The Crawford boys’ story is typical of the 2.5 million American children who have asthma. In many cases, the asthma isn’t diagnosed until the condition becomes acute. Asthma specialists say that’s because many parents - and even many pediatricians - fail to recognize the initial symptoms. Asthmatics have highly sensitive airways that contract and fill up with mucus in response to a variety of triggers such as cold weather, infection, exercise or allergies. A persistent cough or cold could actually signal the first stages of an asthma attack; the child may never exhibit wheezing, the best-known sign of asthma. In very young children, diagnosis is particularly difficult, says Dr. Robert F. Lemanske Jr., a pediatric allergist at the University of Wisconsin, because youngsters have trouble following directions for pulmonary-function tests.
Given the severity of the disease, failing to diagnose it can have serious consequences. “Asthma is the No. 1 cause of lost school days,” says Dr. Allan Weinstein, a Washington, D.C., allergist, “as well as the most common reason for children to be admitted to the hospital. Hospitalizations are up 225 percent since 1969.” During the past decade, childhood asthma deaths increased an average of 6.2 percent each year, according to a study by Dr. Kevin Weiss of George Washington University Medical Center. No one knows why the number of children affected by asthma has increased 50 percent in the last decade, but researchers suspect a variety of factors such as increased pollution or heightened sensitivity to certain allergens. Those most at risk are boys, blacks and urban children. The problem among inner-City children may reflect their lack of access to good health care or perhaps even environmental hazards, says Dr. Meyer Kattan, a pediatric pulmonologist at Mt. Sinai Medical Center in New York.
Ironically, while the prevalence and severity of asthma is getting worse, available treatment has vastly improved. Although children don’t ever really outgrow asthma, their airways do get larger as they get older - making it harder for mucus to build up. In the meantime, there are more ways to keep asthma under control. Children whose asthma is caused by allergens can get injections to make them less sensitive. Other youngsters can learn to recognize and avoid the triggers - such as cold weather or certain forms of exercise. New medications have also been helpful. For example, cromolyn sodium, sold as Intal, stops allergic reactions before they start. Used on a regular basis, it keeps many children symptom-free for long periods of time.
There is also an increasing number of summer camps especially for asthmatic children. Camp Superkids in Potosi, Mo., run by the Eastern Missouri chapter of the American Lung Association, will take 90 kids this summer for a week and teach them how to deal with asthma. In the past, says the camp’s program director, Mary Cesar, surveys have shown that just a week of such health-education training has resulted in a dramatic drop in hospitalizations.
In spite of these new treatments, however, asthma remains tricky. Parents - and the children themselves as they get older - must be constantly vigilant for any physical changes that might signal the start of an asthmatic episode. Many doctors recommend that parents use a “peak flow meter” - a handheld device that measures lung function when the child breathes into it - to spot early symptoms of an attack. In some families, the stress of constant monitoring leads to psychological problems. “Asthma affects the child, the parents and the other children in a family,” says Dr. Fred McDaniel Atkins, a pediatric allergist in Washington, D.C. Unlike other illnesses, asthma is never completely cured. Even with the best of care, “you’re still going to have times when there’s a setback,” Atkins says. “For parents and kids, that’s hard to take, and some people get angry and frustrated, and they look around for someone to take it out on. Sometimes parents take it out on each other, or on other family members or on the doctor.”
In addition to traditional family counseling, there are many self-help groups that have sprung up in recent years for parents of asthmatics. Nancy Sander, whose daughter suffered from severe asthma for several years, founded Mothers of Asthmatics in Fairfax, Va. Another support group, the California-based Parents of Asthmatic and Allergic Children, has chapters around the country. The current president, Mindy Thompson, says the group gets many calls from parents who feel helpless after staying up all night with a sick child. Says Thompson: “We tell them, ‘I know what you feel, and you’re not alone’.” That reassurance won’t cure asthma, but it does make everyone breathe a little easier.
Over the past 10 years, the number of children hospitalized for asthma has steadily increased.
SOURCE: NATIONAL CENTER FOR HEALTH STATISTICS
