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Childhood asthma rates are declining, but disparities persist

REUTERS/Kim Kyung-Hoon
Children with asthma are having fewer asthma attacks and are missing fewer days from school due to the lung disease than a decade or so ago.

After increasing for more than a decade, the rate of asthma among children in the United States has declined in recent years, dropping from 9.4 percent in 2010 to 8.3 percent in 2016, according to a report issued last week by the Centers for Disease Control and Prevention (CDC).

The report has more encouraging news: Children with asthma are having fewer asthma attacks (a sudden and potentially life-threatening worsening of symptoms) and are missing fewer days from school due to the lung disease than a decade or so ago. And the rate of hospitalization among kids with asthma has dropped significantly, from 9.6 percent in 2003 to 4.7 percent in 2013.

But the report contains some troubling news as well. One in six children with asthma still goes to a hospital emergency department each year because of an asthma attack, and one in 20 is hospitalized. In 2016, more than half of U.S. children with asthma had one or more asthma attack.

The report also found that almost half (49 percent) of children with asthma in 2013 had no action plan for managing the disease and almost half (46 percent) of the children were not regularly using asthma-control medications as prescribed by their doctors. (Both medications and action plans, which include guidance for reducing exposure to allergens and other triggers of the disease, can help control symptoms — wheezing, breathlessness, chest tightness and nighttime or early morning coughing — and reduce the risk of attacks.)

Also troubling are the report’s findings about the racial and income disparities associated with childhood asthma. Asthma-related visits to hospital emergency departments, for example, are 3 times higher and asthma-related hospitalizations are 3.6 times higher among black children than among white children. And the rate of asthma-related hospitalizations are 40 percent higher among children in families living below the poverty threshold than among those whose family’s income is 450 percent or greater than the poverty threshold.

“We are making progress — but health care providers, parents, caregivers, and schools can do more to help children avoid asthma attacks,” said Dr. Anne Schuchat, the CDC’s acting director, in a news release about the report. “Asthma attacks can be terrifying for children and their families. Over the past decade, we’ve identified asthma management actions that work — not alone but in combination. Now we need to scale up these efforts nationwide.”

Minnesota’s children

Here in Minnesota, about 1 in 14 children, or 7.1 percent, had asthma in 2016, according to the Minnesota Department of Health (MDH). That’s below the national rate of 8.3 for that year, but higher than the 6.4 percent rate reported in Minnesota in 2015.

It’s too early to tell, however, if the state’s rate is actually rising, said Wendy Brunner, manager of the asthma program at MDH, in an interview with MinnPost. “We would need more data points going into the future to see what the trend is over time,” she explained.

In Minnesota, both black and American Indian children are more likely than other children to be diagnosed with asthma. For example, among ninth-grade students who participated in the 2016 Minnesota Student Survey, 23.6 percent of American Indian students and 23.9 percent of black students said they had been diagnosed with asthma. That compared to 17.4 percent of white students.

Experts don’t know what is driving those differences in the asthma rates because, said Brunner, “we don’t know what causes asthma to develop in any one person.”

But the experts do know a lot about what can worsen asthma — things like mold, dust mites, animal dander, cockroach droppings, pollution (both indoor and outdoor), secondhand smoke and psychosocial stress.

“A lot of those triggers are connected to housing quality and where you live,” said Brunner.

No wonder, then, that children with asthma from low-income families are at greater risk of having attacks.

“Asthma exacerbations are associated with poverty,” stressed Brunner. “So we see higher rates of asthma ER visits and hospitalizations in poorer communities.”

“We can connect those higher rates to housing quality, access to medical care, access to insurance coverage — all those things you need in place in order to manage asthma,” she added.

Lifting the burden

Among Minnesota’s children aged 5 to 17 with asthma, only 46 percent have a current asthma action plan in their medical record, according to MDH data.

“That speaks to the fact that there’s a lot of work to be done,” said Brunner.

MDH is currently working with local public health agencies and other groups to provide home-based asthma services, including supplying families with air filters for their child’s bedroom. But, as Brunner acknowledges, managing asthma triggers in the home is particularly challenging for low-income families.

“It is a burden,” she said. “Your child gets an asthma diagnosis and you need to address triggers in the home. But you rent your home, and it may be really difficult to get your landlord to remove the carpet or to fix the plumbing to get rid of mold.” 

Or you may not be able to afford the medications. That is certainly true of adults with the disease.

In a 2016 Minnesota health survey, 14.5 percent of adult Minnesotans with asthma reported that there was a time during the previous year when they needed to see a doctor but couldn’t because of the cost. That compared with 9 percent of adults who did not have asthma.

That same survey found that 15.3 percent of adult Minnesotans with asthma said there was time during the previous year when they didn’t take their medication as prescribed because of the cost. That compared with 5.6 percent of adults who didn’t have asthma.

FMI: The CDC Vital Signs Report on asthma was published in the agency’s Morbidity and Mortality Weekly Report, where it can be read in full. For local information about asthma, including links to asthma-related resources, go to the MDH Asthma Program website.

Comments (2)

  1. Submitted by Ray Schoch on 02/13/2018 - 08:22 am.

    Finding the cause

    …seems to be far more difficult than discovering methods to deal with the symptoms. My own bias is that the psychosocial aspects deserve more attention than they seem to get in the research.

    With zero prior symptoms, I developed severe asthma at age 7, within 60 days of my father’s death (he was a test pilot, killed on a test flight). I suffered severe (i.e., crippling) attacks at least annually for more than a decade after the initial attack, and went through the whole routine of medication, emergency inhaler, allergy tests (and results), diet alterations, and avoidance of a variety of allergens. I likely avoided hospitalization only because my mother was an RN and my stepfather a physician.

    Though the various treatments and medications helped, the condition persisted until I was well into my 20s. In the half-century since then, however, I can count the number of episodes on one hand. Cold weather – breathing very cold air – was an issue, for example, when I was a teen. That should make Minnesota a potentially dangerous place to live, but I’ve had no weather-related breathing problems at all in the 8+ years I’ve been here as an old man.

    Food allergies have disappeared, and while household dust will make me sneeze when it’s stirred up, it has that effect on plenty of people who are not, and have never been, asthmatic. My experience, then, is that most of the physical “causative agents” no longer have much effect, and haven’t had any effect for many years. So – from a relatively safe chronological distance – I’m inclined to give more weight to psychosocial and emotional “causative agents” than many are inclined to do.

    • Submitted by David Markle on 02/16/2018 - 12:44 pm.

      Good insight

      My understanding is that the effects of typical asthma are mediated by the central nervous system. The same can be true of some allergies. Once when I happened to mention the existence of my household cat, a visitor immediately began to exhibit symptoms of his allergy.

      I knew a rather eminent and skilled psychoanalytically trained MD who had achieved good results providing therapy to asthma sufferers. Years before, during his service on an army post, one of his fellow officers went out the door of the barracks or officers’ quarters and was stunned to see his mother coming down the street to visit. In fact more than stunned: he went into status asthmaticus and perished on the spot.

      While undergoing competent psychodynamic therapy does not guarantee success, it does offer potential relief from underlying mechanisms, not merely relief from symptoms.

      In these times when poverty is said to foster criminal behavior because of the interpersonal environment, is it mere coincidence that poverty correlates with elevated incidence of asthma?

      That’s not to deny the possible coincidence of an individual’s physical predisposition.

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