Asthma Healing

An estimated two million children in the U.S. with moderate to severe asthma may not be getting the care they need, making them sicker than they need to be, according to a study in a supplement to this month's edition of the journal Pediatrics.

Asthma is the most common chronic illness of childhood. According to figures from the CDC, the prevalence of asthma has grown 75% between 1980 and 1994. There have been many advances in treatment. However, hospitalizations continue to increase for the illness.

Jill S. Halterman, MD, lead author of the study, tells WebMD, "one of the reasons that we even started this study in the first place was that we knew that asthma was getting worse, we know that it's the most common chronic illness of childhood, and we know there are effective preventive medications."

"So, our question was whether or not the children were actually receiving the medications. We can't say why asthma is increasing or getting worse for children, there could be a lot of reasons ... but it does seem that children aren't receiving medications that could be helpful," she says. Halterman is with the Children's Hospital at Strong, University of Rochester School of Medicine and Dentistry in New York.

The disease currently cannot be cured, only controlled. It is a long-term, progressive disease that causes inflammation of the airways, which, in turn, can lead to difficulty breathing. Without proper care, in time, the recurrent inflammation can cause permanent lung damage.

This study focused on more than 500 children aged 2 months to 16 years from the third national health and nutrition examination survey. The children had moderate to severe asthma, and only 26% had taken a maintenance medication in the month before being surveyed.

"All we know from the survey is that they weren't getting the medications. We don't know whether the medications weren't prescribed by physicians, whether parents weren't getting the prescriptions filled, or whether parents were having difficulty with the administration of the medications. All we know is that they [the children] weren't getting them," Halterman tells WebMD. "So, really the next step is to examine that further and to try and find out where the deficit is, and what the best way would be to assure that the children will get the medications that they need."

This held true even after 1991, when guidelines were introduced recommending daily maintenance medications for children with moderate to severe asthma. Inadequate therapy was found to be more likely among the very young, the poor, and Spanish-speaking children. But the problem was evident across the board.

Halterman says, "the children at highest risk for inadequate therapy were poor children and Hispanic children. However, one of the interesting things that we found was that all children were getting inadequate therapy."

Martha White, MD, is with the Institute of Asthma and Allergy at the Washington Hospital Center and a fellow with the American Academy of Allergy, Asthma and Immunology. She had no dispute with the findings.

White tells WebMD most pediatric asthmatics are treated by their pediatricians or family practitioners, who are often "excellent" at treating asthma, but are also often spread too thin. "So, the aggressiveness of the care that you receive from a primary care physician who has to deal with everything, and therefore is expected to keep up with everything, is not going to be the same as the aggressiveness that you have from a specialist."

And then there's the medications themselves. The preventive medications, which are anti-inflammatories, are often inhaled steroids. That word, White says, "scares the 'bajiggies' out of [even] your more-informed patient."

In addition, any of the anti-inflammatories "don't provide immediate relief. And so, from a parent's perspective, unless somebody has spent a lot of time talking to them ... the symptom controllers, the quick fix medications are the one's that they perceive are working, and all those are, are Band-Aids, and the medications that are really most important, that they are addressing in this study, are the one's where's there's no perceived benefit. And that's a big problem," White tells WebMD.

"Somewhere in the middle," she says, "is the person who happily does what you tell them to do, assuming you've talked to them a lot, and you've had time to tell them. You do have to spend a lot of time convincing people of the necessity of taking a medication that they don't perceive works, they have to understand why they're doing it. And then you have to jump the hurdle of getting them over their fear of a class of medications they've heard a lot about, where they have a lot of misconceptions ... people need education."