Childhood Asthma Still Increasing

Asthma is a chronic disease that affects the bronchial tubes, which carry air in and out of the lungs. In asthma, these airways become easily inflamed and as a result react more strongly to allergens or irritants that are present in the environment. Upon exposure to these triggers, the airways become narrower and less air flows through to the lung tissues. This causes classic asthma symptoms such as wheezing, coughing, chest tightness, and difficulty breathing.

In the United States in 1993 and 1994, an average of 13.7 million people reported that they experienced asthma-related conditions. Today that number has risen to about 15 million, nearly 5 million of whom are children. Asthma is now the third leading cause of hospitalization among children under 15 years old, and accounts for more than 14 million lost school days each year. The impact of illness and deaths due to asthma is disproportionately higher among low-income populations, minorities, and children in inner cities than in the general population.

"It's become a common problem," says William Gershan, MD, Associate Professor of Pediatrics (Pediatric Pulmonary) at the Medical College of Wisconsin. Dr. Gershan, who practices at Children's Hospital of Wisconsin, reports that researchers cannot yet point to one specific reason for the increase, but says there are most likely many factors involved: "The rise could be attributed to an increase in environmental factors, or it could be that people are just more attuned to asthma than they used to be."

Causes
Dr. Gershan says that asthma is most commonly part of an allergic reaction to seasonal factors like ragweed, tree pollen, or grass pollen; or to environmental factors such as cigarette smoke, dust, cockroaches, or animal dander.

But, he says, asthma is not always allergic in nature. "A viral infection can bring on asthma, as can certain smells, like a particular perfume," says Dr. Gershan. Exercise-induced asthma is fairly common, and is usually triggered by strenuous activity. Genetic predisposition also plays a part in childhood asthma: "If one or both parents have asthma, children are much more likely to have it as well," he explains. Children who are frequently ill with respiratory problems at an early age are also more likely to develop asthma, as are those born prematurely or those who have been on ventilators for prolonged periods.

Another condition linked to childhood asthma is Respiratory Syncytial Virus, or RSV. RSV is most common in infants, and although most babies fully recover from an RSV infection, some go on to develop permanent asthma. "It's a chicken-or-egg scenario," says Dr. Gershan. "Are children who are at risk for asthma more prone to RSV, or does RSV bring on asthma?"

Treatment
Treatment for asthma falls under two categories. Short-term treatment for acute asthma attacks can include the use of an inhaler with a bronchodilator such as albuterol, or a nebulizer, a small machine that converts the proper medication into a mist to be inhaled.

Long-term, or chronic, asthma treatment generally consist of preventive medications, some in pill form, and can also frequently include the use of an inhaler or nebulizer. Once asthma sufferers learn what conditions set off their attacks, they can try to control their environments and avoid these triggers. Medical treatment with anti-inflammatory agents (especially inhaled steroids) and bronchodilators, however, is usually necessary to prevent and control attacks. "The inhaled steroids that are used for chronic asthma are not the same steroids as used by athletes," says Dr. Gershan. "These inhaled steroids have been used for over ten years, and are proven safe."

Prevention
If your child has allergic asthma, the best way to prevent an asthma attack is to avoid the allergen whenever possible. For instance, if pollen is an issue, keep the child indoors on days when the pollen count is high and run an air conditioner to remove allergens from the air in the house.

To keep dust mites down, wash sheets, pillows, blankets, and stuffed animals in hot water every week. If there are cockroaches in the home or school, they should be trapped or killed, and food areas kept free of crumbs and spills to prevent further infestations.

If cold weather is a trigger, says Dr. Gershan, don't allow the child to stay out in the cold too long, and then only with a scarf over both mouth and nose to warm the air as it enters the airways. If asthma is brought on by activity, the child's physician might recommend taking a dose of albuterol before exercise or active play. Dr. Gershan also recommends that children with asthma get a flu shot every year and stay away from people who are already sick.

Asthma cannot be cured, but in most children it can be controlled so they can live an active life. For parents who have children with asthma, Dr. Gershan has some important points to remember. Since parents are responsible for the health of their children, it's vital that they know how to recognize and treat asthma in their child. Parents need to help their children use medications as directed, and must be sure to keep their medications filled and up to date.

If a child uses a home nebulizer, it's important to keep it clean and in good working order. Parents should include the child's teacher in any asthma treatment plan, and can also advocate for school-based asthma programs, so their children are safe at school as well as at home. Dr. Gershan's last warning to parents is very significant: do not smoke in the house or near children with asthma, or allow anyone else to do so. Second-hand smoke is very dangerous for anyone with asthma.

P. J. Early
HealthLink Contributing Writer

This article includes information from the National Heart, Lung and Blood Institute and the US Centers for Disease Control and Prevention.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.