Asthma Out of Control in America's Kids

Nearly one in 10 U.S. kids — 7 million children — suffer from asthma. Many suffer much more than they have to.

Why? Most parents don't know how bad their kids' asthma really is. The result: Kids miss out on modern treatments. Proper treatments prevent recurrent asthma attacks. To kids, it's the difference between a normal life and a worsening handicap.

The new findings come from a major survey funded by GlaxoSmithKline and spearheaded by Asthma Action America. Asthma Action America is an education campaign supported by more than 20 medical, pharmacy, business, and youth organizations. GlaxoSmithKline is a WebMD sponsor.

Survey advisor William "Dr. Bill" Sears, MD, teaches pediatrics at the University of California, Irvine. He's the author of 32 childcare books and the father of eight children.

"Children with asthma should be symptom-free most of the time," Sears tells WebMD. "Kids tend to downplay the severity of their illness. They don't want to worry their parents and they don't want to miss activities. That is [the reason behind] the communication gap. Parents think their kids' asthma is under control — but really, it isn't."

Kids with poorly controlled asthma can suffer lifelong consequences, says Norman H. Edelman, MD, scientific consultant to the American Lung Association, and dean of the SUNY-Stony Brook School of Medicine. The tragedy is that most kids — and their parents — settle for much less asthma control than they need.

"Children with asthma should be able to sleep through the night; should use their quick-relief inhaler no more than once or twice a week and should be able to engage in most physical activities," Edelman tells WebMD. "But we find people are accepting much less than that. There are severe consequences, such as learning difficulties. And now there's evidence that poor control over years leads to irreversible lung disease — scarring of the airways that doesn't go away."

Asthma in Kids: Eye-Opening Survey

The Asthma Action America survey queried more than 41,000 randomly selected households in the U.S. to come up with a nationally representative sample of 801 children with asthma. Researchers conducted 47-minute interviews with the parents. They also interviewed 284 of the children after their parents had been interviewed.

The major findings:

—80 percent of the parents said their child's asthma was under control, yet many of these kids weren't getting state-of-the-art care.

—Kids with asthma — and their parents — accept a much lower quality of life than they have to.

—Parents and kids give very different answers to questions about the severity and frequency of kids' asthma attacks.

—Kids' treatments lagged far behind treatment goals established by the National Institutes of Health.

Kids' Asthma Attacks Often Frequent and Severe

Proper asthma treatment makes asthma attacks less severe — and less frequent. But the survey shows that most kids aren't getting this kind of treatment:

—Two-thirds of kids with asthma had an attack in the last month.

—1 in 5 kids with asthma have daytime attacks at least three times a week.

—1 in 3 kids with asthma wakes up during the night from asthma symptoms.

—More than half of kids with asthma had a sudden, severe attack in the last year.

—More than 1 in 4 parents have felt their child's life was in danger during an asthma attack.

—1 in 10 parents feared for their child's life in the last year.

—More than 1 in 4 kids with asthma have moderate or severe disease — yet half of their parents think their asthma is good or very good.

Kids' and Parents' Lives Affected by Asthma

The survey turned up plenty of evidence that asthma is hurting families’ quality of life:

—Asthma attacks made most kids with asthma miss school or daycare in the last year. On average, they missed four days of school — and their parents missed three days of work.

—One in 10 kids with asthma missed more than two weeks of school — and one in 10 parents missed more than a week of work.

— Two out of five parents say asthma interferes with their kids' lives.

—Two-thirds of kids with asthma had limited activities.

—One in three kids with asthma feels fearful at least some of the time. One in five sometimes feels depressed.

Asthma Communication Gap

The survey shows 71 percent of parents and their children disagree about the child's overall health status:

—A third of parents and children disagreed about whether the child had asthma symptoms in the past month.

—Nearly half of parents and children disagreed about whether the child had any daytime asthma symptoms in the past month — and nearly a third disagreed about nighttime symptoms.

—Three-fourths of parents and children disagreed on how often the child's asthma interferes with a planned activity.

—Nearly two-thirds of kids and parents tended to disagree on the worst thing about asthma. Parents tended to say that inability to breathe and taking medicine were the worst things. Kids tended to focus on missed activities.

Talking to Kids About Asthma

All children with asthma should develop a written asthma treatment plan with their doctors — and update it as needed. This can't happen if parents don't know what's going on.

"We are trying to get parents to talk to their child and ask specific questions," says Sears. "It would be good if they took the asthma control test with their child. If they are on the same wavelength with their child, parents can rest assured."

The test, developed by Sears, can be printed out from the Asthma Action America web site. But regular, simple, direct questions also are helpful.

"Ask, 'Honey, do you cough much at night?' 'Was your sleep interrupted?' 'Did you have to stop in the soccer game?' Parents need to communicate with children about the severity of their symptoms, not just ask, 'How did you do today?'" Sears says.

By Daniel J. DeNoon, reviewed by Charlotte E. Grayson, MD

SOURCES: "Children & Asthma in America," Asthma Action America, December 2004. Asthma Action America web site. William Sears, MD, associate professor of pediatrics, University of California, Irvine. Norman H. Edelman, MD, scientific consultant, American Lung Association; and vice president, health science center and dean, SUNY-Stony Brook School of Medicine.