Asthma and Children in the US

Childhood Asthma

The word asthma comes from the Greek word aazein which means to exhale with one's mouth open or to breathe with a pant; in literature its first emergence appears in the Illiad (Benson & Haith, 34). The exact definition of asthma be it with children or adults is that it is "a chronic disease of the lung manifest clinically as episodic obstruction of pulmonary airflow (Benson & Haith, 34). Asthma is an extremely common childhood illness and one which appears to be increasing each year with the number of children who have died from asthma tripling in the last few years (Martin & Fabes, 262). This is a major public health concern as asthma not only contributes to many missed days of school for children, as well as hospitalizations, but it puts an enormous strain on the health care industry. "Hospital admission for asthma alone increased from 21 per 10,000 children in 1980 to 29 per 10,000 children in 1999" (EPA, 75).

Asthma is a condition that is more common in boys and more common in the African-American population; one in six children will experience asthma at some point in their lives (Rubin, 1998). Generally between five and ten percent of children will develop this disease by the age of five, which will frighteningly manifest for the first time in the form of an acute attack, alerting parents to the fact that their child has developed the condition.

Causes

"No one really knows why more and more children are developing asthma. Some experts suggest that children are being exposed to more and more allergens such as dust, air pollution, and second-hand smoke. These are factors that can all trigger asthma" (Gelfand). Thus, the idea that this environment is becoming more and more unsafe for children is a significant reason as to why a child might develop asthma. This is based on the notion that today's environment is more unsafe and full of more toxins than fifty years ago.

However, other childhood experts believe that it's not so much a question of the environment, but a problem with the way that children are being raised within this environment. "Others suspect that children are not exposed to enough childhood illnesses to build up their immune system. It appears that a disorder of the immune system in which the body fails to make enough protective antibodies may play a role in causing asthma" (Gelfand). This would indicate that asthma is a result of all the mandatory vaccinations and immunizations that babies have to receive, alluding to the idea that this form of "protection" has a side effect: it makes children more vulnerable to conditions like asthma. On a related note, "Still others suggest that decreasing rates of breastfeeding have prevented important substances of the immune system from being passed on to babies" (Gelfand).

While there is a great deal that experts still don't quite understand about why some children develop the disease, whereas other children do not, there are some common trends which act as a guidepost for developing the condition. For example, having certain inherited traits, and certain types of airway infections as a child, along with early contact to certain environmental pollutants such as cigarette smoke or air pollution can make a child more likely to develop this condition (mayoclinic staff).

It's crucial to adequately understand this condition and work to find the most manageable forms of treatment for kids so that they can live long, happy and safe lives. Furthermore, without proper treatment, as child's asthma will generally get worse over time (Martin & Fabes, 262).

Risk Factors for the Condition

As stated earlier, growing up in an environment where there are a lot of contaminating irritants like cigarette smoke or other pollutants puts one at extreme risk for developing the condition. However, there are other factors at work which can make a child more or less likely to develop the disease. "Black, native American, and Hispanic children have higher rates of asthma than white children. Prevalence among Puerto Rican children is more than double that among non-Hispanic white children. Hospitalizations, emergency department visits, and deaths due to asthma are much higher among black children than among any other group of children. Black children have a six-fold higher death rate from asthma than white children, although the rate of ambulatory-care visits by black children is lower than that for other racial groups" (Levy et al., 63). This demonstrates that when it comes to this condition there appears to be a significant amount of racial disparity at work, but that medical experts may or may not be able to understand why this is.

Studies which have been designed to determine why these racial disparities exist with childhood asthma have often done little to shed light on the issue. For example, the study, "Racial Disparities in Childhood Asthma in the United States" (McDaniel et al., 877) seeks to determine why there is a higher prevalence of asthma in black children and why the mortality rate is also equally high. Unfortunately, all the study does is re-asserting what professionals in health care already know, illuminating the fact that the researchers are unable to come up with any real answers. The study concludes, "Black children are more likely to have asthma and to experience ED visits for asthma, compared with otherwise comparable white children, and these racial disparities cannot be explained by differences in measurable child or family characteristics. These results suggest that racial disparities in asthma continue to pose risks for black children" (McDaniel et al., 877). The researchers conclude with the obvious notion that more research needs to be done to provide greater insight and actual answers into why this is the case.

However, two years later, a study conducted by Haskelkorn and colleagues was able to shed adequate light on the issue. The study involved 1,885 white patients and 243 black patients around America who were treated by a range of specialists at a wide variety of study sites (Haskelkorn et al., 263). At first the study proved what experts in the field already knew, that African-Americans were more likely to have asthma, and that it was more likely to be severe (Haskelkorn et al., 263). "However, the researchers found no differences in access to treatment between the two racial groups and no evidence of differences in asthma-related knowledge or behavior in the patients. Socioeconomic status, adherence to drug therapy, treatment setting, the presence of other diseases and various allergy measures also did not explain the differences in asthma-related illness and severity between the two races" (Reuters). "Asthma is a serious health problem in blacks and is not explained by differences in demographics, severity, or other health conditions" (Haskelkorn et al., 263). Essentially, these findings indicate that one has to acknowledge a genetic component at work when it comes to asthma, race and the African-American community. This means that researchers need to take this into consideration when it comes to treatment and prevention of this condition.

