Kids 'Silently Suffering' With Asthma

From the WebMD Archives

May 2, 2001 (Baltimore, Md.) -- Children continue to suffer with asthma despite many advances in asthma treatment. Two studies presented here at this week's Pediatric Academic Societies' Annual Meeting show that patients, parents, and doctors equally contribute to the continuing problems of managing childhood asthma.

To discuss issues surrounding your, or your children's asthma, go to WebMD's Asthma: Open Discussion board.

In the first study, researchers found that fewer than half of the children suffering from moderate to severe asthma symptoms are seeking help from healthcare providers. The researcher also suggests that many children aren't getting the drug treatments they need to keep their symptoms under control.

The researchers, led by Jill Halterman, MD, a pediatrician from Children's Hospital at Strong in Rochester, N.Y., looked at 168 children, aged 6-19, from Upstate New York who had three or more asthma-associated medical visits during the previous year.

Halterman and colleagues asked the families to keep diaries detailing their struggle with asthma, including use of medications and visits to the doctor for asthma.

During the three-month study period, over half of the children had more than two days of asthma symptoms each week, meaning they had moderate to severe asthma. Only 47% of the children with significant symptoms used preventive steroids or anti-inflammatory drugs to treat their asthma. Even among children having daily breathing difficulties, only half, or less, got to see a doctor.

"The term we used was 'silently suffering.' They're having symptoms at home but they're not hooking up with their primary care providers to get appropriate care," Halterman tells WebMD. This is particularly frustrating, she says, because great strides in asthma therapy have been made in recent years. But they won't help unless patients use them.

There could be several reasons why kids don't get help. Halterman suggests that parents sometimes become desensitized to asthma. Or they may fear the medicine's generally modest side effects and simply don't tell the doctor what the problem is. Managed care that limits access to care could be another factor, says Halterman.

However, whatever the reason, Halterman worries that too many children are living with asthma when good treatments could dramatically alter their lives.

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"Providers really need to ask specific questions about symptoms when they see families, but not just have you been to the emergency department? But how many days per week are you having symptoms of asthma?" urges Halterman.

If anything, Halterman says, her studies indicate the problem is even worse than the findings suggest, because families tend to report that their children are being treated since they think that's what doctors want to hear.

The second study presented at the meeting suggests that doctors may also play a part in the problems of managing childhood asthma. The study found that doctors often "beat around the bush" when it comes to diagnosing asthma.

In the large study, supported by the American Academy of Pediatrics (AAP), researchers compared what doctors reportedly told families about their child's asthma to what 600 parents say they heard about their child's illness.

In 62 cases, doctors thought asthma was the right diagnosis, but only told 46 patients of their belief. Even so, parents often don't hear the proper diagnosis.

"The [doctors] are using euphemisms because the parents are reporting that they weren't told asthma, they were told something else ... they were told asthma-wheezy bronchitis, or reactive airway disease. For example, in asthma, only nine of the 17 parents who the doctors say were told their children had asthma, actually heard that diagnosis. They heard something else," says study researcher Stacia Finch, MA, of the AAP.

In other words, only about half of the doctors and parents agreed on an asthma diagnosis. And that can lead to trouble getting the right treatment. "If it is asthma, [doctors] need to say it's asthma rather than [something else]," says Finch.

It's not clear why there is this disconnect between doctors and parents, although stigma associated with asthma is still an issue.

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