Children With Asthma More Vulnerable to H1N1 Virus

Nearly a dozen 7th graders with asthma were welcomed along with other classmates back to school yesterday by a special guest who had a message for them about staying healthy -- Kathleen Sebelius, 21st secretary of Health and Human Services (HHS).

Secretary Sebelius met with students and their parents at Thurgood Marshall Elementary, one of 16 schools in Philadelphia that partners with the Merck Childhood Asthma Network, Inc. (MCAN) program partners to help students better manage their asthma. She talked about the importance of education and creating healthy habits to avoid missing school.

"Nothing is more important than keeping our children healthy, in school and ready to learn as we start the new school year," says Dr. Floyd Malveaux, executive director of MCAN and former dean of the College of Medicine at Howard University. "We applaud Secretary Sebelius for recognizing that staying healthy can be a challenge for students with asthma -- a factor that is even further complicated with the possibility of being exposed to the H1N1 virus, which can increase the severity of asthma symptoms, leading to possible hospitalizations."

During the meeting, Sebelius highlighted the work of the Philadelphia MCAN project as a model for inner-city childhood asthma management. Launched in 2005, the Philadelphia MCAN project has improved asthma outcomes for children and reduced school absenteeism by using a community-based approach that integrates families, community agencies, schools and health care providers to implement scientifically proven asthma interventions.

The Philadelphia program brings hope into communities that shoulder a disproportionate share of the childhood asthma burden. Screening conducted with the Philadelphia MCAN project in partnership with The School District of Philadelphia found that one out of four students in the West, Southwest, Olney, Logan and Germantown communities - target communities for the program -- have been diagnosed with asthma or have been admitted to the hospital for wheezing, compared to one out of ten nationwide.

The Philadelphia program provides children with asthma and their families access to three key services: Community Asthma Prevention Program (CAPP) classes that educate parents, other caretakers and children with asthma; CAPP home visits where community health workers help families eliminate or control allergens and irritants within the home; and Health Promotion Council (HPC) Link Line services that connect families to asthma care coordinators.

"The unique structure of our program allows us to bring multiple stakeholders to the table to create a successful team that can get children to care and services for better long-term and immediate asthma management," says Dr. Michael Rosenthal of Thomas Jefferson University and co-lead investigator of the Philadelphia MCAN program. "By collaborating with specific schools to identify children that have asthma, the Philadelphia MCAN project has armed school nurses with essential information to assist students who are at higher risk for complications with H1N1 and seasonal flu virus, allowing them to be better prepared to manage these children at school."

Nationally, MCAN, a non-profit organization funded by the Merck Company Foundation, provides funding to four other local programs that target low-income, urban populations with high rates of pediatric asthma in Chicago, Los Angeles, New York and Puerto Rico. The goal is to evaluate the effectiveness of these programs and use the findings to develop model programs that can be replicated and tailored in communities across the country.

"The Philadelphia MCAN program has shown that we can help children manage their asthma and that means improved quality of life, significantly fewer trips to the ER or stays in the hospital, and best of all, more days in school," says Dr. Tyra Bryant-Stephens from The Children's Hospital of Philadelphia and co-lead investigator of the Philadelphia MCAN project. "Empowering caregivers and children with this knowledge has helped to greatly decrease the school days missed by children in Philadelphia, a segment of the nearly 13 million schools days missed each year by the millions of children nationwide that have been diagnosed with asthma."

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Study Finds Some Kids Are Being Misdiagnosed With Asthma

Vocal cord dysfunction (VCD) is the sudden, abnormal narrowing of the vocal cords during inhalation causing obstruction of the airflow, and is characterized by a noise that can mimic the sound of wheezing. A VCD attack can easily be mistaken for an asthma attack though it does not respond to asthma medications.

Treatment of VCD relies on correct identification of the disorder using breathing and relaxation techniques to help the vocal cords relax. During an acute VCD attack, spirometry (a device that measures airflows) can show patterns that are highly suggestive of VCD.

Doctors at Columbus Children’s Hospital performed a clinical research study using spirometry in Children’s Emergency Department to try to identify adolescents who had findings suggestive of VCD compared to an acute asthma attack. The year-long study (February 2005-February 2006) included patients 12-21-years-old who suffered from acute episodes of respiratory distress. The manuscript was published in the July issue of Pediatric Pulmonology.

“Both asthma and VCD are very common, and emergency departments across the country are seeing more and more kids with these kinds of symptoms,” says Dr. Karen McCoy, MD, chief of pulmonology at Columbus Children’s Hospital and a faculty member at The Ohio State University College of Medicine. “While they may appear similar to parents, the conditions act differently and must be treated differently. It is important that parents, coaches and family doctors are aware of the differences.”

According to the study, 12 of the 17 adolescents who presented to the Emergency Department with difficulty breathing, but with high normal oxygen levels, were found to have evidence of VCD on spirometry. This led to a change in the therapy for these patients. Spirometry used in the acute setting of difficulty breathing can help differentiate VCD from asthma attacks.