Signs and Symptoms of Asthma

A child with asthma may wheeze frequently or suffer from a persistent cough, especially in the evenings (Schell & Nurik, 30). Other signs include rapid breathing, being unable to speak except for few words, increased agitation and anxiety, bluish fingertips and lips among other indications (Schell & Nurik, 30). It's possible that some parents might think their child has a frequent cough or an exacerbated cough, and not make the connection that their child is suffering from this debilitating condition. Other times parents will take into consideration the range of symptoms that their child is displaying as a red flag, take their children to a doctor and then the child will be diagnosed with asthma. This is one of the difficult aspects of the disease: there's no one medical test for asthma so a diagnosis generally depends on the child's overall presentation of symptoms (CHP, 21).

However, as a parent, one needs to become acquainted not only with the most common signs of asthma, but with how they most commonly manifest themselves with children. For example, children are given to: "Frequent coughing spells, which may occur during play, at night, or while laughing. It is important to know that cough may be the only symptom present; less energy during play; rapid breathing; complaint of chest tightness or chest 'hurting'; whistling sound (wheezing) when breathing in or out; see-saw motions (retractions) in the chest from labored breathing; shortness of breath, loss of breath; tightened neck and chest muscles; feelings of weakness or tiredness; dark circles under the eyes; frequent headaches; loss of appetite" (Gelfand). These are all ways in which asthma may manifest itself as a childhood disease; a child may display one, a couple or all of these symptoms. However, parents must understand that asthma won't necessarily manifest as difficulty breathing. When a child has difficulty breathing it can take a range of forms and manifestations.

Diagnosing Asthma

Asthma, surprisingly enough, remains generally under-diagnosed as a child will demonstrate certain signs of the condition, but then outgrow them later in life (CHP, 22). This is problematic as the longer asthma allows to subsist being under-diagnosed, the more lasting damage it is able to do to the lungs of the child (CHP, 21).

Dynamics

Children who have asthma live with an inflammation of the bronchial tubes. Generally they can breathe normally, except when something triggers their asthma, at which point their bronchial tubes narrow, making it difficult for air to get in their lungs (Martin & Fabes, 262). Kids who are undergoing an asthma attack will commonly feel a tightness in their chest as well as a sensation that they're breathing through a straw and start wheezing (Martin & Fabes, 262).

Triggers for Asthma

A variety of things can serve as a trigger for asthma; in fact, there are two types of asthma, allergic and non-allergic. The allergic form of asthma is triggered by things that are known to be allergens, such as pollens, dust or molds (Schell and Nurik, 30). Non-allergic asthma can be triggered by things like cold weather, exercise, emotional stress, or respiratory infections (Schell & Nurik, 30). Some children will sometimes suffer from extreme viral infections and then develop asthma as a result (Schell & Nurik, 30). Other triggers in general include things like air pollutants, cigarette smoke and certain medications, such as aspirin (Schell & Nurik, 30).

In these modern times, more and more research is being conducted as to the agents in the environment which can trigger an asthma attack, and the environmental agents which can cause asthma or make individuals more vulnerable to asthma. According to one study, "There is abundant evidence that asthma is frequently exacerbated by infectious agents. Several viruses have been implicated in the inception and exacerbation of asthma. Recent attention has been directed at the role of infections with the atypical bacteria Mycoplasma pneumoniae and Chlamydia pneumoniae as agents capable of triggering asthma exacerbations and potentially as inciting agents for asthma" (MacDowell & Bacharier, 11). This research provides truly insightful work as to specific bacteria in the environment which acts as a very real and present threat to individuals and their health, making people, particularly children more vulnerable to developing asthma.

The 2008 study conducted by Haskelkorn and colleagues demonstrates the issue of genetic factors and asthma, something that scientists weren't necessarily certain about. However, information of this nature was available as early as 1995. Sarafino and Goldfedder conducted a study where, "Health surveys containing questions about children's asthma characteristics were completed by 325 families with twin children across the United States. Data for 39 monozygotic twin pairs and 55 same sex dizygotic twin pairs who were between 2 and 20 years of age and had asthma present in at least one member of each pair were received and analyzed. Results revealed higher concordance for the presence of asthma among monozygotic (58.97%; n=23) than dizygotic twins (23.64%; n=13)" (112). Sarafino and Goldfedder were able to use these findings over 15 years ago as a warning towards the massive role that hereditary and genetic factors can play with a condition like asthma, two factors which can have an extreme impact on developing the conditions, the severity and the types of triggers for asthma.

Management

Managing asthma in a successful and adequate manner is key to having a long and healthy life. This is particularly important for children, not just to keep them out of the emergency room and to prevent them from missing school, but to ensure that these children feel as normal as possible, and don't feel as though there is a limit on what they can achieve of experience. This is crucial in preventing psychological complexes from developing that are caused in part by children, in having asthma, feeling like they have an incurable condition which somehow makes them inferior or unable to do what all the other kids can.

"Therapy revolves around the triad of asthma and is the reason all persistent asthmatics need two categories of therapy. Controller therapy is prescribed to treat inflammation and reliever therapy is given to treat bronchoconstriction. Controller therapies are anti-inflammatory in nature and include medications such as ICSs, cromolyn, and LTRAs. Reliever medications are primarily Beta-agonists but may also include anticholinergics or theophylline to dilate the airways" (Hendershot, 40). However, the most important point that Hendershot makes is that children need to be taught the absolute importance of compliance. One of the biggest issues with a childhood disease like asthma is that it forces children to take on a very adult responsibility at a young age. While parents can help them manage this new responsibility to a certain extent, in making sure medication is up-to-date and that children take their medication regularly, kids are still forced to take on the accountability for remembering to bring their inhaler and other medications to school and social events, when other kids don't have that same level of responsibility.