Childhood asthma still high; individual plans seen as key

Washington -- A 10-year-old baseball-playing patient of Kurt Elward, MD, MPH, can round the bases a lot faster these days, and Dr. Elward, a Charlottesville, Va., family physician, attributes this circumstance to a closely followed asthma action plan.

The young player's dismal past seasons are no more, his mother told Dr. Elward, who first identified the child's asthma and then developed a treatment plan. Now the second baseman's disease is controlled, and he can hold his own on the field.

Newly developed medicines and close adherence to treatment are key to improved performance, said Dr. Elward. And the Charlottesville youngster is not alone. There are 6.5 million children younger than 18 who have asthma, according to a Dec. 12, 2006, report -- revised Dec. 29 -- from the Centers for Disease Control and Prevention's National Center for Health Statistics.

Those numbers seem resistant to change, according to "The State of Childhood Asthma in the United States: 1980-2005." But the good news is that deaths from asthma have declined since 1999, after a steady increase from 1980 to 1998. The disparity in asthma mortality between black and white children, however, has increased in recent years.

Another finding in the report focused on asthma-related visits to physicians' offices. These visits have increased sharply since the early 1990s, from 42 per 1,000 children younger than age 18 in 1990 to 89 per 1,000 in 2004.

"Greater numbers of ambulatory visits imply appropriate awareness of the need for regular follow-up and treatment," said Homer Boushey, MD, chief of the Asthma Clinical Research Center at the University of California, San Francisco, and a member of the board of the American Thoracic Society. "What is needed is a regular adherence to treatment, even when people are feeling pretty well, and a good understanding of action plans."

Dr. Elward tries to make sure that all of his asthmatic patients have individualized action plans. Each is flexible but provides specific guidelines on when to adjust medications -- perhaps when a cold is coming on -- and when to call the physician. "We have the same plan, so when they call, we are literally reading off the same page," he said.

The report also noted that children's asthma-related visits to emergency departments remained fairly stable from 1992 to 2004 at 103 visits per 10,000 children in 2004 compared with 97 per 10,000 in 1992.

But Jay Portnoy, MD, president-elect of the American College of Allergy, Asthma and Immunology, said physician education on the effectiveness of treatment could be making a dent in the number of asthma-related visits to the emergency department at Children's Mercy Hospital in Kansas City, Mo., where he is chief of the allergy, asthma and immunology section.

His hospital's health plan found a significant drop in those numbers, from 10 visits per 1,000 patients in 2001 to four per 1,000 in 2005. "The biggest reason we can think of is that we have been providing a lot of education to our primary care doctors," he said. "And they have been giving patients asthma action plans."

Meanwhile, a panel of childhood asthma experts met in Washington, D.C., last month to identify measures for controlling the disease.

"The prevalence of childhood asthma in the United States remains at unacceptably high levels," said Floyd J. Malveaux, MD, PhD, executive director of Merck Childhood Asthma Network, a nonprofit arm of the drug company. The asthma network convened the meeting.

At the close of its two-day conference, the group recommended that the federal government develop a coordinated asthma research strategy reaching across all relevant agencies and that a well-organized national network gather, evaluate and disseminate asthma information on incidence, morbidity and mortality.

"Moving forward, we need to apply what we know about the best practices in treating this disease to reduce the burden of this condition in all communities," Dr. Malveaux said.