Transcription:
Breathe In and Look Out for Pediatric Breathing Conditions

Joey Wahler (Host): If a child is experiencing excessive shortness of breath, it's one sign they may have a chronic condition. So we're discussing what breathing issues to look out for in kids.

This is my Moed Talk, a podcast from my commodes. Thanks for listening. I'm Joey Waller, our guest, Dr. Joshua Needleman, a pediatric pulmonologist for my commodities, Dr. Niman, thanks for joining.

Dr Joshua Needleman: I'm glad to be here. Thank.

Joey Wahler (Host): Thank you. So at what age do kids typically develop breathing problems? And what are the main ones you. You.

Dr Joshua Needleman: Well, children can develop breathing issues at any age, and my field of pediatric pulmonology starts from birth and travels throughout childhood and adolescence. Many children who develop some version of childhood asthma often have symptoms that start during the first two years of.

Joey Wahler (Host): So when you say even showing symptoms from birth in, let's say an infant or a baby that's several months old, what might we see?

Dr Joshua Needleman: Well, certainly there were many respiratory infections, particularly in the fall and the winter that are particularly serious for. small infants, those that are less than a year of age. Respiratory cial virus. Rsv, is the most prominent one, but there are actually many viruses that cause coughing, wheezing, respiratory distress in young children.

some children have recurrent. Symptoms of coughing and, respiratory distress with respiratory viruses. Those children often turn out to have some version of asthma, and those symptoms often begin in the first year, year and a half of life.

Joey Wahler (Host): So what are the causes of pediatric breathing conditions?

Dr Joshua Needleman: well, it's a wide range of situations. The most common. problem, I think would be asthma, which is a situation where your lungs are more sensitive or irritable than normal. Your lungs overreact to things they don't like. Particularly, viruses or certain types of dust or molds. And, when they overreact, the breathing tubes squeeze down and swell up, and the child responds by coughing, which is your body's protection mechanism, breathing fast.

and often people will hear a noise, which is air whistling through narrow breathing tubes. We call that.

Joey Wahler (Host): Right wheezing, which is a common symptom of asthma. Right? And so, When does a condition cross from stubborn cough to chronic cough?

Dr Joshua Needleman: the definition of chronic cough in pediatrics is a cough that lasts four weeks or longer. and this is when sometimes things get a little confusing because it is, is common in early childhood and, toddlerhood to have many, respiratory infections causing cough that come and go.

And so there's a difference between recurrent cough, whereas you may have a cold with a cough in January and then again in February, and then again in March. or you may be coughing every day, January, February, March. Those are two different things. The chronic cough is persistent usually lasting four weeks or longer?

Joey Wahler (Host): Gotcha. And how about the difference between chronic cough. And asthma, obviously asthma comes along with some of those additional symptoms you just mentioned.

Dr Joshua Needleman: well, cough is a fascinating and frustrating symptom because, Many, many conditions cause cough. Cough is your body's protection. It's the way it protects your breathing apparatus. And so anything that irritates or intrudes on your breathing from your nose to your throat down into the very bottom of your lungs will cause a cough.

Some of the causes of persistent cough are, not particularly dangerous, although very irritating and disruptive to life, and some of them can be. dangerous at times and sorting that out is, challenging. Cough is the most common and most prominent asthma symptom, but not every cough is from asthma.

Joey Wahler (Host): So let's talk please about the usual treatment for cough and then for asthma.

Dr Joshua Needleman: Okay. When you're talking about how do you treat a cough, the most important thing is to get at the cause of the cough and treat that. So if your cough is from asthma, you need to be on asthma therapy. If your cough is from pneumonia, you may need antibiotics for pneumonia.

But, in general, treating symptoms such as cough, like for example, with the. Popular over the counter cough suppressants is often ineffective and sometimes dangerous, and is not something that we as pediatric respiratory medicine specialists really, support. when we look at a persistent cough, we try to understand why is there a cough?

what part of the respiratory system is being affected and how can we get at the.

Joey Wahler (Host): When you say those over the counter cough syrups can be dangerous. How?

Dr Joshua Needleman: Well, in several different ways. they can have, several side effects that are more prominent than younger children. And some children have had very serious reactions to them. Most of those, Cough and cold medicines have many medicines mixed together in the same bottle.

And so it's easy, for example, to take a cough medicine that also has a set of amino phen in it and take a fever reducer that also has a set of amino phen in it and take another medicine that also has that in it, and then have an overdose of ace amino fen because the family didn't realize that that medicine was in all of those.

medications. The other thing that I think is important to understand is that since cough is the symptom, it's not the actual problem. If you have, for example, asthma or pneumonia and you just try to hide the cough, you're not gonna make anything better and things could be getting worse underneath the surface.

if you had a rotting spot on your floor and you put a carpet over it, nobody would see it, but your floor would continue to rot and maybe somebody would fall through it eventually. And so you don't wanna hide the cough. You want to treat the cause when possible.

Joey Wahler (Host): Sure understood. So as for asthma, how is that typically treated? And by the way, how common is pediatric asthma? Any numbers to give people an idea?

Dr Joshua Needleman: asthma is the most common chronic condition of childhood, it's the most common reason that children are admitted to the hospital in this country. and, Estimates of how prevalent it is vary depending on your location, but somewhere between eight and 15% of children have some version of asthma.

There are some studies that have suggested that. In New York City public school children, as many as two out of 10, may have some version of asthma. So in every elementary school class, there are several kids. It's really common. It's not always recognized. Some of those kids have not been diagnosed and some of them have.

