Children's Hospital Colorado

The New Asthma

A preteen aged boy wearing a blue shirt with white sleeves practices using his inhaler at the doctor's office.

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.

Asthma’s impact on lung function

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.

Addressing asthma risk factors

“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.”

Working together to help kids with asthma

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.”

Pediatric asthma care beyond the hospital

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:

  • Our AsthmaCOMP Program partners with Denver and Aurora public schools to identify kids with out-of-control asthma, get them on treatment plans and keep them out of the hospital. Pioneered by Dr. Szefler, it’s become a model for programs like it all over the country.
  • Through our Just Keep Breathing Program, led by Dr. Federico, community health workers visit families of kids with hard-to-control asthma in their homes and help them identify and eliminate triggers — like dust, mold and certain cleaners — that provoke asthma attacks.
  • Recently, our Breathing Institute worked with a local tech firm to pilot wearable technology that monitors how kids use their asthma medication, allowing providers to track patterns and help families make adjustments that can increase effectiveness.

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