Asthma's Impact on Children and Adolescents

by CDC

Asthma is a major public health problem of increasing concern in the United States. From 1980 to 1996, asthma prevalence among children increased by an average of 4.3% per year, from 3.6% to 6.2%. Low-income populations, minorities, and children living in inner cities experience disproportionately higher morbidity and mortality due to asthma. Asthma's effects on children and adolescents include the following:

• Asthma accounts for 14 million lost days of school missed annually.
• Asthma is the third-ranking cause of hospitalization among those younger than 15 years of age.
• The number of children dying from asthma increased almost threefold from 93 in 1979 to 266 in 1996.
• The estimated cost of treating asthma in those younger than 18 years of age is $3.2 billion per year.

Currently, there are no preventive measures or cure for asthma; however, children and adolescents who have asthma can still lead quality, productive lives if they control their asthma. Asthma can be controlled by taking medication and by avoiding contact with environmental "triggers" for asthma. Environmental triggers include cockroaches, dust mites, furry pets, mold, tobacco smoke, and certain chemicals. CDC Asthma Control Programs And Activities

The Centers for Disease Control and Prevention (CDC) conducts a number of child- and adolescent-related asthma control programs and activities throughout many of its centers, institutes, and offices. Following are examples of some major ongoing efforts.

CDC Asthma Control Programs And Activities

The Centers for Disease Control and Prevention (CDC) conducts a number of child- and adolescent-related asthma control programs and activities throughout many of its centers, institutes, and offices. Following are examples of some major ongoing efforts.

National Asthma Control Program

CDC created the National Asthma Control Program in 1999. The program supports the goals and objectives of Healthy People 2010 for asthma and is based on the following three public health principles:

• Tracking: collecting and analyzing data on an ongoing basis to understand the "who, what, and where" of asthma

• Interventions: ensuring that scientific information is translated into public health practices and programs to reduce the burden of asthma

• Partnerships: ensuring that all stakeholders have the opportunity to be involved in developing, implementing, and evaluating local asthma control programs

The goals of the program are to reduce the number of deaths, hospitalizations, emergency department visits, school or work days missed, and limitations on activity due to asthma.

With appropriations of $35.2 million in fiscal year 2002, CDC funded 11 asthma tracking projects, 48 asthma interventions, and 33 asthma partnership projects under its National Asthma Control Program for activities to be conducted in 2003. CDC also funded six urban school districts, one state education agency, and six national nongovernment organizations to support and address asthma control within a coordinated school health program.

All of the following National Asthma Control Program projects include an emphasis on children and adolescents:

Addressing Asthma from a Public Health Perspective

CDC is funding state health departments in Hawaii, Indiana, Massachusetts, Mississippi, North Carolina, Ohio, Oklahoma, Pennsylvania, and Washington, and the health department in Puerto Rico to develop asthma control plans that include disease tracking, science-based interventions, and state-wide partnerships to reduce the burden of asthma in the home, school, and occupational environments.

CDC is funding California, Colorado, Connecticut, Georgia, Idaho, Illinois, Iowa, Maine, Maryland, Michigan, Minnesota, Missouri, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, Texas, Utah, Vermont, Virginia, West Virginia, and Wisconsin and Washington, D.C. to implement some or all of their statewide comprehensive asthma control plans based on resource availability.

Controlling Asthma in American Cities

To decrease asthma-related morbidity, CDC is funding grantees in seven urban communities (New York City, Philadelphia, Chicago, Richmond, Oakland, St. Louis, and Minneapolis/St. Paul) to use innovative collaborative approaches to improve overall asthma management among urban children up to 18 years of age.

Enhanced Surveillance of Asthma Deaths

To understand the circumstances surrounding asthma deaths and determine whether these deaths were preventable, CDC is funding state health departments in California and Michigan to develop, implement, and evaluate a rapid asthma death notification and investigation system. Population-Based Models to Establish Surveillance for Asthma Incidence in Defined Geographic Areas

To better estimate asthma rates, CDC is funding the Kaiser Foundation Research Institute (Portland, Oregon) and the Miami-Dade County Health Department (Miami, Florida) to develop models for identifying new asthma cases.

Replication and Implementation of Scientifically Proven Asthma Interventions

CDC is funding grantees to implement the following two scientifically evaluated asthma interventions shown to decrease acute care visits, decrease hospitalizations, and increase compliance with asthma care plans: the Asthma and Allergy Foundation of America's "Asthma Care Training for Kids" [ACT], (grantees in Illinois [two sites], New York, Pennsylvania, Texas, and Washington) and the American Lung Association's "Open Airways for Schools" [OAS], (grantees in California [two sites], Colorado, Illinois, New Jersey [two sites], and New York). The goals for ACT are to increase asthma control compliance behaviors and to decrease emergency department visits and number of days spent in the hospital. The goals for OAS are to improve school performance and self-management behaviors and to decrease the number of asthma episodes.

School Health

CDC also has a program that focuses specifically on improving asthma management in schools and increasing the number of asthma-friendly schools nationwide. Three strategies for accomplishing this are:

• Data collection
• Science-based guidance
• Support for State and Local Education Agencies and National Non-Governmental Organizations (NGOs)

Data Collection:

CDC funds the inclusion of school asthma management questions in the National Youth Risk Behavior Survey (YRBS), School Health Education Profiles (SHEP), and the School Health Policies and Programs Study (SHPPS).

Science-Based Guidance:

The CDC document "Strategies for Addressing Asthma Within a Coordinated School Health Program" provides a concise list of strategies with accompanying actions for schools to take to help students manage asthma through a coordinated approach.

Support for State and Local Education Agencies and National Non-Governmental Organizations:

Since 1999, with funding of $3.4 million in fiscal year 2003, CDC has funded demonstration school asthma management projects at 13 local school districts and one state education agency, and has funded 11 national non-governmental organizations to develop materials and deliver trainings on school-based asthma management for key target audiences.

CDC is currently funding seven urban school districts and one state education agency: Albuquerque, Baltimore, Charlotte, Detroit, Los Angeles, Memphis, Philadelphia, and Oregon to implement strategies to reduce asthma-related illnesses and absences.

CDC is currently funding six national non-governmental organizations: American Academy of Pediatrics, American Association of School Administrators, American Lung Association, Asthma and Allergy Foundation of America, National Association of School Nurses, and STARBRIGHT Foundation to develop materials and deliver trainings on school-based asthma management for key target audiences.

CDC's Division of Adolescent and School Health (DASH) works with schools nationwide to help students manage their asthma by making schools "asthma-friendly," by supporting staff and students with asthma, adopting asthma-friendly policies and procedures, coordinating services to serve students with asthma, and providing asthma education for students and staff.

About the Author

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The Centers for Disease Control and Prevention (CDC) is one of the 13 major operating components of the Department of Health and Human Services (HHS), which is the principal agency in the United States government for protecting the health and safety of all Americans and for providing essential human services, especially for those people who are least able to help themselves.