Many Asthmatic Kids Not Getting Preventative Treatments

World Asthma Day hopes to heighten ways to combat the disease

TUESDAY, May 7, 2002 (HealthDayNews) -- Black and Latino children are less likely to use preventative treatments for their asthma than white children. And their asthma symptoms are present more often than they are for white youngsters.

That's the finding of a new study published in the current issue of the journal Pediatrics. And it coincides with today's fourth annual observance of World Asthma Day.

As communities across the globe work to raise awareness of this chronic illness, the study highlights just how much work still needs to be done. That's especially true when it comes to getting preventative asthma care to everyone who needs it -- particularly minorities and lower-income families.

Asthma is a chronic disease of the airways that causes periodic episodes of wheezing, coughing, shortness of breath and tightness in the chest. More than 26 million people have asthma in the United States, and 5 million of them are children, according to the U.S. Centers for Disease Control and Prevention. Death rates for African-Americans from asthma are three times higher than for whites, the CDC reports.

While the disease can be deadly, it can usually be managed with medications and by avoiding substances that trigger asthma attacks. Common triggers include pet dander, dust mites, cockroaches, mold and tobacco smoke.

Medications for asthma include those that open up the airways, and others that treat the underlying inflammation of the airways. Moderate-to-severe asthma should generally be treated preventatively with anti-inflammatory medications such as cromolyn sodium or inhaled steroids, according to the U.S. National Heart Lung and Blood Institute (NHLBI).

Because asthma remains a serious public health concern, the World Health Organization and the NHLBI are sponsoring the fourth annual World Asthma Day. These organizations hope to raise awareness of the condition and its symptoms, encourage asthma education and help asthmatics learn to manage the disease more effectively.

The new study looked at 1,658 Medicaid-insured children from California, Washington and Massachusetts. All of the children had been diagnosed with asthma and were between the ages of 2 and 16 years old.

Thirty-eight percent of the youngsters were black, 19 percent were Latino and 31 percent were white. Almost two-thirds of the children lived in homes with a family income of $20,000 a year or less.

Parents of the children were interviewed by phone about their children's asthma symptoms for the past six months. Questions focused on the youngsters' physical health, emotional health and activities, and about the type of medical treatment and service they'd received for asthma during that time.

The researchers found that black children had the worst asthma of the three groups, scoring six points lower on the American Academy of Pediatrics' asthma rating scale than white or Latino children. Latino children reported fewer days of asthma symptoms than white or black children, but their parents reported their children having more severe asthma than the other groups did.

Black and Latino children were less likely to be using inhaled anti-inflammatory medications than white children.

Conversely, black and Latino children were as likely or more likely than white kids to visit a specialist for their asthma, make preventative care visits to their physicians and follow home asthma management practices, according to the study.

The authors aren't sure what accounts for less use of preventative medications in black and Latino youngsters. Because all children in the study were on Medicaid, health insurance is probably not a factor, they say.

They do suggest that perhaps different physicians may not prescribe all of the medications, and that differences in beliefs about the value of prevention, fear of side effects and cultural factors may all play a role.

Dr. Marianne Frieri, director of Allergy and Immunology at Nassau University Medical Center in East Meadow, N.Y., agrees that cultural factors may play a role in these differences, but adds that environmental factors may also be at work. Overcrowding, exposure to tobacco smoke, cockroaches and city air all can trigger asthma, she says.

Also, communication problems could be a factor as well. She says large asthma-treatment centers, like the one in her hospital, should have translators present to explain the importance of taking the medication and reducing triggers in the home. But not all do.

Frieri says the underuse of anti-inflammatory medication isn't limited to blacks and Latinos, however.

"Anti-inflammatory medications are underused because primary care physicians are often a little more reluctant to use them because they're concerned about the side effects of steroids," she says.

But, she says, studies have shown that the side effects aren't serious and anti-inflammatory medication is an important part of treatment for moderate-to-severe asthma.

What to Do: For more information on managing asthma, visit the National Heart Lung and Blood Institute. And check out the Asthma Society of Canada's new Web site for kids with asthma.

SOURCES: Marianne Frieri, M.D., Ph.D., director of Allergy and Immunology, Nassau University Medical Center, East Meadow, N.Y.; May 2002 Pediatrics
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