Asthma and Its Growing Impact on Children and Women
Will My Child Outgrow His Or Her Asthma?
Asthma is on the rise in both pre-school and school-age children, causing almost 3 million physician visits and 200,000 hospitalizations per year. In 50-80% of children, asthma starts before the age of 5. When a physician tells parents that their child has asthma, one of the first questions the parents ask is "Will my child outgrow asthma?" The answer is a resounding, "Maybe, maybe not."
Researchers are looking at factors that can help distinguish between the child who has episodic asthma early in life that never recurs verses the child who goes on to have persistent asthma. Dr. Fernando Martinez and his colleagues in Tucson, AZ have looked at a large number of young children with asthma. Three patterns of disease occur.
- Children who have asthmatic symptoms before age three but not at age six.
- Children who have asthmatic symptoms before age three and continue to show symptoms at age six.
- Children who have onset of asthma after age three.
Children in the first category, who seem to "outgrow" their asthma, tend to have siblings or attend day care, have mothers who smoke and have decreased lung function from birth. Those children in the second category who start to have asthmatic symptoms as infants and continue to wheeze and cough throughout childhood tend to have allergies - especially atopic dermatitis or eczema - and mothers who have asthma. These children start out with normal lung function and end up with abnormal lung function. This suggests that early and aggressive treatment could alter the development of airway changes that accompany persistent asthma.
There are several ongoing studies of toddlers with asthma that should give us definitive answers in the next two to three years about early and aggressive treatment with inhaled steroids. Overall, Martinez found that approximately 60% of children are like those in that first group, who wheeze with viral respiratory infections early in life, but do not continue to wheeze beyond age 6.
What Helps To Predict Which Child Will Have Persistent Asthma?
While there is no definite way to predict the onset of asthma, the following information has been gathered from a growing body of data and can give us clues about who may be susceptible to the disease:
- Boys have more asthma than girls before puberty.
- Atopy (sensitivity to allergens) is strongly associated with persistent wheezing. Babies with severe atopic dermatitis and positive allergy skin tests have a greater risk of persistent asthma. Egg allergy may be a strong predictor of future persistent asthma.
- If a child has bronchiolitis (RSV) or multiple episodes of croup in early childhood their chances of having persistent asthma increase significantly.
- There is definite evidence to link parental smoking with persistent asthma.
- Wheezing tends to abate in patients with less wheezing/asthma during the first years. If asthma is severe at the onset, this child seems to be at increased risk of more severe persistent asthma
Most studies show that as many as 50% of adults who report having asthma in childhood no longer have symptoms. Is their asthma gone completely or just in remission? Have they outgrown their asthma? Interestingly, some studies have shown totally asymptomatic patients who by all appearances are "cured" of their asthma continue to have ongoing inflammation without any outward signs of asthma. Under the right circumstances - such as in areas with high concentrations of asthma triggers like dust and pollen, or during intense exercise - this inflammation intensifies and the patient again suffers from coughing, wheezing, chest tightness and shortness of breath. Several long-term studies following patients with childhood asthma have found relapses of asthma later in adulthood. So, even if you or your child has ceased showing signs of asthma, you may not be out of the woods yet! Research is continuing to identify markers of inflammation that could help us to identify those children who will have persistent asthma. With this knowledge, we will be able to target those children with the greatest chance of having persistent asthma with aggressive early intervention to help prevent the progression of the disease.
Asthma - A Growing Problem for Women
While asthma affects 5 million children, there are 12 million teenage and adult Americans who suffer from the disease as well. Asthma does not discriminate, affecting men and women, boys and girls of all ages and nationalities. When asked about the diseases that have a major effect on the lives of women in particular, most would list breast cancer, osteoporosis and heart disease. Few are aware of the problems women have with asthma when compared with men.
Some of the statistics about asthma as it affects women are staggering!
- In a recent report from the CDC, doctors reported that significantly more women than men have asthma in the United States: 9.1% of females vs. only 5.1% of males.
