Who we are

The Paediatric Asthma Clinic (PAC) at RVH consists of three paediatricians and over ten Certified Asthma Educators who are available to help children and their families manage their asthma.   The award-winning PAC has existed in its current form for over a decade and currently has over 2,000 patient visits per year.  For further details please see Favorite Asked Questions below.

Who you are

You are the parent or guardian of an infant or child under the age of 18 years (yes, even babies) who has breathing problems that may be related to asthma.  This not only includes children with a clear diagnosis of asthma, but also includes any infant or child with a chronic cough or who has been diagnosed with recurring breathing problems that are typically labeled as bronchiolitis, bronchitis, wheezing, pneumonia or reactive airways disease.

What we do

Your child will first be assessed by a Certified Asthma Educator who will review your child’s symptoms as well as how well they take their puffers.  If over the age of 5 years, your child may also have breathing tests done (spirometry and/or exhaled nitric oxide testing).  These tests are not invasive and do not require x-rays or needles, but are important ways to monitor lung growth and function.  This first part of your clinic visit will take 15-30 minutes.

After the above assessment you will see the paediatrician who will review all aspects of your child’s breathing problems and clarify the diagnosis.  Medications (if needed) will be reviewed and you will be provided with a written Action Plan to help you manage your child’s asthma at home.  This part of your clinic visit will take an additional 15-30 minutes.

If your child appears to have asthma, you will be invited back to clinic every few months to ensure the breathing problems remain under control.  Please note that there are many different types of childhood asthma – some disappear by the age of 5 years whereas others can progress and require more help as your child gets older.  Therefore, regular follow-up is important and we will continue to provide help for as long as it is needed. The RVH Paediatric Asthma Clinic currently manages approximately 1,000 children with active asthma.

Your primary healthcare provider will receive a written summary after each clinic visit and will therefore be able to help you with any problems between these visits.  Unfortunately, we are unable to provide urgent care between scheduled appointments.

Where and when

The paediatric asthma clinic is held Mon-Thursday in the Child and Youth Treatment Clinic within the Royal Victoria Regional Health Centre (201 Georgian Drive, Barrie, ph 705.797.2395).  Your primary healthcare provider can refer you by faxing a request to 705.739.5674.

Why we do this

Not only does uncontrolled asthma cause very unpleasant and dangerous symptoms in children, it can also lead to permanent lung damage.  Our goals are to ensure that your child

  1. only has ‘regular’ colds that last a week or so and do not lead to doctor visits for breathing problems
  2. does not cough when playing or sleeping (except for the first days of a cold)
  3. rarely requires ‘rescue medication’
  4. never needs to urgently see a doctor because of breathing problems
  5. continues to have completely normal lung function and growth
  6. is using as little medication as possible

We can help

We use standard asthma therapies from published paediatric asthma guidelines – but also provide you with the skills to manage your child’s asthma along with your primary healthcare provider ….. and this works!  We have over a decade of data that shows this approach greatly reduces the number of urgent asthma-related doctor visits and hospitalizations .

 

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Frequently asked questions

 How common is asthma in children?

Before the age of 5 years, over 50% of children will have at least one episode of wheezing when they have a cold – and this often starts with very young infants.  Although this looks like asthma, many of these children will not need medical help and do not have asthma – but approximately one-third of these children will have recurrent problems and be diagnosed with asthma.  By the age of 6 years, approximately 13% of Canadian children will continue to have asthma (Ontario Lung Association 2019; www.lungontario.ca/disease/asthma).   In Ontario, children outnumber all other ages groups combined for needing hospital care for their asthma (Figure 2).

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Will my child outgrow their asthma?

That depends.  There are several different types of asthma in children.  Many children who start wheezing with colds when they are very young will actually outgrow their asthma by the age of 5.  Other children who develop asthma a little later, especially if they also develop environmental allergies, may have asthma for several years or even lifelong.  Unfortunately we cannot cure asthma or make your child outgrow it; but we can help you to control the asthma so your child remains happy and well.

Can babies have asthma?

Yes. The Canadian Paediatric Society recognizes that infants as young as 12 months can have a form of asthma, although establishing the diagnosis and managing symptoms can be very challenging in this age group.  Infants under the age of 12 months who have recurring breathing problems, as well as risk factors for asthma, may also benefit from asthma therapies.  For further information please see: www.cps.ca/en/documents/position/asthma-in-preschoolers

Will my child become dependent on the puffers?

