Asthma continues to be a major public health concern affecting 26.5 million Americans nationwide. Currently, it is the most common chronic condition among children with approximately 6.1 million children under the age of 18 diagnosed with asthma, and the third leading cause of hospitalizations in children. Asthma also has a significant financial impact, as it is currently responsible for an annual expenditure of $50.3 billion in healthcare costs and leads to numerous missed school and work days approximating $3 billion. Fortunately, asthma symptoms and costs can be controlled when affected individuals have access to appropriate care and education. Therefore, there is an increasing need to provide proper asthma education to patients and their families in order to prevent recurrent ER visits, hospitalizations, and even death.
Uncontrolled asthma can have many effects on the social, psychological, and physical well-being of a child. Social impacts include not being able to participate in physical activity such as after-school sports or gym class at school. Socially, this may cause a child to be ridiculed for having low athletic skill, or prevent a child from forming bonds and friendships typically formed from participating in group sports and other physical activity. Inactivity can also have lasting long term effects on health, for example, by contributing to the obesity endemic, and perpetuating sedentary habits from a young age. Not to mention the impact of hospitalizations causing missed school days. Psychologically, children are more likely to view themselves as inferior than their more physically fit colleagues.
Fortunately, action has been taken to help improve the quality of life for people affected by asthma. In 1999, the CDC established the National Asthma Control Program which helps provide funds to 24 states and Puerto Rico to help them improve surveillance efforts, train healthcare professionals, and educate affected individuals about asthma. Since its initiation, the National Asthma Control Program has made a significant difference in improving disease outcomes: death rates from asthma have decreased by 41%. Additionally, the number of people having asthma attacks decreased by 5 percent from 2001 to 2016 and there were 24% fewer hospitalizations due to asthma from 2003 to 2010.
However, despite these very positive effects of the NACP, funding has continued to be an issue for the program—with frequent funding freezes or even cuts. For example, the president proposed a cut of nearly $4 million for the 2018 fiscal year to the CDC’s NACP program from $29 million to $25 million. Thankfully, with advocacy from physician groups such as the American College of Allergy, Asthma and Immunology, amongst other medical and community organizations, the previous funding amount was restored. Due to this legislative success, these organizations lobbied to increase funding to $30 million for the 2019 fiscal year. This reiterates the importance of advocacy on a policy level and demonstrates the impact this can have on patient care. With continued advocacy and legislative support, we are hopeful that this program can expand to more states, thereby lessening the effects of asthma.
The NACP is just one example of how national and state-run initiatives have decreased the burden of asthma on population through improved patient education on inhaler use and avoidance of triggers, and through more routine surveillance of patients with asthma. On a more microscopic level, other ways to improve asthma care are to use state and national assistance programs (such as those funded by the NACP) to obtain free or subsidized inhalers for patients. Additionally, creating an asthma action plan is another simple and cost-effective way to provide patients with detailed education regarding their asthma severity and the appropriate treatment responses. Through continued patient education efforts in the clinical setting and advocacy on a legislative level, we can continue to transform the lives of children with asthma.
Gaytri Patel, M.D.