Children and Asthma in America, one of the nation's largest and most comprehensive surveys on children and asthma, revealed that more than half (54%) of all the children with asthma had a severe asthma attack in the previous year and more than one quarter (27%) had an asthma attack so severe that it was thought their lives were in danger. The survey findings indicate that the United States is falling short of the national treatment goals established for asthma and the condition is poorly controlled. The survey was conducted by Schulman, Ronca, and Bucuvalas, Inc., a national research firm specializing in health issues. A national sample of 41,433 households was screened to generate data on households with a child 4 to 18 years old currently suffering from asthma. The interviews were conducted from February to May 2004. The survey was released on behalf of Asthma Action America(R), a national asthma education campaign supported by leading organizations committed to improving asthma care in the US. It was funded by GlaxoSmithKline, a research-based pharmaceutical company and a world leader in respiratory care.
Four out of five respondents reported that their child's asthma was well (43%) or completely controlled (35%), but when compared with the treatment goals established by the National Heart, Lung, and Blood Institute (NHLBI), the children scored low on nearly every established goal.
NHLBI goals of therapy include as follows:
* minimal or no chronic asthma symptoms (coughing, wheezing, shortness of breath, and chest tightness) during the day or night;
* minimal or no exacerbations (including hospitalization or emergency room visits);
* no limitations on activities; no school/parent's work missed;
* minimal use of short-acting beta-agonists (rescue inhaler);
* having a written Asthma Action Plan;
* visit your healthcare professional to monitor your asthma at least two times per year.
Two-thirds of the children experienced asthma symptoms during the day, during night, or during exercise. Twenty-three percent reported that they have visited the emergency room in the previous year and 54% indicated that they have missed school or daycare in the previous year because of their asthma. According to the survey, 24% of the children had not seen their healthcare provider to discuss about their condition in the past year and 54% had not had a lung function test in the past 12 months.
A written Asthma Action Plan was also included in the NHLBI treatment goals. Fifty-four percent of the children with asthma stated that they did not have a written Asthma Action Plan. A copy of an Asthma Action Plan can be found at http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=261875 along with the NHLBI goals of therapy for treating asthma. The action plan includes three colored zones: a green zone for doing well, a yellow zone indicates getting worse, and a red zone for Medical Alert. Each zone contains symptoms to be aware of and actions to be taken within each of the different zones. Parents should work with their child's doctor to write an asthma action plan. "A written plan can give you and your child the confidence to treat asthma signs and symptoms promptly," states James Li, MEd, an asthma and allergy specialist at Mayo Clinic, Rochester, Minn (Mayo Clinic Web site, 2005). Each action plan is unique to the child and will assist the parents in managing the child's medication, recognizing an asthma attack, and deciding what to do on the basis of the symptoms the child is experiencing. A copy of the plan should be provided to the school nurse and teachers.
Asthma is one of the most common chronic diseases of childhood. According to the American Lung Association, an estimated 4 million children under the age of 18 years have had an asthma attack in the past 12 months. As asthma is a chronic disease, it is the most common cause of school absenteeism. William Sears, MD, a nationally acclaimed author, pediatrician, and an associate clinical professor of pediatrics at the University of California Irvine School of Medicine, stated, "We need to help parents recognize that proper asthma control means children are symptom-free all or most of the time" (Sears, n.d.). Results of the survey revealed a difference in how parents perceive their child's asthma and how the child perceives it. Comparing responses of parents with their children ranging in ages from 10 to 15 years, a majority (71%) disagreed about the child's overall health status. "It is concerning to see so many parents thinking their child's asthma is under control when many children are experiencing symptoms on a daily basis," said Dr. Sears (Sears, n.d.).
Even more concerning is the fact that more than half of those surveyed did not understand the causes of asthma symptoms. There was a widespread misunderstanding about the causes of and treatments for asthma symptoms. More than 90% of the respondents admitted that they never heard of bronchoconstriction (tightening of the muscles surrounding the airways) or inflammation (airway swelling and irritation). These are the two underlying causes of asthma symptoms. Only 53% were classified as having severe asthma and 63% of those with moderate asthma reported taking prescription medication for daily maintenance therapy on a regular basis.
Another tool that can assist parents to get their child's asthma under control is the Childhood Asthma Control Test for children aged 4-11 years and for teens 12 years and older. This questionnaire can identify children with poorly controlled asthma and assist parents to improve the management of their child's asthma. Andy Liu, MD, Associate Professor of Pediatrics at National Jewish Medical and Research Center (NJMRC), states, "In addition to their primary goal of evaluating asthma control, these questions can open a valuable dialogue between parent and child about asthma" (NJMRC Web site, 2005). The development of the test was funded by the pharmaceutical company GlaxoSmithKline. A printed version of the tests can be found at http://www.njc.org/news/health-news/y2005/childhood-act.aspx. An online version of the Asthma Control Test is available at http://www.asthmacontrol.com.
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