- In the last decade the death rate from asthma increased 54% in women compared to only 23% for men.
- Doctor visits increased 8% for females with asthma but decreased 23% for men.
- A 10-year study in the Yale New Haven Hospital found that females with severe asthma were admitted to the hospital almost twice as often as men with severe asthma. These same females stayed in the hospital almost a day longer than their male counterparts.
Are Hormones To Blame?
No one can explain these differences for sure. However, research is focusing on the role of hormones and the menstrual cycle. The hypothesis to explain the relationship between sex hormones and asthma is that the changes in estrogen and progesterone levels that occur during the menstrual cycle may cause constriction of the airways.
For years doctors have recognized a definite change in the pattern of asthma from childhood to adulthood. As was said above, asthma is more common in boys than girls. At the time of puberty, asthma occurs in boys and girls equally. After puberty, women are more likely than men to have asthma. Therefore as a woman's hormonal system matures it may play a role in the changing prevalence of asthma.
Studies have shown that approximately one third of women think that their symptoms are worse just before or during menstruation. Further evidence of the hormone-asthma link was discovered after a lengthy study by researchers at Brigham and Women's Hospital in Boston. They found that hormone replacement therapy may as much as double the risk of developing asthma in postmenopausal women.
If you are a woman and have asthma what can you do?
- Keep a diary of your symptoms and compare it to your menstrual cycle. See if there is any pattern.
- If symptoms worsen consistently during a portion of your menstrual cycle, talk with your doctor about increasing preventative medication during this time.
- Some women who suffer from the menstrual/asthma connection may benefit from manipulation of their cycle with birth control pills.
- Aspirin and other non-steroid medications such as Advil and Aleve can worsen asthma symptoms. These drugs are commonly used for relief of menstrual cramps. Be sure to note if there is a pattern with your asthma symptoms flaring up with the use of pain relievers.
Asthma And Pregnancy
Asthma affects 7% of women in their childbearing years and is the most common serious medical condition to complicate a pregnancy. It is rarely fatal but could cause serious problems for the mother and baby including high blood pressure (toxemia), premature delivery and retardation of fetal growth.
If you are pregnant and have asthma what can you do?
- See your asthma specialist early in your pregnancy to discuss an appropriate asthma treatment plan.
- Know that most medications prescribed to treat asthma are safe to take during pregnancy, as are allergy shots.
- Know the "Rule of 3's"
- One third of pregnant patients with asthma get better
- One third of pregnant patients with asthma get worse
- One third of pregnant patients with asthma stay the same
- Monitor your asthma, particularly in the late second early third trimesters.
- Know that rarely will asthma be a problem at delivery.
Hope For Asthma Sufferers Of All Ages
Controlling the possible asthma triggers in your environment is another way to control your symptoms. Asthma sufferers and parents of asthma sufferers can start off on the right foot by not smoking! Also, covering beds with dust mite-proof encasings
and taking other measures to limit exposure to household allergens are important steps to help you or your children feel better.
Both children and adults can control their asthma and lead normal lives by educating themselves about the disease and forming good habits. We at National Allergy Supply believe that children and adults who suffer from asthma should be able to SLEEP, WORK, LEARN and PLAY without persistent coughing, wheezing and worrying. The following are some products available from National Allergy Supply to help children and adults cope with asthma. Follow the links on each product to further educate yourself about these asthma management tools and products.
*Important Note: Compressors and MDI Spacers require a prescription to purchase which can be sent to us after ordering. These items are not available for sale to California residents.
Most of the information in this newsletter was contributed by Dr. Kathleen Sheerin, a practicing allergist with the Atlanta Allergy and Asthma Clinic, one of the largest allergy and asthma practices in the country. Dr. Sheerin is actively involved with both patient & family asthma education and is the founder of Breathe Georgia, a not-for-profit organization whose mission is to improve asthma care through education.
Other Helpful Resources: Atlanta Allergy & Asthma Clinic American Academy of Allergy Asthma & Immunology Allergy & Asthma Network Mothers of Asthmatics