Clander Williams of Augusta has sat down with an asthma educator three or four times to go over the medications for her 15-year-old daughter, Semaj, and how and when she should take them.
“It was worth it,” she said, “because now we do it correctly. We weren’t doing it right in the beginning.”
“We find that a lot,” said Reva Crandall, a respiratory therapist at AU Health System who is part of the team overseeing Semaj’s care.
While the 6 million children with asthma in the U.S. are seeing fewer attacks and hospitalizations, more than half had an attack in 2016, and only about half had a comprehensive plan to control their asthma and many are not taking their controller medication correctly, according to a new report from the Centers for Disease Control and Prevention.
In its monthly Vital Signs report, the agency found that the number of children who had at least one asthma attack dropped from 61.7 percent in 2001 to 53.7 percent in 2016, while hospitalizations dropped from 9.6 percent of children in 2003 to 4.7 percent in 2013, with the number of children missing school and the number of school days dropping as well. While the number of children receiving an asthma action plan increased from 39.5 percent to 50.1 percent, still about half had no asthma action plan, said Dr. Anne Schuchat, acting director of the CDC. And while 55.2 percent were taking asthma control medications, the percent using them regularly as prescribed actually dropped from 65.7 percent in 2003 to 54.5 percent in 2013.
“Overall, there are some encouraging trends,” Schuchat said. “But not all of the news is good. Severe asthma attacks can be terrifying for children and for their families. Today’s report reveals that in 2016, one in six children with asthma still ended up in the Emergency Department or Urgent Care. More than half of all children with asthma had one or more attacks in 2016.”
Getting a personalized asthma action plan for each child is important and more of them need to get one, she said, “but we think that it takes multiple efforts to make sure that kids are under good control. The plan alone is not enough. In addition to that, we recommend assessing the home environment for those triggers and self-management education can be helpful.” Less than half of the children got advice about how to manage or eliminate environmental triggers in the home, Schuchat said.
A decade ago, concerns were heightened in the Augusta area when 10 children died from asthma within a 20-month period and groups came together in 2008 to form the CSRA Asthma Coalition to push for greater use of asthma action plans and allow children to have medication stored at school. But at AU Health that has been the practice for decades, said Dr. William Dolen, professor of pediatrics and medicine, who saw Semaj for a checkup on Tuesday.
In addition to asthma plans and regular education for caregivers, the health system stresses the use of lung function tests and asthma control tests to really assess how well a patient is breathing and controlling asthma, he said. The problem is people can misjudge how well they are breathing and think they are fine when they are not, which are called “poor perceivers,” Dolen said.
“Those folks are at real risk of coming into the hospital or even dying from asthma because they think they are okay but they are on the verge of respiratory failure and they don’t realize it,” he said. “And then they get a virus infection or some smoke exposure or something and that sends them over the edge very, very rapidly.”
That is why things like the current flu epidemic can be particularly concerning, Schuchat said. Of the 180 children hospitalized with flu so far this season for which the CDC has data, about half had no underlying medical condition but 24 percent had asthma, which is consistently the most common medical condition among children hospitalized from flu, she said.
It is another reason controlling asthma in children is important, Schuchat said. CDC would like to see more funding for greater dissemination of innovative projects that work, such as a home visit program for higher risk children in Rhode Island that helped improve control and reduce costs, she said.
“What’s needed now is to help children have more control of their asthma by scaling up these effective strategies so that children have fewer of these awful episodes,” Schuchat said. “We know that the progress we’re reporting today is just the beginning. We hope we can see a lot more progress in the future.”