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When a chronic disease or condition affects one in nine children in Florida, we need to take action. When it affects specific communities more than others, those actions must address the issues in order to improve the health of our children.
So what disease are we talking about? It’s asthma, a chronic illness of the lower airways, which causes the airways to become inflamed and hyperactive, and produce extra mucus, resulting in coughing and wheezing as the children try to breathe. Asthma can range in severity and there can be acute exacerbations – sudden acute “attacks.”
Parents need to be attuned to the early warning signs, which are exercise intolerance, night-time cough, chronic day cough, tightness in the chest, and lower tolerance for physical activity.
Genetics, environment, and diet can all play a role in developing asthma.
Asthma Risk
Children can be born with a genetic predisposition for asthma. This is particularly apparent in African-American and Puerto Rican communities, which have a higher prevalence in Florida.
Environmental and diet issues are also significant risk factors for people living in low-income and inner-city areas. Children in those communities may be exposed to mold and cockroaches, which are strong allergy triggers. Families may not have air conditioning to help clear airborne allergens. Diet-wise, children may not have easy access to healthier food choices or be aware that their diet is exacerbating their breathing problems. Processed foods and products with artificial colors and flavors (which also tend to be cheaper) may worsen respiratory symptoms.
Diagnosing asthma
Identifying asthma is not always straight forward. For example, adolescents with asthma are often undercounted, as are children under five.
Adolescents are working on their independence and may not always recognize or report symptoms to their parents or physician. They also may not be as compliant about taking medications. Teens also usually have great lung capacity. Even if they have mild-to-moderate asthma, it might not be evident until they have an exacerbation.
In preschoolers, diagnosing asthma can be difficult because physicians must rely on symptoms, physical exams, and family history; lung function is difficult to assess in this age group. Usually, asthma cannot be diagnosed before age two, although an earlier diagnosis is possible when an infant has signs of food and environmental allergies and recurrent wheezing.
School-age children with asthma are the easiest to identify because it is easier to document their symptoms, do testing, and parents, teachers, and other adults involved in their lives can report anything untoward.
More Barriers to Diagnosis and Treatment
There is another possible barrier to diagnosis and treatment, aside from age: access to healthcare. Even if families do have a primary care physician (PCP), they might not be able to get to the doctor’s office because of transportation or scheduling issues.
When this happens, parents may bring their sick child to an urgent care center, often as symptoms become significantly worse than they would be had they gone earlier to their PCP. Their child will be treated, but usually only with medications to treat the immediate issue, not the underlying problem.
This leads to the last barrier to effective treatment: the medications physicians are allowed to prescribe. Most asthma medications available on the Medicaid and some commercial insurance formularies only decrease the symptoms. These drugs don’t treat the airway hyper responses and inflammation that caused the symptoms. There are very effective medication inhalers that do address the causes, but they aren’t covered. And so starts the cycle of symptoms and treatment – but not prevention.
Multi-Pronged Approaches to Care
Unfortunately, little in Florida has changed over the past 20 years when it comes to identifying and treating children with asthma.
The American Lung Association has been working with schools, teaching kids about asthma, and getting parents involved. School nurses do help. The state is working with hospital emergency rooms and urgent care clinics to identify patients who may be “frequent flyers.” And since asthma often runs in families, identifying patients can also impact siblings or even adults who were never diagnosed. But this is not enough.
The Take-Away
Asthma is treatable through the use of preventative medications and by modifying risk factors. More efforts are needed to support parents who have children with asthma and provide preventive medicines to help control it. Vaccines against influenza and pneumonia help prevent exacerbations in adults and children.
Asthma isn’t curable; it doesn’t go away. But good management can reduce the frequency of asthma symptoms for weeks, months, and even years.
