Diagnosis and management of bronchial asthma in patients with severe motor and intellectual disabilities (SMID)

Abstract

Recent advances in neonatal intensive care, especially for extremely low birth weight infants, have drastically improved life prognosis of the infants. However, ‘intact’ survival without sequelae for all babies is still to be achieved and prevalence of severe motor and intellectual disabilities (SMID) secondary to central nervous system damages of any cause in childhood, especially in neonatal period, is increasing. Patients with SMID have complex problems involving multiple organs and multidisciplinary approach is mandatory. However, a lack of evidence in optimal diagnosis and treatment procedures for the complex problems poses a host of issues in daily medical care. Wheeze is one of the most common symptoms in SMID, which can be caused by various pathogenesis not only in the respiratory system but in other organ systems such as the gastrointestinal tract. Bronchial asthma, one of the major causes of wheeze, is a chronic inflammatory disease of the airways and may be present in SMID patients. Once a SMID patient is diagnosed as asthma, he/she has to be properly managed as recommended by asthma guidelines. However, lack of diagnostic criteria for asthma in SMID often results in overtreatment or undertreatment. We retrospectively analyzed 40 SMID patients in our institution. Twenty two patients (55%) had wheeze during the past 12 months. Basic procedures including suction of upper respiratory exudates and saliva and stabilization of the jaw resulted in resolution of wheeze in 18 of them (81.8% of wheeze). The rest, 4 patients (18.2% of wheeze) underwent beta-2 agonist inhalation. Wheeze resolved in 2 out of 4 patients (9.1% of wheeze). We also performed impulse oscillometry (IOS) when they did not have wheeze. Significant reduction in airway resistance with IOS was confirmed in the patients. We diagnosed them as asthma (5% of total patients). The other 2 cases were respectively diagnosed as laryngomalacia and sinusitis. Our experience indicates that prevalence of asthma in SMID is comparable to that in general population and careful diagnostic procedures may allow us to identify those who need anti-inflammatory treatment and those who do not need other type of care. In addition, IOS may be a good tool to measure respiratory function in SMID since no voluntary effort is necessary to perform the test. We reviewed respiratory care in SMID and proposed a diagnostic diagram for wheeze in SMID.