Fact Sheet: Childhood Asthma

Asthma is a chronic inflammatory disease characterized by airway obstruction, inflammation, and hyper-responsiveness, yielding variable and recurring symptoms such as wheezing, shortness of breath, coughing, and chest tightness. Genetics, early childhood exposures (e.g., infections), and environmental variables (e.g., airborne allergens, viral infections) are believed to be etiological factors in childhood asthma.  

Prevalence and Course

Over 9 percent of children in the United States have asthma, making it the most common chronic childhood disease. Highest childhood prevalence rates recently have been found in poor children and non-Hispanic Black youth. Although childhood prevalence is higher in males, prevalence is higher in adolescent girls and this gender trend continues into adulthood. There is no cure, but long-term, daily maintenance medications (e.g., inhaled corticosteroids) and rescue medications (e.g., albuterol) are used to manage asthma symptoms.

Health and Psychosocial Consequences

When asthma is not well-managed, it is associated with negative health consequences (e.g., lung functioning, hospitalizations), as well as problems in daily functioning (e.g., school absences, participation in extracurricular activities). Children with severe asthma seem at higher risk for behavioral difficulties, especially internalizing concerns, than healthy children.

Evidence-based Assessment

Areas to assess include knowledge of asthma and its management, stress and emotional triggers, adherence, behavioral adjustment, and family management of asthma care. Barriers to adherence also are important areas to assess, including demandingness of treatment regimen, financial limitations, low education levels, psychological problems, family relationship difficulties, struggles in access to care and low motivation to change health behavior. Self-report often overestimates adherence; objective measures (e.g., pharmacy refill data, electronic monitoring) have better evidence for monitoring medication adherence.

Culture, Diversity, Demographic and Developmental Factors

Adherence to asthma medications seem to be lower in ethnic minorities and during adolescence; consequently, emergency health care and mortality rates also tend to be higher for adolescents and non-Hispanic Black youth.

Evidence-based Interventions

Interventions typically target patient and family education, adherence, psychosocial barriers to asthma management, and healthcare provider behaviors. Meta-analytic reviews suggest that behavioral and multicomponent interventions are effective at improving adherence, while educational and psychosocial interventions are mildly effective. Habit cough and vocal cord dysfunction are disorders that mimic asthma, but do not respond to asthma medication; in contrast, they often benefit from psychological intervention alone (e.g., stress management).

References

Bender, B.G. (2002). Overcoming barriers to nonadherence in asthma treatment. Journal of Allergy & Clinical Immunology, 109, S554-9.

Clark, N. M., Mitchell, H. E., & Rand, C. S. (2009). Effectiveness of educational and behavioral asthma interventions. Pediatrics, 123, S185-92.

McQuaid, E.L., Kopel, S.J., & Nassau, J.H. (2001). Behavioral adjustment of children with asthma: A meta-analysis. Journal of Developmental and Behavioral Pediatrics, 22(6), 430-439.

Munzenberger, P., Secord, E., & Thomas, R. (2010). Relationship between patient, caregiver, and asthma characteristics, responsibility for management, and indicators of asthma control within an urban clinic. Journal of Asthma, 47, 41-45.

National Institutes of Health: National Heart, Lung, and Blood Institute (2007). National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 08-4051).