Kids' Asthma Out of Control

Four out of five kids with asthma don't keep their
symptoms under control, a new study shows.

University of Rochester researcher Jill S. Halterman, MD, MPH, and
colleagues analyzed data from a telephone survey of 975 asthmatic children in
Alabama, California, Illinois, and Texas.

Among children with persistent asthma, they found:

More than one in three kids -- 37% -- isn't getting the prescription drugs
needed for asthma control.

• An additional 43% of these kids have asthma drugs but still aren't
  controlling their asthma.


• Only 20% of kids with persistent asthma keep their symptoms under
  control.

"We found inadequate treatment is still a problem. We found a large
number of kids had persistent asthma symptoms but no medications,"
Halterman says.

An even larger number of kids had their lives interrupted by persistent
asthma symptoms despite having inhalers. There were several reasons for
this.

One major reason is that these children weren't using their inhalers every
day. The drugs work properly only when used consistently.

"And a significant number of these kids were exposed to triggers --
including secondhand smoke -- which clearly makes asthma worse even if
medications are being used," says Halterman.

The study appears in the March issue of Ambulatory Pediatrics.

Parents Who Smoke -- and Other Asthma Triggers for Kids

Smoking? Around kids with asthma?B Yes. More than 15% of the kids'
parents admitted to smoking around their children in the past week.

"That's obviously an underestimate, as many parents would not admit
this," Halterman says. "But that's still a striking
percentage."

Indeed, more than a third of children under age 18 live with at least one
smoker, according to new statistics released by the U.S. Agency for Healthcare
Research and Quality.

Children with asthma are just as likely to live with a smoker as other kids
are, the AHRQ finds.

But smoking isn't the only household asthma trigger for child asthma. Nearly
three out of four kids with asthma symptoms live with an asthma trigger in
their home, Halterman and colleagues find.

The list includes:

• A fireplace or wood stove


• A kerosene heater


• An unvented gas stove


• Cockroach infestation


• Dust mites


• Visible mold


• Indoor pets

Pets and Asthma

Does this mean Fluffy and Fido must find a new home?

"That is a tough question," Halterman admits. "Some children are
clearly allergic to pets. They would benefit. But others might not, so it takes
treatment planning with your doctor."

Pediatric allergist Lisa Kobrynski, MD, MPH, assistant professor of
pediatrics at Atlanta's Emory University, agrees that the pet discussion is
always a hard one for families of children with asthma.

One solution, she suggests, is keeping the pets outside. Some families try
frequent washing, but Kobrynski notes that this means washing a dog or cat at
least three times a week. And new research suggests that some pet allergens
aren't from pet dander, but from pet saliva.

An allergist, Kobrynski suggests, can give a child a skin or blood test to
see exactly which triggers are most important to avoid.

Asthma Control Key: Frequent Evaluation

Controlling a child's asthma, Halterman and Kobrynski stress, is not a
simple matter. It requires collaboration between parents, the child, and the
child's doctors.

The first step is reporting the child's symptoms to a doctor. The doctor
then develops an individualized asthma-control plan, which often includes daily
use of an inhaler and may requie oral medications, too. Daily use of these
drugs is essential. But taking medicine isn't the end of the job.

Avoiding asthma triggers is an essential component of asthma control. And
asthma triggers are tricky -- new ones can pop up, and old ones may or may not
go away.

"Asthma is not a static disease -- it changes over time," Kobrynski
says. "Kids may develop new triggers, and their asthma may change -- it may
become more severe. At least two or three times a year, they need re-evaluation
to see if their treatment plan is adequate."

By
Reviewed by Louise Chang
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