Kids' Asthma Out of Control

4 Out of 5 Kids With Asthma Don't Control Symptoms

Medically Reviewed by Louise Chang, MD on March 15, 2007
From the WebMD Archives

March 15, 2007 -- 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.

All children with persistent asthma symptoms should use daily corticosteroid inhalers, Halterman tells WebMD. Flovent and Pulmicort are two popular brands.

"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? 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 require 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."

Show Sources

SOURCES: Halterman, J. Ambulatory Pediatrics, March 2007; vol 7: manuscript received ahead of publication. Machlin, S. "Children Living with Adult Smokers, United States, 2004," MEPS Statistical Brief #147, Agency for Healthcare Research and Quality, U.S. HHS, November 2006. Jill Halterman, MD, MPH, associate professor of pediatrics, Golisano Children's Hospital at Strong, University of Rochester, N.Y. Lisa Kobrynski, MD, MPH, assistant professor of pediatrics, Emory University, Atlanta.

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