Washington – Only one in five children with asthma has the disease under good control, sobering findings that are helping to fuel a shift in care.
The change: A stronger focus on day-to-day symptoms, not just the bad attacks, so that more of the 20.5 million Americans of all ages who have asthma can breathe easier without limiting their activities.
Federal guidelines due this summer are expected to urge doctors to more closely monitor whether treatment is truly controlling everyday symptoms and improving patients’ quality of life and to adjust therapy until it does.
Already, a campaign is underway to teach patients to recognize whether they need better help and how to convey that to a doctor. For example, if a doctor is happy that a patient has had no flare-ups but doesn’t know that the patient had to quit playing soccer to do it, that is not achieving good control.
Too often, physicians don’t realize how severe symptoms are, says Dr. Jill Halterman, a pediatric asthma specialist at the University of Rochester. With children, their parents may underestimate symptoms.
It’s more complicated than denial: When wheezing while running or waking up at night coughing has been routine for years, people may not know to complain.
“It may be part of what they view as normal,” says Halterman, who is studying the control gap.
That’s the goal for adults too, as specialists shift from asthma’s severity as the chief treatment guide to this broader goal of asthma control, adds Dr. Allan Luskin of the University of Wisconsin in Madison.
Asthma is a chronic lung disease caused by inflammation inside airways that, in turn, makes them supersensitive, narrowing in response to irritants that wouldn’t bother a healthy lung.
There is no cure. But there are effective daily medications that reduce inflammation and prevent flare-ups, especially if patients also minimize their exposure to environmental triggers. Yet asthma still kills more than 4,000 people a year and causes 2 million emergency-room visits and half a million hospitalizations.
Many are children, and Halterman took a closer look at why. She analyzed almost 1,000 asthma sufferers culled from a federal child-health study in Alabama, California, Illinois and Texas.
About 37 percent had not been prescribed preventive medication despite current guidelines, a long-recognized problem.
The surprise was that 43 percent did have those medications yet still experienced persistent symptoms, more than one attack in the last three months, or both.
“This is a group that has been largely neglected in the past because we’ve done our thing – prescribe the appropriate medications and the hope was the child should do well,” Halterman explains. “At that point, still much more needs to be done.”
