When it comes to children’s asthma attacks… is less still enough?
And, if it isn’t, what can be done about it?
Those are some of the questions being asked in the wake of a new government report on children and asthma.
Fewer children are having asthma attacks, according to the U.S. Centers for Disease Control and Prevention (CDC). But about half of all kids with the disease still had at least one asthma attack within the past year.
Between 2001 and 2016, the rate of reported recent asthma attacks among children ages 17 and younger declined from 61 percent to 53 percent.
The CDC also found that asthma hospitalizations among children dropped from 9 percent in 2003 to 4 percent in 2013.
Children with asthma also missed fewer days of school.
“There is no single strategy or magic bullet that prevents asthma attacks. But recent evidence shows that a combination of actions can be highly effective,” said Dr. Anne Schuchat, the CDC’s acting director, during a Feb. 6 teleconference on the report release. “These actions include using asthma action plans, reducing asthma triggers like pet dander, using medicines properly, self-management education offered at home and in school, and providing guidelines-based care. Also, avoiding secondhand smoke.”
“What’s needed now is to help children have more control over their asthma by scaling up these effective strategies so that children have fewer of these awful episodes,” she said.
Drugs making a difference
Dr. Christine Cho, a pediatric allergist and immunologist at National Jewish Health in Denver, told Healthline that reports on the efficacy and safety of drugs that combine long-acting beta agonists and steroids (such as Advair), have made doctors more willing to prescribe these drugs to children.
“Previously, I think a lot of providers felt uncomfortable prescribing these drugs to children in elementary school or younger,” she said. “Clinicians are now more apt to increase drug therapy and that has helped decrease the number of attacks.”
The Food and Drug Administration’s 2016 decision to remove the “black box” warning from these drugs also has increased acceptance, Cho said.
“I think that increased comfort level is a contributing factor” in reducing asthma attacks, she said.
Obstacles to overcome
Despite the reported progress, Schuchat noted that about half of all children with asthma experienced an attack within the previous 12 months — an experience that “can be terrifying for children and their families,” she said.
The CDC reported that asthma attacks still land 1 in 6 children with the disease in emergency rooms each year, with 1 in 20 requiring hospitalization.
Children under age 4 were at the greatest risk of having an asthma attack, the CDC report found.
Cho said asthma often goes undiagnosed at this age because young children have difficulty describing their symptoms and asthma is easily mistaken for a cold.
“People don’t think about asthma unless there’s a hospitalization,” she said.
Asthma is the most common chronic lung disease among children. About 6 million children in the United States have asthma.
The disease is more common among boys, children 5 to 17 years old, non-Hispanic black children, children of Puerto Rican descent, and children from low-income families.
“By linking the efforts of health systems, state and local health departments, schools, individuals, and CDC, we can control asthma in children,” said Cathy Bailey, PhD, acting chief of the Air Pollution and Respiratory Health Branch in the CDC’s National Center for Environmental Health. “Doctors, nurses, and other healthcare providers are working with children and parents to assess each child’s asthma, prescribe appropriate medicines, and determine whether home health visits would help prevent attacks.”
“Schools have a large part to play to help children manage their asthma, including having asthma-friendly policies about children’s medicine use,” she added. “Parents and children can reduce triggers in the home, including not smoking. They can make sure children use their medicines as prescribed and let others know about their child’s asthma action plan.”
The Asthma and Allergy Foundation of America (AAFA) “supports policies that encourage asthma-friendly school environments, as well as policies that encourage a reduction in outdoor and indoor air pollution,” Melanie Carver, vice president of community services at AAFA, told Healthline.
“Children who are exposed to air pollution as infants have a higher chance of developing asthma,” she said.
As the Trump administration released its proposed 2019 budget, the foundation also called for continued funding of the CDC Asthma Control Program, access to affordable asthma care and medicine, and reimbursement from healthcare plans for the education of children with asthma.
“There is still work to be done to ensure all children with asthma are receiving the best care,” said Carver.