Asthma in Children: A Chronic Condition Requiring a Multi-Faceted Approach
Background: Asthma is a serious chronic disease with physical, academic, and economic consequences that affected more than 7 million children in 2010. The physical consequences of asthma are estimated to have caused more than 1,700 childhood deaths between 2002 and 2007. One of the ways to reduce the impact of asthma is to avoid triggers—including exercise, allergens, viral infections, excitement/stress, and environmental triggers such as air pollution, allergens, and cold weather—that exacerbate asthma symptoms. Unfortunately, many children are regularly exposed to potential triggers, which can have a negative impact on their health and well-being. Asthma also negatively impacts school attendance and school performance. Children with asthma are more likely to be absent when compared to their non-asthmatic peers, with more than 10.5 million missed days of school due to asthma in 2008.[5,6] Furthermore, pediatric asthma costs the United States about $27 billion every year, largely to due health care expenditures. In 2007, children experienced nearly 151,000 hospitalizations; 640,000 emergency department (ED) visits; and 6.7 million doctor visits that were asthma-related.[8,9] While the impact of asthma is significant, affected children can manage the disease with proper medical care and by avoiding potential triggers. The Centers for Disease Control and Prevention (CDC) has reported that teaching people how to independently manage asthma is one of the most important aspects of controlling this disease. Proper asthma management education can reduce the number of asthma-related deaths, hospitalizations, emergency room visits, and missed days of school.[12,13] A focus on children is important because this population is at a higher risk for poor asthma management, due in part to the disconnect that occurs between children and the adults supporting their asthma management. Properly managed asthma in children leads to improved health outcomes, contributing to decreased economic costs and improved quality of life. Technology provides an inexpensive, accessible conduit for educational programs; and with children’s increased access to technology both in and out school, there is a valuable opportunity to incorporate these resources in asthma interventions, management, and education for this population. This paper aims to review the literature on asthma management programs for children, highlight successful interventions incorporating the use of technology, and discuss policies to aid in improved asthma management. We will also provide recommendations for asthma management programs, future research, and policy development. Methods: A systematic review examining asthma management programs/policies that targeted school-age children was conducted. The terms “best/practices,” “asthma,” “school,” “education,” “interventions,” “public/policy,” and “children/pediatric” were entered into the PubMed database. Inclusion criteria for search results were: 1) topic, i.e., articles that addressed best practice for asthma management, and 2) population, i.e., interventions targeted toward children or adolescents. Our search yielded 2,381 articles meeting inclusion criteria. We then excluded articles that 1) were written in a language other than English, 2) provided only vague descriptions of interventions, 3) focused primarily on chronic obstructive pulmonary disease (COPD) and other non-asthma respiratory diseases, and/or 4) did not characterize results. Using the exclusion criteria, our results narrowed to 44 articles. Results: This review demonstrates that asthma management programs, which reportedly led to significant improvements in the targeted health-related outcomes, incorporated one or more of the components recommended by the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. The NHLBI states that effective asthma management requires 1) measures of assessment and monitoring of asthma severity and controls, 2) education supporting a partnership in asthma care, 3) control of environmental factors affecting asthma, and 4) pharmacologic therapy. Based on the articles reviewed, this paper demonstrates the possibility for innovative programs, particularly those using technology, to be used in schools. The results suggest that the NHLBI components as well as innovation should be considered critical to developing a successful asthma management program targeting children. Discussion: Proper asthma management results in improved health outcomes for asthmatic children, leading to decreased absenteeism from school, decreased economic costs, and an improved quality of life.  However, proper management requires multiple components addressing various aspects of this disease. This includes measures of assessment and monitoring of asthma severity and controls, education supporting a partnership in asthma care, control of environmental factors affecting asthma, and pharmacologic therapy. While interventions incorporating one or two of these components may still report positive outcomes, longterm sustainable effects are still a concern.[19,20] Multi-faceted asthma management programs could encourage long-term use and improved health outcomes. Schools, in particular, provide a valuable opportunity to incorporate programs targeting school-age children because they allow families, school staff, clinicians, and school nurses to work together to manage asthma. The use of technology, such as Web-based education and monitoring, provides additional opportunity to develop programs that incorporate all of the NHLBI recommended components. Furthermore, policies that support multi-faceted asthma management, interventions, and education for children are crucial to improving management of asthma.