An estimated 6.3 million children in the United States under the age of 18 years of age currently suffer from asthma(1) - making it the most common chronic illness among children.  Asthma accounts for 14 million school absences annually(2) and is the third leading cause of hospitalization among children.(3) 

As the prevalence of asthma among children has grown in recent years, the price of treating asthma among children has also increased – now estimated at $3.2 billion a year.(4)  As a result, pediatric asthma has increasingly become a public health concern and controlling asthma has become one of the objectives of the Healthy People 2010 initiative.(5)

What is Asthma?

Asthma is an “obstructive lung disease caused by an increased reaction of the airways to various stimuli”(6).  The inflammation underlying asthma is continuous, making asthma is a chronic condition, however, children usually experience asthma breathing problems in "episodes."  These episodes can be triggered by exercise, allergies to dust, pollen and mold, infections, and irritants such as second-hand smoke and air pollution. 

The frequency and severity of asthma attacks or “episodes” vary from child to child as do the triggers of these attacks, however, most children with asthma have only mild to moderate problems that can be controlled through prescription medications.  Anti-inflammatory medications are often prescribed for children with asthma to reduce inflammation in the airways and prevent most episodes.  Rescue medicines can also be taken during asthma attacks.  In addition to taking medication, it is important for children and their parents to learn to recognize and avoid the particular factors that can trigger episodes. 

In taking these steps to control asthma, most children can maintain normal lives with few disturbances.  Unfortunately, many cases of asthma among children are not properly managed, resulting in numerous school absences and trips to the hospital emergency room.

Using data from PHMC’s Community Health Data Base (CHDB) 2002 Southeastern Pennsylvania Household Health Survey, the following article examines the prevalence and severity of asthma among children in Southeastern Pennsylvania and Philadelphia.

Asthma Prevalence Among Children in Southeastern Pennsylvania

According to the 2002 Household Health Survey, 10.9% of children in SEPA under the age of 18 currently have asthma – representing 104,840 children in the region.  

• Children ages 9-12 are the most likely to have asthma (15.2%) compared to children ages 5-8 (12.3%), children ages 13-17 (10.4%) and children ages 0-4 (6.5%).  (See Figure 1)
• Boys are more likely than girls to have asthma (12.1% vs. 9.7%).
• The majority of children in SEPA take prescription medication to control their asthma (89.6%).
• In the past year, 42.5% of children with asthma have gone to the emergency room at least once due to problems with asthma, 24.2% have gone two or more times and 12.9% have gone three or more times – in SEPA, this projects to more than 95,000 emergency visits among children in the past year due to asthma.
• Nearly one out of four children with asthma are in fair or poor health (23.2%), compared to only 4.1% of children without asthma.

Certain sub-group populations have a higher prevalence and severity of asthma.  Reports from the Centers for Disease Control (CDC) indicate, “low-income populations, minorities, and children living in inner cities experience disproportionately higher morbidity and mortality due to asthma.”(7)  Environmental factors such as second-hand smoke, poor air quality and living conditions can increase the rates and/or severity of asthma among children.

• In SEPA, 16.9% of children who are poor(8) have asthma, as compared to only 9.8% of children who are not poor.  Poor children are also more likely than non-poor children to have visited the ER at least once in the past year due to asthma problems (53.9% vs. 38.6%).  (See Figure 2)
• Twice as many black children in SEPA have asthma than white children (16.2% vs. 8.7%).  Comparatively, 5.3% of Asian children have asthma.  (See Figure 2)
• In SEPA, 17.7% of Latino children have asthma, as compared to only 10.5% of Non-Latino children.  Additionally, two out of three Latino children have been to the emergency room at least once in the past year due to asthma (65.5%) as compared to only 40.4% of Non-Latino children with asthma.  
• Children who live in a household where there is a smoker are more likely to have been to the ER at least once in the past year due to asthma problems than children who do not live in a household with a smoker (46.1% vs. 40.5%).

Asthma Prevalence Among Children in Philadelphia

The prevalence of asthma among children is higher in Philadelphia than in the surrounding suburban counties of SEPA (13.7% vs. 9.1%).  (See Figure 3)  This is especially true among the Latino population in the city, among which 18.1% of children have asthma as compared to only 7.3% of Latino children living in the suburbs.  The health status of children with asthma in Philadelphia is worse than that of children with asthma in the suburbs, and the number of ER visits due to asthma among children in Philadelphia is also higher than in the surrounding suburban counties.

• In Philadelphia, 29.2% of children with asthma are in fair or poor health, compared to only 17.3% of children with asthma in the suburbs.
• More than half of children with asthma in Philadelphia have gone to the emergency room at least once in the past year due to asthma problems (51.3%) as compared to only one-third of children in the surrounding suburban counties of SEPA (33.8%).  
• Children with asthma in Philadelphia are more likely to have made repeated visits to the emergency room than are children with asthma in the suburbs.  In Philadelphia, 14.3% of children with asthma have been to the ER twice in the past year due to asthma as compared to only 8.4% of children in the suburbs.  An additional 18.0% of children in Philadelphia with asthma have been to the ER three or more times, as compared to only 7.9% of children in the suburbs. (See Figure 4)

What is being done?

Several national, state and local campaigns have been launched to address the needs of children with asthma.  One of these campaigns, focusing specifically on the city of Philadelphia, is the Allies Against Asthma Coalition.

The Philadelphia Allies Against Asthma (PAAA) Coalition is currently focusing its efforts in Philadelphia among populations largely composed of Latino and African American children.  The Coalition represents over 40 organizations and continues to grow.  Through its Child Asthma Link Line (CALL), the coalition is trying to improve coordination of the fragmented care provided for children with asthma and systemizing the range of asthma services and activities that are available in the community.(9)  The coalition emphasizes asthma education for both children and parents by broadening the availability of these resources within community.  To learn more about the Philadelphia Allies Against Asthma Coalition, contact Claudia Kane, Project Director, at (215) 731-6107 or Claudia@phmc.org.

By educating children and their parents about asthma and providing better health resources, the quality of life for children with asthma will be greatly improved.  These measures will also help to reduce the number of hospitalizations and ER visits, lower the number of asthma-related deaths and the number of school absences due to asthma. 

For information regarding PHMC’s Community Health Data Base 2002 Household Health Survey, or to learn more about asthma among children in Southeastern Pennsylvania, please contact Diana Levengood, at (215) 731-2039 or dianal@phmc.org.

Notes

1. Asthma and Children Fact Sheet - American Lung Association, 2002. (www.lungusa.org)
2. Asthma’s Impact on Children and Adolescents - Centers for Disease Control and Prevention, 2004. (www.cdc.gov/asthma/children.htm)
3. Asthma and Children Fact Sheet - American Lung Association, 2002. (www.lungusa.org)
4. Asthma and Children Fact Sheet - American Lung Association, 2002. (www.lungusa.org)
5. Healthy People 2010, U.S. Department of Health and Human Services.  (www.healthypeople.gov)
6. Asthma and Children Fact Sheet - American Lung Association, 2002. (www.lungusa.org)
7. Asthma’s Impact on Children and Adolescents - Centers for Disease Control and Prevention, 2004. (www.cdc.gov/asthma/children.htm)
8. Poor is defined as at or below 100% of the federal poverty level.
9. Allies Against Asthma – (www.asthma.umich.edu)