Communities tackling asthma as number of U.S. cases increase: Nearly 10 percent of kids have asthma
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* Charlotte Tucker

More than 24 million people in the United States now suffer from asthma, a 12.3 percent increase over the rate in 2001, a new Centers for Disease Control and Prevention study found.

The study, which reviewed the number of asthma cases between 2001 and 2009, found that 9.6 percent of children had asthma and that the rate is highest among poor children. Fully 17 percent of black children had asthma, according to the findings, which were published in CDC’s *Morbidity and Mortality Weekly Report* on May 3 and as a Vital Signs report.

The study is important because it confirms that cases of asthma are rising, despite the belief among some in the field who had suspected the numbers might be declining, said Maureen Damitz, AE-C, board chair of the Chicago Asthma Consortium.

“People are under the impression that asthma’s just a little breathing problem,” she told *The Nation’s Health*. “But if they’ve seen someone in a severe asthma episode I think they would see asthma differently.”

The study’s authors said it is not clear why the number of cases of asthma has increased by more than 12 percent. CDC and the Environmental Protection Agency have said in the past that climate change and air pollution could be a contributing factor to asthma, as could mold spores and other environmental issues.

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[Figure1](http://www.thenationshealth.org/content/41/6/1.1/F1)

At the Venice Family Clinic in Los Angeles in 2007, asthma program director Alex Aldrete shows 15-year-old asthmatic Jesus Ayala how to use a new environmentally friendly inhaler.

Photo by David McNew, courtesy Getty Images

The new study points to a need for people to better manage their asthma, and said physicians play a large part in that. But the report found disparities in access to care as well. People without health insurance reported more trouble seeing or talking with a primary care physician or specialist than people with health insurance, and many uninsured people said they could not afford to buy prescription medications.

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[Figure2](http://www.thenationshealth.org/content/41/6/1.1/F2)

Asthmatic Gloria Gonzalez is assisted by physician Jeff Collins, MD, right, at the Chelsea Health Clinic in Massachusetts in January. The number of Americans with asthma has increased.

Photo by David L. Ryan, courtesy The Boston Globe/Getty Images

Asthma, which is characterized by episodes of wheezing, chest tightness, shortness of breath and coughing, is not curable, but its symptoms can be controlled to some extent through a number of measures, including limiting contact with dust and dander, prohibiting smoking by or near a person with asthma and use of asthma control medication, according to the CDC study.

Communicating the importance of taking those steps can be a challenge, say many public health professionals, but a number of programs are working to make them clear through tactics such as personal home visitations.

One such program in Chicago has community educators visit families at home to give education on asthma and obesity prevention. That step is critical, Damitz said, because “quite often, asthma is one of the diseases that’s really impacted by what’s going on in the home.”

The home visit is essential because sometimes parents of children with asthma are not forthcoming about the situation at home when they visit a doctor’s office, according to Damitz. If, for instance, they are living in a home with other family members, they might not feel that they have the ability to prohibit smoking in the home, she said.

The solution to such problems is the community educator, the program has found. Generally, educators come from the same community in which they work, and they can more easily help families than an outsider could, Damitz said.

A similar program in south Texas uses Spanish-speaking “promotoras” who go into homes and talk to families about steps they can take to mitigate their child’s asthma. The families generally live in low-income neighborhoods, where parents might struggle to make it to meetings held at their child’s school to discuss asthma interventions.

Promotoras are trained and certified to educate families about asthma and help dispel some of the myths surrounding asthma treatment and prevention.

Paul Garbe, DVM, MPH, chief of CDC’s Air Pollution and Respiratory Health Branch, said during a conference call announcing the report’s findings that home education programs help reduce the burden of asthma on children and adults who rely on emergency rooms as their primary source of health care.

“What the program found in implementing this work was that there was a dramatic reduction in the average number of physician visits after the home visit,” he said.

In the months before the home visit, he said, participants averaged nearly three visits to the doctor for urgent care. In the six months following the visit, they averaged one.

Providing good, science-based information to parents has been shown to reduce the frequency and severity of asthma attacks, which is why communication with parents is key, Genny Carillo-Zuniga, MD, ScD, of the McAllen Asthma Coalition, which runs the Texas program, told *The Nation’s Health*.

“When parents learn what they have to do to lessen asthma, that’s very important, because you empower them to do something good,” said Carillo-Zuniga, an APHA member.

The CDC study also found that among people with asthma, only 34.2 percent said they had been given a written asthma action plan by their health provider, which may also be related to lack of access to care. Action plans tell patients how to recognize the early signs and symptoms of an asthma attack and when to call a physician and also provide information on triggers.

Education and action plans are important, Damitz said, because they ensure that people are aware of the seriousness of asthma. Between 4,500 and 5,000 people die of asthma every year, and she said most people assume that it is people with severe cases of asthma who are most at risk for death. But in reality, one-third of the people who die from an asthma attack have a mild case of the disease, and another third have a moderate case.

“Asthma’s become so common that people think there’s a magic cure-all, so some people wait too long to take that first puff of inhaler,” she said. “Those are the people we lose. People need to know what to do to take care of themselves.”

The CDC report makes a number of recommendations about what more can be done to reduce the threat of asthma.

Federal, state and local officials can track asthma rates and the effectiveness of control measures, promote flu and pneumonia vaccination for people with asthma, and promote improvements to indoor air quality, the report said.

Schools, too, need to be involved, the report said. Students’ asthma action plans can be used to guide use of asthma medications. Schools can also make sure quick-relief inhalers are available and they can take steps to fix indoor air quality problems such as mold, and outdoor air quality problems such as idling school buses, according to the recommendations.

“What we can do and what these projects are shown to be doing is we can prevent their asthma from being active, (that) those with asthma have fewer episodes. These projects have been very successful,” Damitz said.

The *MMWR* study is online at [www.cdc.gov/mmwr](http://www.cdc.gov/mmwr). The Vital Signs report is online at [www.cdc.gov/vitalsigns/asthma](http://www.cdc.gov/vitalsigns/asthma).

*   Copyright The Nation’s Health, American Public Health Association