No.  The medications used do not cause dependence, addiction or weaken the lungs in any way.  You and your child will likely notice, however, that their breathing problems are much better and you will want to continue using them.  Asthma medications do not influence when, or if, your child will outgrow their asthma.

Are puffers with steroids dangerous?

No.  There are many types of steroids used in healthcare and they are used in different ways for different conditions.  Inhaled steroids for asthma are considered very safe because the doses used are extremely small when compared to the doses needed to treat other illnesses.

Many years ago, the older forms of inhaled steroids for asthma had the potential to interfere with normal growth if used at high dose and every day for years at a time.  Thankfully, the inhaled steroids currently used do not appear to be associated with any impact on growth and it is very uncommon to need to use high dose therapy for more than a few days at a time.

All medications have the potential to cause side effects but this is extremely rare with modern inhaled steroids for asthma.  Nevertheless, all medications require close supervision and should only be used with ongoing follow up with your healthcare provider. For further information please see:

www.academic.oup.com/pch/article/20/5/248/2648913

 Does my child need medicine every day?

That depends.  As mentioned above, there are different forms of asthma in children and these forms may have different triggers.  As a result, your child may do best with year-round daily medicine, medicine during certain seasons only, or perhaps medicine only when they have a cold.  Our goal is to always use as little medication as possible to control your child’s asthma.

Well, that’s interesting …

     At the 2012 Ontario Hospital Association Health Achieve Conference, the PAC was invited to present a Leading Practices poster featuring our success in reducing the impact of paediatric asthma in our community; with further details available at: http://www.rvh.on.ca/newsroom/Publications/PR – RVH Wins Big at OHA – 2012.pdf

In  2014 we were very pleased to be named by the Ontario Ministry of Health to the Honour Role for the Minister’s Medal Honouring Excellence in Health Quality and Safety; further details can be found at:

http://www.rvh.on.ca/newsroom/Publications/PR – Pediatric Asthma Clinic is Honoured – 2014.pdf

 

Further reading:

The Paediatric Asthma Clinic has twice published scientific articles about our success:

Fleming, B. Kuzik and C. Chen. Hospital-Based Inter-professional Strategy to Reduce In-patient Admissions and Emergency Department Visits for Pediatric Asthma. Healthcare Quarterly 2011; 14:47-51.

https://www.longwoods.com/content/22577/healthcare-quarterly/hospital-based-inter-professional-strategy-to-reduce-in-patient-admissions-and-emergency-department

Kuzik, C. Chen, M. Hansen and P. Montgomery. Sustainable Benefits of a Community Hospital-Based Pediatric Asthma Clinic. Healthcare Quarterly 2017; 20(2): 63-67.

https://www.longwoods.com/content/25230/healthcare-quarterly/sustainable-benefits-of-a-community-hospital-based-pediatric-asthma-clinic

We have also published other contributions to medical research on asthma and related breathing issues in children:

Kuzik. The routine use of oral steroids in paediatric asthma is not routine. Paediatrics & Child Health 2018: 1–2 doi: 10.1093/pch/pxy005. https://academic.oup.com/pch/article-abstract/23/3/237/4964708?redirectedFrom=fulltext

Kuzik. Maybe this is just asthma. Pediatric Pulmonology. 2017;52:1531.   https://onlinelibrary.wiley.com/doi/full/10.1002/ppul.23826

Kuzik. Maybe there is no such thing as bronchiolitis.  CMAJ 2016 188: 351-354. http://www.cmaj.ca/content/188/5/351

Kuzik. Inhaled corticosteroids in children with persistent asthma: effects on growth. Paediatrics & Child Health 2015; 20(5): 248-250. https://academic.oup.com/pch/article/20/5/248/2648913?searchresult=1

Kuzik, Flavin MP, Kent S et al. Effect of inhaled hypertonic saline on hospital admission rate in children with viral bronchiolitis: a randomized trial. Can J Emerg Med 2010;12(6):477-84.  https://www.cambridge.org/core/journals/canadian-journal-of-emergency-medicine/article/effect-of-inhaled-hypertonic-saline-on-hospital-admission-rate-in-children-with-viral-bronchiolitis-a-randomized-trial/42136259C075A42AA361B3F9F8AEBE71

 Kuzik, Al Qadhi S, Kent S, et al. Nebulized Hypertonic Saline in the Treatment of Viral Bronchiolitis in Infants. J Pediatrics 2007;151:266-70.  https://www.jpeds.com/article/S0022-3476(07)00345-9/fulltext