May is Asthma Awareness Month!

Did you know that asthma is the most common chronic disease among children? Approximately 6.7 million children are currently living with asthma in the United States (CDC, 2009). Asthma disproportionately affects:

• African Americans
• People with lower income
• People living in urban areas

Unfortunately, children with asthma must live with this condition for their entire lives. If asthma is poorly controlled, it can lead to:

• Restricted activity
• More sick days (from school or work)
• Emergency room visits
• Decreased quality of life

However, if asthma is properly and effectively controlled, children with asthma can live healthy and active lives no different from children without asthma. Here are some tips for helping your child control his or her asthma and avoid hospital visits:

• Visit the doctor regularly
• Develop an asthma action plan with your primary care provider
• Make sure your child regularly takes any prescribed asthma controller medication
• Always carry a rescue inhaler wherever you and your child go
• Identify your child’s asthma triggers (e.g. dust mites, mold, pets, pollen, cigarette smoke, etc.)
• Help your child avoid contact with their asthma triggers

*Note: If your child experiences an asthma attack that cannot be alleviated by a rescue inhaler, take them to the emergency room immediately.

These tips may seem simple, but in practice, they carry some degree of difficulty and I’ll tell you why. Controlling a child’s asthma often relies on a behavior change with the parent or other members of the household. This can include reminding a child to take their medication, quitting smoking, regular cleaning, or getting rid of a pet. As with any behavior change, there are a number of internal and external factors that come into play, such as time, motivation, and social support.

I once worked on an asthma control pilot study targeting children with asthma and their caregivers who lived in rural mountain areas of North Carolina and were on Medicaid. Participants came in and developed an asthma action plan and a set of short-term goals related to reducing asthma triggers with their health care provider. Participants were supposed to return one and three months later for follow-up on their goals and other variables, such as use of rescue inhaler and emergency room visits. But participants never returned . When we found out why, it primarily came down to lack of finances, time, and knowledge.

· Follow-up visits required a parent to take off work – they could not afford to take time to not work

· Follow-up visits required round-trip drive times of up to 2 hours due to the mountainous, rural landscape

· Parents did not see a reason to bring their child into the doctor for follow-up if the child was not experiencing any immediate asthma complications

But there’s hope! There is some recent research regarding caregiver behavior change. A study published in the Archives of Pediatric and Adolescent Medicine in March 2009 by Fisher, et al showed that asthma coaches were effective in reaching low-income parents of African American children (http://archpedi.ama-assn.org/cgi/content/abstract/163/3/225 ). Asthma coaches consisted of trained community members who provided information and social support by regular contact (monthly or bi-weekly) with parents over a two year time period. As a result, parents who had regular contact with asthma coaches experienced 50% less hospitalizations among their children compared to a control group.

There are two things I’d like you to ponder:

1. Our choices and health behaviors as parents can have a significant impact on the health status of our children.

2. Could social support be the key ingredient that’s been missing from the medical model?

Hmmm...