Guest: Dr. Ronald J. Teufel - Pediatric Hospitalist
Host: Dr. Linda Austin. – Psychiatrist
Announcer: Welcome to an MUSC Health Podcast.
Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. Ronald Teufel, who is a Pediatric?Hospitalist at the Medical University of South Carolina Children’s Hospital. Dr. Teufel, what is a hospitalist?
Dr. Ronald J. Teufel: A hospitalist is a specific type of physician that focuses on taking care of hospitalized patients and specifically a pediatric hospitalist is one who focuses on taking care of hospitalized children.
Dr. Linda Austin: I know you have a special interest in the treatment of children hospitalized with asthma, just what is asthma?
Dr. Ronald J. Teufel: Asthma is a chronic condition in children that results in repetitive episodes where they have trouble breathing where they will get some obstruction of their airways deep down inside their lungs and what parents and children see will often be shortness of breath, coughing, or wheezing and it is a recurrent condition. It’s a condition where child may have it during seasonal allergy season, but it will come back and affect them later. They will get better typically after a period of about a week or shorter time periods when they get treatment, but it recurs and can again cause trouble breathing in that child.
Dr. Linda Austin: It seems to me that asthma is becoming increasingly common, is that actually the case or do just diagnose or talk about it more than we used to?
Dr. Ronald J. Teufel: The number of patients with asthma is actually increasing and that’s pretty well known, and the exact cause for the number increasing is really not known. There are different theories behind that and that may it is air quality and may be it is dealing with children’s immune system, but it is clearly increasing in number of cases over the years.
Dr. Linda Austin: Now, asthma is an allergic condition, what are some of the most common things that kids become allergic to?
Dr. Ronald J. Teufel: So, there are allergic children that have trouble with dustmites, tree, and grass pollen. Dust mites would be something associated with their house and the tree and grass pollen all that would be different seasons during the year, and that can make their asthma worse. So, a lot of children will have trouble breathing in the spring or fall when their allergies get worse then they have worsening of their asthma exacerbation during that time. It’s not just allergies; their lungs can be very sensitive to cigarettes smoke, so while children with asthma, who are living in houses with adults who smoke often get exacerbation of their asthma due to that.
Dr. Linda Austin: What are some of the things that parents can do to minimize the chance that their children will either become asthmatic or that their asthma will become worse because of environmental kinds of problems?
Dr. Ronald J. Teufel: Prevention of asthma is very difficult, but what is not as difficult as when someone is diagnosed with asthma and treatment of that. It is a chronic condition meaning that once it occurs, it’s likely to recur and to be continued to some degree to be a problem for that child, but there is a lot of treatment out there for asthma that can improve a child’s quality of life. There are inhaled corticosteroids that children can take. It is a daily medication, which can be somewhat of a challenge for families especially with young children, but these medications, these inhaled corticosteroids, clearly improve a child’s quality of life meaning that they are more capable of running, exercising, and playing, and the stuff that the children do. It’s also shown that inhaled corticosteroids is preventive medication, decreases the time that children spend in the emergency room, it decreases a likelihood of hospitalization, and decreases likelihood that a child will actually die from asthma. Again, that’s a very rare event, but it something we would all like to prevent and these preventive medicines are very effective. One of the best strategies for parents would be to get a primary care doctor that they can really rely on and they have good relationships, so that these preventive medications can be delivered to the child and they can be seen overtime.
Dr. Linda Austin: It sounds that as if you are saying that the treatment of asthma is not an event, it’s a process that depends upon a relationship between parents, child, and physician to create an environment and to use these preventive medications in order to minimize the impact of the illness.
Dr. Ronal J. Teufel: Yes, I think that’s fair to say.
Dr. Linda Austin: Let’s talk more about treatment of asthma in another Podcast. What about in terms of environmental issues. You mentioned secondhand smoking for instance, what advice would you give to parents if there is a smoker in the household?
Dr. Ronald J. Teufel: Well, clearly the best advice for that is to quit smoking, and this is not just for the child’s welfare, but for the adult’s health also; at very least, the child’s exposure should be minimized. So, if this individual cannot stop smoking, which is definitely not ideal to minimize the child’s exposure to the smoke that would mean no smoking in cars. I think people underestimate the amount of smoke they expose their child to, not just while they are smoking that cigarette in the car but, you know, if they smoked in the car on their way to work and now four hours later they are taking their child, picking their child up from daycare; well that child is still getting exposed to the toxins from that cigarette smoke, so they really need to not smoke in cars or any enclosed area where the child is going to be repeatedly present, the home for example. If people are smoking inside their house, we all know you can go into a smoker’s home and tell that someone is smoking in that house, and that’s all the cigarettes smoke and all the toxins that are still lingering in the air, in the couches, and in the chairs throughout that house, and that does affect to child’s lungs, so smoking outside of the house is also very important. What we typically tell our families outside of, everyone needs to quit smoking, is that if you are going to smoke, to smoke outside and to have a smoking jacket or smoking shirt that you use, so even when you come in, you are not even wearing the same cloths you’re your were when you were smoking outside. The whole goal of that is to minimize the exposure of this child to cigarette smoke and that’s especially important for asthmatics or asthmatic children, but it should also be highly considered for children in general.
Dr. Linda Austin: Have there been any studies looking to see if asthma is more common in children whose parents smoke?
Dr. Ronald J. Teufel: It’s very clear from the studies that children exposed to the tobacco smoke have worsening asthma. It can worse on their asthma exacerbations and that is part of the reason why we advocate in just removing the tobacco exposer to the child.
Dr. Linda Austin: Any housekeeping strategies that you would suggest?
Dr. Ronald J. Teufel: I think if it is shown that a child clearly has allergies, to say dust mites or etc., then working with an allergist to investing some household strategies, to get some of the hypoallergenic products like the pillow covers and bed sheet spreads. I don’t know if I would recommend those unless you have seen an allergist to confirm that person’s asthma is exacerbated by say dust mites because they are very expensive and they are somewhat cumbersome to use. So, if that is that child’s trigger then it’s a worthwhile investment, which you should really know that’s it before you pursue that treatment.
Dr. Linda Austin: Dr. Teufel, thank you so much.
Dr. Ronal J. Teufel: Thank you.
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