Al Rizzo, MD: Biggest Asthma Threats

Pediatric asthma is a critical condition to treat and manage—before it worsens to another respiratory condition or leads to associated disease.

In an interview with MD Magazine®, Al Rizzo, MD, chief medical officer of the American Lung Association, explained the greatest drivers of pediatric asthma, what patients may also be susceptible to, and the importance of treatment education for patients and their parents.

MD Mag: What is currently the greatest threat to increased asthma rates?

Rizzo: I think the most likely trigger right now is the air that we're breathing. There's a number of theories about why asthma develops in childhood, in the sanitary versus dirty environment that individuals grew up in. They might be exposed to things sooner, that allows them to tolerate their environment better.

But air quality tends to be a trigger for developing asthma, as well as the genetic processes that we may not completely know about at this point in time, and the allergies. But we do know that the incidence may be going up a bit; we maybe recognize it a little bit more. But I think the changing in air quality may have a role as well.

MD Mag: What are the most prevalent comorbidities within pediatric asthma?

Rizzo: Well, children hopefully don't have too many comorbidities at that age. Allergic asthma tends to also be associated with a lot of the hay fever, the allergic rhinitis-type symptoms, nasal polyps, may be another thing that can be associated with it.

But I'm not sure of any specific comorbidity that would coexist with the asthma, other than what the asthma leads to—recurrent bouts of bronchitis, possibly pneumonia, and unfortunately lost days from school because of the flare-ups that can occur.

MD Mag: Could you speak to the significance of increased maintenance and treatment options for pediatric asthma?

Rizzo: As I said before: the patients who have ongoing asthma, who need a maintenance medication, there needs to be a lot of education—both of the child as well as the parents—as to why drug is being given on a daily basis versus just when they're having flare-ups.

Some asthmatics may get away with what's called intermittent use of a drug, because they have exercise-induced symptoms, or they only have certain symptoms when they're exposed to a specific allergen.

But by and large, if there's ongoing inflammation, the recommendation is to control the inflammation as much as possible, because as a child, that airway being inflamed could chronically become distorted and develop what's called airway remodeling—where there's a little more stiffness in the airways.

And that may lead to other similar complications of COPD down the line, and that may be where that COPD-asthma overlap occurs. The other place where that may occur is when an asthmatic individual who's in their teens decides to start smoking, and later on, over the course of the next 5 to 10, 15 years has a reason to have COPD as well as the reason to have their asthma.