Children's Hospital Colorado
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Just Ask Children's

Thinking Differently About Long-Term Lung Function for Kids with 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.

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 approximately 11% of the population had pulmonary function consistent with the later stages of chronic obstructive pulmonary disease — or COPD — even in their late 20s,” says Dr. Stanley Szefler, director of our Pediatric Asthma Research Program.

“COPD is the third-leading cause of death for adults in the U.S.,” says Dr. Robin Deterding, medical director of our Breathing Institute. “That’s not just smokers.”

Addressing asthma risk factors

The risk factors 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 our pediatric pulmonologist Dr. Monico Federico.

In many ways, