What incredible advances have taken place in world health during the past half century! From the mid-20th century on, discoveries like penicillin, steroids, and other drugs and vaccines have changed the trajectory of human health. Thanks to these advances, the average human life span has doubled from the mid-40s to the mid-80s in less than a century. Amazing progress!
Yet for all our success in treating polio, malaria, and bacterial infections, many diseases are far more prevalent today than they were in decades past. And despite advances in treatment, they remain hard to control. One such example is asthma. Rates of asthma are increasing every year and we don’t quite know why. Asthma is a complex condition. There seem to be factors in “westernization,” including microbial exposure, lifestyle changes, and obesity that have affected our immune systems, making them function in a different way.
Today, there are an astounding 300 million people with asthma globally. The number of people diagnosed with asthma grew by 4.3 million from 2001 to 2009. During that period, asthma rates rose the most among black children, almost a 50 percent increase, according to the Centers for Disease Control and Prevention. In the United States, about 22 million people have asthma, including 6.5 million children. Among kids, asthma accounts for 13 million school days lost and 200 deaths annually. Direct health care expenditures for asthma total more than $14 billion a year in this country.
Many factors contribute to the challenges of keeping asthma under control in kids, socioeconomics being an important one. Does their environment cause or worsen their symptoms? Do they have appropriate access to care? Does their insurance present barriers? Can they afford doctor visits and medication? Does their family’s lifestyle affect compliance? Is the child getting the type of care he or she really needs?
Primary care doctors effectively manage the care of many children with asthma. But when should a child see an asthma specialist, either in allergy/immunology or in pulmonary (lungs) medicine? The World Health Organization and others have provided guidance on when an asthma patient would benefit from specialized care including if:
- they have daily symptoms as well as nightly symptoms
- the asthma symptoms force them to limit their activity
- they are failing to meet the goals of their treatment plan
- an evaluation of their triggers is necessary
- they need intensive medical management (have other medical issues besides asthma)
- they need immunotherapy (allergy shots)
- they are on high doses of inhaled steroids or oral steroids
- they take oral steroids more than once a year
- they have been hospitalized for asthma
- they are young (4 years or younger) and wheezing frequently, three times a week or more
From a global perspective, better asthma management and access to medical care is needed for the growing number of children with asthma.