May 6, 2002
InteliHealth News Service
With childhood asthma rates reaching an epidemic level, a committee of experts has recommended the launching of a national asthma public education campaign and stepped-up asthma programs in schools.
These proposals were among 11 specific steps outlined in the May issue of the journal Pediatrics. "In an asthma-friendly community, children with asthma are quickly diagnosed and receive appropriate and ongoing treatment; health care, school, and social agencies are prepared to meet the needs of children with asthma and their families; and children are safe from physical and social environmental risks that exacerbate asthma," the article says.
RAND Health, Santa Monica, Calif., coordinated the report. The committee included physicians and researchers from institutions around the country.
Childhood asthma is so common that it is considered an epidemic, and rates are increasing. Between 1980 and 1994, asthma rates more than doubled in children under 5 and almost doubled in children 5 to 14.
About 5 million U.S. schoolchildren have asthma, making it the most common chronic disease of childhood. Although death in children from asthma is rare (in 1998, 247 children died from the disease), asthma often causes serious illness; children with asthma make 900,000 emergency department visits and 5.8 million outpatient visits each year.
The social and financial burdens of the disease are also great. Each year, asthma accounts for nearly 12 million missed school days (as well as lost work days for parents) and in 1994, for example, the United States spent almost $11 billion on asthma.
A related article in the same issue of Pediatrics studied more than 1,600 children with asthma who were on Medicaid managed-care health plans. The data showed that minority children had worse asthma (for example, had symptoms and missed school more often) and used preventive medications less than white children did, regardless of their family income, parental education, poverty status or other socioeconomic variables.
Here are the specific recommendations from the expert panel for improving the management of childhood asthma nationwide:
- Develop primary-care performance measures for childhood asthma care.
- Teach all children with persistent asthma a specific set of self-management skills.
- Provide case management to high-risk children. Case management of services provided by medical and social work professionals that include tracking, coordinating care, and follow-up.
- Extend continuous health insurance coverage to all uninsured children. Many studies have shown a link between insurance and access to health care. The recommendation states that insurance programs should be expanded to children of working parents who do not qualify for public insurance but do not receive insurance from their employers, and children who are not U.S. citizens.
- Develop model benefit packages for essential childhood asthma services. Having insurance is not always enough — children must have coverage for all of the services included in accepted guidelines for asthma care.
- Educate health-care purchasers about asthma insurance benefits.
- Establish public-health grants to foster asthma-friendly communities and home environments.
- Promote asthma-friendly schools and school-based asthma programs. Children spend a significant amount of time in school, yet many barriers exist to recognizing and treating asthma in schools.
- Launch a national asthma public education campaign. There is a general lack of information within communities about asthma risk factors, symptoms and management. National educational messages should be tailored to those with special cultural and linguistic needs.
- Develop a national asthma surveillance system. Collection of information at local, state, and national levels using surveys and other methods would improve data on asthma; current information is inadequate for developing prevention, treatment and management strategies.
- Develop and implement a national agenda for asthma prevention research. In order to develop strategies to prevent asthma, it is necessary to increase the research done on the causes of asthma, including possible environmental, genetic, lifestyle (diet, exercise) and health-care system factors.