So the first step in treating asthma is to recognize it and to understand how it impacts that child's life. Some children have asthma symptoms intermittently once every few months, and those kids, get treated aggressively when the symptoms come, and then they, go about their, way. many children have symptoms that are.

Quite frequent that can actually, if left untreated, can, limit their abilities and their lives. and those children benefit from daily controller therapy. But we're very fortunate now that we have so many options for controller therapy, and our expectation. Of asthma control is such now that I don't expect any child, I treat to miss any more days of school than anybody else in their class.

They can play any sport that they want. They can have any career options open to them. and I always tell the families, whatever their potential is, asthma will not be the thing that holds them back. We will control the asthma. The asthma will not control.

Joey Wahler (Host): That's great. And you mentioned youth sports, which I want to talk to you more about in a moment. But first controller therapy you mentioned. So what is that for those that are un.

Dr Joshua Needleman: Yeah, there's a wide array of options. and so, the basic principle is the same for all of them. A controller medicine for asthma is something that. , if you take it, you don't feel any different when you take it. but if you take it every day, good days and bad days, over time your lungs become calmer.

And then when you bump into that respiratory virus or very cold air or. some other irritants, you don't have the same reaction. And so, it's a daily prevention or protection. That's the general principle. There are many different types. some are inhaled, some you take by mouth.

some people get, monthly injections, but most kids take a controller inhaler once a day or twice a. Every day and they find their asthma symptoms much more manageable.

Joey Wahler (Host): And so when you mention those steps, talking now about youth sports being involved in physical activities, when you have a breathing condition like asthma, is it simply what we've gone over that those kids need in that situation as well? Or do they need any extra layer of protection?

Dr Joshua Needleman: the most important thing is to develop a personalized plan for the individual, child or, adolescents. we have had so many Olympic gold medalists. With severe asthma in this country that it no longer gets attention in the, sports reports. so some children just take a daily, asthma controller.

Some children take that plus another inhaler right before they compete. but the underlying principle is understanding that we can control it so that. it should not limit their performance. And as a pediatric pulmonologist, I've had several patients who were captains of their high school track team.

And I had one girl with pretty significant asthma, who set her, school record for the Mile Swim. So I know that we can do this for pretty much, almost,

Joey Wahler (Host): We need to have some of these great athletes do some PSAs to get the word out there.

Dr Joshua Needleman: Yeah. You know, it's funny, many years ago that was happening and then I think, people got kind of used to it. So the athletes who were famous, for, Having asthma. a lot of my young people don't, know them anymore but I think you're right. we do need to make people understand this because there should not be any limitation, but the first step to having no limitation is agreeing that there should be no limitation.

Once you agree that our goal is no restrictions, that's the first step to making that.

Joey Wahler (Host): Well, it's so great to hear you say that that can be the goal and that you're able to meet that as well. Just a couple other things, so first before we go any further, who are a couple of the famous athletes that people would know that had asthma and they just didn't realize?

Dr Joshua Needleman: Jackie join or Percy. Very famous athlete with asthma. You remember her? She used to do a lot of, spots about that. One of the greatest athletes I think we've ever had. and, Olympic swimmer, Tom Dolan, also. well known. and many, many more, like I said, many more recently, but that aspect of their career is not getting the attention

In some ways, that's a really good thing. It means we're so good at controlling their asthma that nobody makes a big deal about it. But it gives me, less to point out to a young person who's considering, sports with his asthma.

Joey Wahler (Host): Sure. Do some kids outgrow breathing conditions like asthma over time? And if so, how common is?

Dr Joshua Needleman: Yeah, that is a fascinating question that we are always, deepening our understanding of. if you look at the children who have recurrent wheezing with respiratory viruses, when they're under the age of two, about half of them when they're. Like seven or eight years of age, about half of them won't still be, doing that and half of them will.

so there are a group of kids that do seem to, as they say, outgrow it. There are also are other kids who have asthmas who need. And severity changed throughout their lives. So they go through periods where they need lots of support and lots of controller therapy, and then they go through periods where they need hardly any.

And then maybe again, periods where they need more controller therapy and more attention. And the important thing is to recognize, it as it changes and. Make sure you're giving the child and the adolescent what they need, not giving them less. and if they're doing well, testing the waters to see if they can get by with, less control of therapy at other times.

Joey Wahler (Host): And finally, what is it on a personal note about your background that you think more than anything else led to you being so passionate about this particular specialty? Pediatric pulmonology.

Dr Joshua Needleman: I love the field of pediatric pulmonology. I find the science of it fascinating. I think the structure of the. Is quite beautiful and elegant, but more than anything, the opportunity to take a child whose abilities in life might be constrained, might be limited, and that child have a normal experience in every aspect, sports, school, music, there's no greater feeling than that, that's my.

Joey Wahler (Host): That's great to hear. Wow. So folks we trust you're now more familiar with what breathing issues to look out for in kids. Dr. Joshua Needleman Continue your great work and thanks so much again.

Dr Joshua Needleman: Thanks for having me. It's been a pleasure.

Joey Wahler (Host): Same here. And for more information, please do visit mimo.org. Again, that's mimo.org. To make an appointment, please call 7 1 8 2 8 3 7500.

Again, 7 1 8 2 8 3 7 500. And thanks again for listening to MIMO Med Talk, a podcast from my modernities, hoping your health is good health. I'm Joey.