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Asthma is the most common chronic disease of childhood. According to the Centers for Disease Control and Prevention, about 6.2 million children between birth and 18 years old were living with asthma in 2014. That’s more than double the population of Chicago.
The good news for these millions of children is that, properly managed, asthma is very treatable. The bad news is that, for many, a host of seemingly unrelated factors may contribute to making asthma hard to control.
Even when breathing normally, asthma sufferers’ lung tissue is inflamed, making it sensitive to the triggers that provoke asthma attacks. Good management can prevent attacks, but it doesn’t seem to help recover lung function.
“There’s a baseline inflammation,” Stanley Szefler, MD, Director of our Pediatric Asthma Research Program and one of the nation’s foremost pediatric asthma experts. “The lungs take a hit during an exacerbation, and often they don’t fully recover. That can affect lung development in kids.”
And when not well controlled, repeated attacks may contribute to further reduced lung function. A recent study published in the New England Journal of Medicine found that 75% of more than 1,000 children ages 5 to 11 developed lower-than-normal lung function by adulthood. And 11% of them had lung function equivalent to that of chronic pulmonary obstructive disease — a condition most often associated with lifelong cigarette smoking.
“Your mid-20s are peak lung function,” says Robin Deterding, MD, Medical Director of our Breathing Institute. “After that, there’s a natural decline.”
For Dr. Deterding, the increasingly apparent fact means treating asthma has to be about more than attacks. It’s about careful monitoring and prediction, about identifying kids most at risk and setting them up to improve their lung function by adulthood — not the other way around.
To accomplish that, the field of asthma treatment has a number of new tools: evidence-based models that predict attacks, biomarkers that help target treatment to specific asthma types, new drugs that treat those types more effectively. It’s a set of discovered and undiscovered concepts Dr. Deterding calls “the new asthma.”
But changing long-term outcomes will require more than just doctors. It’ll require a cooperative effort — for kids, for parents and for primary care providers.
“It’s going to mean changing the dialogue,” says Dr. Szefler. “We can at least say, look, here’s where your lungs are now and this is your trajectory, and these are the risks.”
The risks range from gestational age at birth to living near a highway to tobacco smoke in the home. “It can be social determinants like race and education of the parents, where they live, home situation and other stresses,” says pediatric pulmonologist Monica Federico, MD.
“It’s not enough to say, ‘Okay, here’s your inhaler,’” says Dr. Deterding. “If we have someone who has low lung function at 15 or 16, they’re at significant risk. We need to help the family guide this child and say, you know, ‘Woodworking is not something I’d do without a mask; being a traffic cop wouldn’t be my career choice,’ because the data suggests these types of exposure can lower lung function further over time.”
“Our intervention needs a tailored approach,” Dr. Federico adds. “It has to include not only medications, but families, schools, the Boys and Girls Club — whoever is working with that child. You really have to look at the whole child and the whole family.”
It also demands collaboration: pediatric lung specialists and researchers partnering with primary care providers, teachers and coaches, along with experts from all over the nation in air quality, nutrition, advocacy and technology, inside and outside the healthcare industry. Dr. Deterding, Dr. Federico and many others at Children’s Colorado are beginning the process of bringing them together.
“We have to say, ‘How will we respond, when the data is overwhelming, and these are our patients?’” says Dr. Deterding. “The onus is on us. The way we care for these children today will impact their health for the rest of their lives.”
Asthma treatment is great at shutting down attacks, but to truly be effective, it has to stop them before they start. Here are three novel ways Children’s Colorado is working to make that happen: