Standard Of Care Childhood Asthma

It happened nearly every night. Two or three hours after my 8 year old daughter fell asleep, I’d hear the first cough. Within minutes, she’d be sitting up in her bed coughing and wheezing until she started gagging. An attack could last minutes or an hour. And on the nights when she didn’t have one, she often woke terrified and screaming from nightmares that she couldn’t breathe. I understood the nightmares all too well – her terrified eyes and pale, pinched features haunted my own dreams.

My daughter was one of the millions of children affected by childhood asthma. According to statistics from the National Institutes of Health, childhood asthma affects 10.1% of all children under 18 in the United States. In the year 2002, children between the ages of 5 and 17 missed 14.7 million days of school due to asthma. Even with the growing prevalence of asthma among children, it often goes undiagnosed for months, or even years. In our case, it took several trips to the doctor before the night-time coughing spasms were recognized for what they were.

Childhood asthma is a chronic respiratory disease that is characterized by inflammation of the passages in the lungs. The inflammation causes tightness in the chest and difficulty breathing. The symptoms of an asthma attack can include coughing, wheezing, tightness in the chest, difficulty breathing and shortness of breath. Asthma attacks can range from mild to life-threatening. The treatment for asthma includes education, lifestyle changes, medication and ongoing monitoring to pinpoint and prevent severe episodes.

The current standard of care for childhood asthma focuses on both prevention and management of acute episodes. According to the NIH, proper management of childhood asthma includes:

Education for both the child and family about childhood asthma, triggers, prevention and maintenance.
Monitoring the child’s health, including doctor’s visits, ER visits, peak flow measurements of lung capacity.
Inhalant medication – usually corticosteroid – for use in acute episodes and asthma attacks
Regular medication (often daily) to manage and reduce inflammation of the airways in the lungs, and reduce bronchial spasms
Managing the child’s environment to remove allergens and triggers

Each of these components of a long-term childhood asthma management plan is important. If any one is missing, the standard of care for childhood asthma is not being met. Even more importantly, if any one component is missing, the effectiveness of the rest is seriously compromised.

One of the most disheartening facts about childhood asthma is the disparity in the standard of care given urban and suburban children, and the far more evident disparity in the standard of care for childhood asthma received by Black and Hispanic children as opposed to that received by children of Caucasian descent. There are a number of national initiatives originating with the Center for Disease Control and the NIH to address this disparity and ensure that the same standard of care for childhood asthma applies to all children with childhood asthma.

We were lucky. Once her pediatrician diagnosed my daughter’s problem as a type of childhood asthma, the treatment options were simple. He prescribed both daily medication and an inhaler to use during acute attacks, and strict instructions to call if she needed the inhaler more than three times a week. We removed the carpeting from her bedroom and took the stuffed animals off her bed, and within weeks, the incidence of her asthma attacks had dropped from every night to almost never.