Download Autism and lung diseases ARHerradura AAAP

Renato B. Herradura, M.D.
F.P.C.P. Antonio F.P.C.C.P.
Pulmonary & Internal Medicine
University of the East
R Magsaysay Medical Center
Lecture Outline

1. Association between autism and asthma and other
allergic disorders
2. Clinical presentations of pulmonary disease
3. Hindrances to medical care of autistic patients
4. Approach to autistic patients with respiratory
symptoms/disease
Autism and Pulmonary
Disease

 A greater than 2-fold elevated risk of ASD was observed for
maternal asthma and allergy diagnoses recorded during the
second trimester of pregnancy. Croen JAMA Pediatrics 2007
 Asthmatic infants and children exhibited a higher accumulative
incidence rate of ASD than did the controls (1.3% vs
0.7%,P = .007). Po-Hsin Tsai et al 2014 (Taiwan study)
 Asthmatic infants and children exhibited an elevated risk of
developing ASD (hazard ratio: 2.01, 95% confidence interval:
1.19–3.40).
 Overall, no clear association between autism and lung disease
Po-Hsin Tsai et al 2014 (Taiwan study)

 Logistic regression analysis showed that the
 ADHD + ASD group,
 ADHD-alone group , and
 ASD-alone group had an increased risk of allergic
co-morbidities compared to
 the control groups (without ASD or ADHD) after
adjusting for age, sex, and level of urbanization.
Ting-yang Lin 2014 (Taiwan study)
Clinical Presentations of
Lung disease

 Abnormal chest radiograph
 Cough
 Dyspnea
 Wheezes/stridor
 Chest pain
Abnormal Chest
Radiographs

 In asymptomatic patients, are commonly
encountered during pre-employment check-up,
annual exams, executive check-up.
 Usually focal infiltrates or pulmonary nodule/s.
 Not likely to be seen in autistic patients.
Cough

 Duration
 Phlegm production
 Usually signifies airway irritation/inflammation
 Associated symptoms




Other respiratory symptoms
Coryza
Fever
Weight loss
Cough Duration

 Acute: (< 3weeks)
 Acute RTIs (URTI, LRTI)
 Viral or bacterial
 Subacute: (3-8 weeks)
 Bacterial LRTIs (Pertussis, Lung abscess)
 PTB
 Postinfectious cough
 Chronic (> 8 weeks)
 Chronic lung diseases (infectious and noninfectious)
Dyspnea

 Subjective complaint
 Accompanying symptoms including chest pain
 Signs of respiratory distress
 Fast breathing
 Alar flaring
 Contraction of neck, shoulder, chest wall and
abdominal muscles
Wheezing

 Wheezes – narrowing of the lower airways
 asthma, bronchitis, bronchial edema
 Stridor – upper airways obstruction
 Diphtheria, foreign body aspiration, laryngeal edema
Chest Pain

 Chest constriction
 Bronchogenic
 Esophageal
 Cardiac
 Pleuritic pain
 Pleural inflammation
Hindrances to Medical Care of
lung disorders in persons
with 
autism
 Symptoms not clearly expressed
 Chest pain
 Dyspnea
 Patient uncooperative during physical exam
 “Take deep breaths”
 Patient uncooperative during lab procedures
 Pulmonary function tests
 Patient unable to follow treatment instructions
 Inhaler devices
Approach the ASD Patient
through Caregiver

 Close observation, with particular attention to
symptoms that the patient can not verbalize
(dyspnea, chest pain, wheezes/stridor)
 Documentation of signs/symptoms (pictures,
videos)
Approach to the ASD
Patient by Clinician

 Meticulous history-taking and physical exam
 Awareness of “missing pieces” of data
 Judicious non-invasive testing
 Use of treatment aids (e.g. inhaler aids)
Summary

 Association between asthma, allergic disorders and
ASD is seen; the exact relationship is unknown
 Hindrances to medical care are present, and must be
overcome
 Awareness of caregivers is important
 Proper care is very possible