellent tools to get them under control and there’s no real reason to be worried or kind of scared. It’s important to talk to the pediatricians about that and I think within BayCare, we have a lot of excellent tools right across our hospital. We have a standardized method for the way that we evaluate our asthmatics in the emergency room. We have a standardized symptom based approach in terms of the medications that we use. So, if you walk into a BayCare hospital, whether it’s our main children’s hospital there at St. Joseph’s in Tampa or if it’s any of our other BayCare hospitals, there’s a bar that we’ve set. Your child is going to receive the best and the most standard of care in terms of asthma management.
And then when we – also if we get admitted, the same thing. We’ve got a very regimented, very standardized treatment approach to our asthmatics that includes education for the children, education for the parents and then of course, we also have available testing while in the hospital if we need it both spirometry where we can measure air flows as well as allergy testing if we need it. And so I do feel like – I feel comfortable that if you come into a BayCare hospital, you’re going to receive the most comprehensive and up to date care for your asthma that’s currently available.
Host: Wow. What a great segment. Dr. Prpich, thank you so much for joining us today and sharing your incredible expertise. To learn more about BayCare’s Children’s Health services, please visit www.baycare.org. And that concludes this episode of BayCare HealthChat. Please remember to subscribe, rate and review this podcast and all the other BayCare podcasts. For more health tips and great advice, like you heard today please follow us on your social channels. I’m Melanie Cole.