The ACAAI educates children and parents on the importance of diagnosing and treating asthma through an annual screening program
Many people never associate their wheezing and shortness of breath with asthma, considering periodic coughing fits as just something they have to live with, no matter how unpleasant. But statistics show that asthma is more than a simple nuisance. Asthma is a health issue that has the potential to be fatal.
In addition to AIDS and tuberculosis, asthma is one of three chronic diseases whose death rate is on the rise. Currently, between 14 and 15 million Americans suffer from the disease, and more than 5,000 of them will die from their asthma this year—an average of 14 people every day. Asthma is this country’s most common and most costly illness. In 1998, the cost of asthma was estimated to be $11.3 billion, with hospitalizations accounting for the largest portion of that cost.
The prevalence of asthma makes early detection and treatment all the more imperative, which is why Arlington, Ill-based American College of Allergy, Asthma, and Immunology (ACAAI) developed the Nationwide Asthma Screening Program 4 years ago.
“A few years ago, the college recognized there was a growing need for such a large-scale event, because in spite of medications, the impact of asthma on people’s lives is still growing,” says John Winder, MD, chairman of the program, which is funded by an educational grant from pharmaceutical company AstraZeneca, Westborough, Mass. Cosponsors are the Asthma and Allergy Foundation of America and the Allergy and Asthma Network/Mothers of Asthmatics.
“A good percentage of people walking around with asthma don’t know it,” Winder says. “There are a lot of people who accept the fact that they wake up at night with breathing difficulties.”
That acceptance of occasional discomfort adheres to the former clinical view of asthma as episodic, with few or no symptoms manifested between attacks. However, asthma is now known to be a chronic inflammation of the air passages, resulting in a temporary narrowing of the airways that transport air from the nose and mouth to the lungs. That narrowing leads to the typical symptoms of asthma—coughing, tightness of the chest, wheezing, and shortness of breath. An asthma attack can be triggered by allergens, certain drugs and food additives, viral respiratory infections, or physical exertion. Once diagnosed, asthmatics should undergo aggressive treatment with allergen avoidance and medication. The most effective medications are those that reduce inflammation of the lungs and airways, particularly inhaled cortico-steroids. Use of these drugs has been shown to improve control of the disease by normalizing lung function and possibly preventing irreversible damage to the lung airways.
Before treatment is considered, asthma must first be diagnosed. Throughout the month of May—known officially as “Asthma and Allergy Awareness Month”—allergists will provide free screenings for adults and children at 257 shopping malls, civic centers, and health fairs in communities around the country. The events will be facilitated by volunteer nurses, pulmonologists, respiratory therapists, home health care agencies, and medical students from area communities, and local hospitals will loan equipment to assist in the testing. Dates and locations of the screenings can be found on http://allergy.mcg.edu.
Participants in the screenings first undergo a lung function test that involves blowing into a tube, followed by completion of a written Life Quality test designed to pinpoint key symptoms. The Life Quality test focuses on activities that prompt breathing difficulties, such as walking, doing chores, or sleeping, and asks whether people therefore avoid exercising or taking part in sports. The test also includes questions about any emergency department visits or overnight hospitalizations, and inquires whether using an asthma inhaler or medicine does not seem to control the disease. It also covers whether people have anxiety or stress about their breathing problems.
An allergist then interviews the participant, looks over the test results, and makes a recommendation whether medical attention is necessary. In the 3 years that the program has been under way, a total of 20,000 people—half of those screened for asthma—have been referred to an allergist or primary care physician for further treatment of the disease.
“The screening program is for anyone who experiences breathing difficulties and wonders if it might be asthma, or for those who have asthma and want to get a checkup and see how well they are controlled,” Winder says.
Since asthma is the most common chronic childhood disease, affecting more than one child in 20, a special test has been developed for kids as well. The Kid’s Asthma Check will be presented for the first time this year, and it allows children ages 8 through 14 to answer questions themselves about their breathing problems. Another test designed for children 7 and under is completed with assistance from their parents.
“Sometimes we do get more information from the children, including stuff that their parents might not even pick up on,” Winder says. “Kids wake up and go back to sleep without telling their parents about breathing problems.”
Determining whether such children have asthma is crucial, as the disease has reached epidemic proportions in preschool children over the past 15 years. It also has increased substantially in school-aged children over that same time period, and the death toll due to asthma has nearly tripled since 1985. Among children ages 5 to 17, asthma is the leading cause of school absences due to chronic illness, accounting for an annual loss of more than 10 million school days. It also leads to more hospitalizations than any other childhood disease, and children with asthma spend an estimated 7.3 million days per year restricted to bed.
“This type of screening helps increase public awareness, especially in the case of children, where chronic changes are starting to happen that can become permanent,” Winder says. “The earlier the treatment, the less likely it is that children will have consequences.
“Asthma is preventable. If we catch it early, we can often forestall things that might occur if they are not recognized in time,” Winder says. “That’s why we’re going after kids in particular.”
Children are not the only ones missing out on life due to asthma. The disease is the fourth leading cause of work loss in adults, resulting in 9 million lost workdays each year. Asthma also accounts for about 1.8 million emergency department visits and 10 million doctor office visits each year, in addition to nearly a half million hospitalizations annually. More women are hospitalized for asthma than men, and African-Americans are hospitalized three and a half times more often than whites. African-Americans also are three times as likely to die from the disease, and in 1995, the death rate for African-American children was more than four times the rate in white children.
The racial differences in asthma prevalence, morbidity, and mortality are highly correlated with poverty, urban air quality, indoor allergens, lack of patient education, and inadequate medical care. The environmental triggers most likely to cause asthma attacks in children have become increasingly well defined. House dust mites, cockroaches, mold, and animal dander have been identified as the principal allergens that trigger asthma symptoms. Tobacco smoke also can trigger an asthma episode and possibly worsen the effects of allergies. In addition, upper respiratory viral infections are recognized as important triggers for asthma episodes. Reducing exposure to environmental allergens and air pollutants will reduce the frequency and severity of asthma attacks in children, reduce their need for medicine, and improve their lung function.
People with asthma need to avoid environmental factors that make the disease worse, recognize early warning signs of worsening asthma, recognize the severity of an asthma episode, take appropriate medications as prescribed, and seek prompt medical help when problems occur.
“There’s nothing normal about waking up at night coughing or becoming short of breath after exercising or walking up stairs,” Winder says. “The screening program helps make people aware that they shouldn’t have to suffer. Treatment is available.”
Liz Finch is a contributing writer for RT Magazine.
