DISABILITY ISSUES
Vol. 21 No. 2

A Report on Disabling Childhood Asthma

The following article is adapted from an Issue Brief published by the NRH Center for Health & Disability Research.

This issue brief describes disabling childhood asthma as a major public health problem, one that challenges the medical community and society to address the comprehensive, continuous health care and rehabilitation needs of children with asthma.

Asthma is growing in prevalence among all children under the age of 17, but it is also unevenly distributed across income groups, and across families living in urban versus rural environments. If untreated, severe asthma is a life-threatening condition. Poorly controlled asthma may result in avoidable hospitalizations and emergency room care, and may have life-long disabling consequences.

Asthma is the fastest growing chronic disabling condition in children.

l Asthma is a chronic inflammation of the airway system due to airflow obstruction.

l The number of children with disabling asthma under 17 years of age has nearly doubled within the last two decades to nearly 1 million children.

l Boys are more likely to be diagnosed with asthma than girls.

l Between 5 and 10 percent of children under 17 have asthma in the United States.

l Asthma is more common in children than it adults.

l Asthma is triggered by a variety of factors. The living environment plays a crucial role in the development of asthma. Among the known allergens are dustmites, cockroach and mouse droppings, and nicotine.

l Unhealthy behavior (e.g. lack of physical exercise) associated with the increase of other chronic conditions (such as diabetes and hypertension) may also have a role in asthma. These other behaviors may lead to exacerbated symptoms with potentially disabling consequences, if not addressed.

l There is no cure for asthma and the cause of the disease is unknown.

Asthma causes multiple impairments.

l Almost 14 percent of children with asthma have functional limitations in the areas of walking, crawling and playing.

l More than 10 million school days are missed annually due to asthma.

l Nocturnal asthma is associated with impaired cognitive functioning and fatigue due to sleep deprivation.

l Severe asthma can result in impaired growth of lung function followed by declining lung function in adulthood.

l Clinical allergies and sensitization towards inhaled allergens during childhood may persist into adulthood. Children raised in allergen-rich environments are especially at risk for adult asthma.

l Less than 25 percent of children with asthma will experience a symptom-free adulthood.

Asthma is a social problem.

l Asthma is more common in cities than in rural areas. Urban, low-income children are at a higher risk for developing asthma and for poor asthma management.

The increased number of asthma cases in inner-city environments is the result of a complex array of factors including low-income households with unsanitary housing conditions, limited access to care due to insufficient insurance coverage, lack of family support, and little knowledge about asthma, its consequences and ways to control it.

Asthma is often poorly managed.

Effective control of childhood asthma depends on timely education and access to care and medication. There are two therapeutic strategies for effective control of disabling childhood asthma: intervention measures to stop acute symptoms, and maintenance measures to prevent symptoms from reoccurring. The child's guardians and school administrators play important roles in successful long term asthma management. These roles include: constant vigilance of environmental quality to prevent triggering episodes at home or school; assuring that the child takes maintenance medication and knows how to use his or her inhaler; recognizing when the child's control is worsening; and knowing when to give the child anti-inflammatory corticosteroids (which act slowly) so that urgent care is not needed. The parent also needs to take the child to his or her regularly scheduled appointments with the clinician monitoring the child's condition.

Rehabilitation of Childhood Asthma.

Pulmonary rehabilitation programs include exercise training, patient education about asthma management strategies, breathing exercises, relaxation techniques and recreational activities. Rehabilitation can improve functional status in terms of physical endurance and cardiovascular fitness. Greater exercise tolerance, in turn, is related to greater perceived quality of life.

To obtain the complete Issue Brief on Disabling Childhood Asthma, contact the NRH Center for Health & Disability Research, Suite 400, 1016 16th Street, NW, Washington, DC 20036; or visit their website at www.nrhchdr.org.

Kroll, T., Neri, M.T. & Palsbo, S.E. (2001). "Disabling Childhood Asthma" Health & Disability Issue Brief. Washington DC: NRH Center for Health & Disability Research. April.