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Although asthma is the most common chronic disease in children, recent studies show that labeling this condition "asthma," especially in association with chronic wheezing, remains a matter of dispute. Nonetheless, data confirm that wheezing and asthma place great burdens on the caregivers of affected children. A principal source of information on diagnosis and treatment is the practical guide published by the National Asthma Education Prevention Program. The implications for nurses in the management of young children whose wheezing is chronic or who have been diagnosed as having asthma include a need for knowing the program guide's recommendations, assessing the child's family history, teaching primary caregivers an action plan, providing consistent asthma education, encouraging parents to evaluate the child's environment, and identifying related resources.
About 22 million persons identify themselves as having asthma, with about 9 million being younger than 18 years (Centers for Disease Control, 2002). Most children with asthma develop symptoms before their fifth birthday (Velsor-Friedrich, 2000).
According to a National Asthma Education and Prevention Program (NAEPP) report, pediatric asthma morbidity has not changed and mortality has increased despite major therapeutic advances of the last decade (Velsor-Fredrich, 2000). Epidemiological studies have concluded that the cumulative prevalence of asthma is as high as 22% by the age of 4 years, with some studies further suggesting that pulmonary development in infants can be adversely affected by asthma, with significant long-term effects (Covar, Spahn, & Szefler, 2003).
Hospital admission rates for children under age 4 years with asthma are greater than those of all other pediatric groups, coinciding with the high annual rate of asthma mortality (Covar et al., 2003; Weinberger, 2003a). Younger children also are more likely to have hospital readmissions for acute exacerbations. About 75% of children in a retrospective study of 49 children with asthma (ages 2 to 16 years) admitted to a Pediatric Intensive Care Unit (PICU) were aged 6 years or younger (Covar et al., 2003). These disturbing statistics place tremendous economic, social, and psychologic burdens on the child's caregivers, their families, and the health care system.
Although the incidence and prevalence of wheezing and asthma in young children are noteworthy, some confusion continues about how these wheezing children are labeled or categorized, particularly regarding when they should be diagnosed as...