“Our study suggests that if more emergency departments made use of the spirometry test, it could cut down on the number of kids who are misdiagnosed and potentially hospitalized,” says Muffy Chrysler BS, RRT, NPS, AE, a co-author on the study and an asthma coordinator in Respiratory Care at Columbus Children’s Hospital.

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Healthwatch: Kids With Asthma Gain Confidence, Knowledge At Camp

For kids with asthma, the summer months can be hard -- breathing can be harder work. And summer camp can be torturous -- their physical activity limited by the weather and their condition.

But children with asthma are learning to how to manage their condition and believe in themselves at Camp Superkids.

Kellye Lynn of WJZ TV in Baltimore reports:

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Study: Cigarette Use May Explain Asthma Epidemic in Children

The rise in cigarette use by adults over the past century may explain the asthma epidemic in children according to a study by researchers at the Mailman School of Public Health. The study is published this month in Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI).

The prevalence of asthma has increased at least threefold during the past several decades, but the cause for this remains unknown, according to author Renee D. Goodwin, PhD, MPH, assistant professor in the Department of Epidemiology at the Mailman School of Public Health.

The increase is occurring most prominently in industrialized countries, but now developing countries are beginning to experience similar increases.

“We have identified parallel increases in childhood asthma and cigarette use among adults during the past century in the United States. These parallel trends suggest that the increase in cigarette use may be a contributing factor to the rise in asthma among children during the same period through increased exposure to environmental tobacco smoke,” says Goodwin.

Approximately 4.8 million children under age 18 have asthma in the United States. Although treatment and asthma management strategies can help control symptoms, asthma is a chronic condition with no known cure. Asthma most frequently begins in childhood. The cause is unknown, but allergies are a factor in the majority of children with asthma.

Environmental tobacco smoke (ETS) inhaled unintentionally by nonsmokers has a higher concentration of some toxic substances than the smoke inhaled by smokers, such as carbon monoxide and carbon dioxide. Children breathe more air than adults and have narrower airways, so ETS is a greater causal risk factor of asthma in children. It can also increase the severity of their asthma symptoms.

Both genetic and environmental risk factors for asthma have been identified, notes Goodwin. Globally, six studies have shown environment tobacco smoke to be a risk factor of incident asthma. The risk for the development of childhood asthma was 2.5 times greater in young children with mothers who smoke more than 10 cigarettes per day indoors compared with mothers who smoke fewer cigarettes or not at all. Exposure to environmental tobacco smoke, especially in the home, increases a child’s likelihood of developing asthma by 63 percent according to the Department of Health and Human Services.

Cigarette use, currently considered one of the most pressing public health problems worldwide, has become increasingly concentrated among economically and socially disadvantaged segments of the population, as well as among younger persons.

“Previous data that show more recent higher rates of cigarette smoking among lower socioeconomic status segments of the population within the United States are consistent with our theory, since these are the most vulnerable segments of the population among whom rates of childhood asthma are currently the most concentrated,” she says.

“Although cigarette consumption has declined in some segments of the United States population since its peak around 1981, the consequences and health effects of the drastic increase in the mid-1980s are still affecting adults and children,” Dr. Goodwin says.

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Developmental, Behavioral Problems May Plague Kids With Asthma

Much of the research surrounding childhood asthma has sought new approaches to managing the disease. However, little was done to address other conditions that often appear along with asthma including depression and Attention Deficit Hyperactivity Disorder (ADHD), which can negatively affect a child's ability to cope.

Research completed at the University of Virginia Children's Hospital asserts that until these extra conditions or "co-morbidities" are addressed, asthma education programs will not be able to help young patients to the fullest. The results will be published in the April 12 issue of The Journal of Developmental and Behavioral Pediatrics.

"We can definitively state that families with asthmatic children not only report higher incidences of ADHD, but also of depression, anxiety and learning disabilities," says Dr. James Blackman, developmental pediatrician at the Kluge Children's Rehabilitation Center at UVa Children's Hospital and lead study author. "If we can manage these co-morbidities, we can better help children with asthma and their families to manage the disease in the healthiest way possible."

Data for the research came from the National Survey of Children's Health 2003, which was obtained from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics. The survey results came from telephone polls of households with children. Parents who reported that their child had asthma also were asked to report the severity of their children's asthma and any behavior problems. Information was gathered on a total of 102,353 children from ages 0-17 years during 2003-2004. The survey results were analyzed using SUDAAN, specialized software for analyzing clustered data.

The study uncovered depression, anxiety, behavioral problems, and learning disabilities as co-morbidities common among children with asthma. The more severe the child's asthma was, the higher the incidence of these types of problems. More than 10 percent of asthmatic children experienced problems that lasted longer than a year and required counseling or treatment.

What's more, these children often missed ten or more days of school, leading parents and caregivers to worry about their children's healthy academic and emotional development.

"What also is important about this research is that it shows how asthma can lead to psychosocial disadvantages for children in our society," adds Blackman.

While the medical and research establishment should continue to address the societal problems of poverty and poor education, Blackman believes that children with asthma need to receive tailored and precise treatments addressing their physical and mental and developmental health. This could lead to fewer missed days in school and fewer calls home to parents for behavioral and academic problems.


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