Asthma in Children

What’s the Problem?

Asthma is a chronic inflammatory disorder of the airway passages in the lungs. Episodes occur when the airways narrow after a viral infection, during exercise or exposure to triggers such as animal dander, dust mites, cockroach particles, pollen, tobacco smoke, air pollution, and chemical irritants. Symptoms of an asthma episode or attack can include coughing, wheezing, chest tightness, and difficult breathing.

Who’s at Risk?

In 2001, asthma, one of the most common chronic diseases among children in the United States, affected about 6.3 million children.

Among children and youth, death from asthma is not common, but can be caused by lack of early treatment, poor control of the disease, and repeated exposures to pollution, tobacco smoke, dust, etc. In 2000, there were 223 childhood deaths from asthma in the U.S., along with 728,000 emergency department visits and 214,000 hospitalizations. Low-income populations, minorities, and children living in inner cities have disproportionately higher rates of illness and death due to asthma.

Additionally, asthma accounts for 14 million lost days of school missed annually and it is the third-ranking cause of hospitalization in the U.S. among those younger than 15 years of age.

Can It Be Prevented?

Most episodes can be prevented. Physicians can work with children and parents to develop asthma management plans, including long-term controller medication. They can help families become aware of the environmental conditions and other factors that trigger asthma episodes and suggest ways to avoid these.

It is sometimes difficult for children and parents to adhere to asthma management plans. In some school districts, regulations prohibit children from carrying medications such as inhalers, which means that although they may have appropriate medication at home or at a school office, they don’t have their inhaler if they have an attack traveling to and from school. Students, families, health care providers and national organizations are promoting modifications of these restrictions to permit students to self-carry and self-administer emergency medications like quick-relief inhalers and auto-inject epinephrine. Federal laws support these modifications. Physicians, parents and school nurses assess the maturity and skills of students and authorize students to self-carry on a case-by-case basis where appropriate. Some schools establish contracts with students to emphasize the student’s responsibilities.

Tips for Scripts

• INFORM viewers that preventive treatment with long-term controller medications and reduced exposure to environmental triggers allows many children to control their asthma and live normal lives. Children with asthma can do almost anything if they learn how to control their asthma. Many Olympic athletes have asthma.
• EDUCATE viewers that children who have asthma require medication quickly when an episode occurs. Asthma episodes cannot be ignored!
• REMIND people with asthma to: adhere to their asthma management plan; never take over-the-counter medications without a doctor’s consent; stay away from their specific triggers. Avoiding triggers includes not smoking, staying away from smoke, perfume, talcum powder or hairspray; minimizing exposure to roaches, molds, dust, animals with fur or feathers, and strong household chemicals (e.g., cleaners); and limiting outdoor exposure on high-pollution or high pollen count days.

Case Example

High pollution warnings are in effect when seven-year-old David has an asthma episode on the way home from school. Mrs. Jones, the neighbor who usually watches David in the afternoon, asks if he has an inhaler in his backpack. He says he doesn’t because his school won’t permit kids to carry medication. There’s an inhaler in the school nurse’s office if he needs one at school, but only empty inhalers in the apartment. The boy admits his mother had no money for refills. As his breathing worsens, Mrs. Jones tries to phone his mom at work, but can’t reach her. Mrs. Jones rushes David to the busy emergency room of the local trauma center. The frightened mother arrives from work and realizes the delays and lack of medication have created a life-threatening situation. After several hours of intensive treatment and an overnight stay with IV medication, David is released with new medications and an appointment to see his pediatrician.

The next day, an asthma case manager from the hospital visits Davis’s home. She reasserts how important it is to always have enough medication in the house (reminding her that Medicaid pays for inhalers), helps the mother identify environmental exposures in the apartment that can lead to asthma attacks, reminds her to limit her son’s outdoor exposure when air pollution levels are high, and talks to neighbors about stopping secondhand smoke in the hallways.

On the following day, his pediatrician revises David’s asthma management plan to include a daily, long-term control medicine. The office nurse makes sure that David and his mother know how to use his inhaler with a holding chamber. She also reviews how David uses his peak flow meter.

The asthma case manager meets with the school nurse at David’s school to go over his new asthma management plan and they make sure that David can always get his quick-relief inhaler if it is needed. She also provides a peak flow meter for David to use at school. Because David still needs help to follow his asthma management plan, his pediatrician and mother decide to wait a while before requesting permission for David to self-carry his quick-relief inhaler at school.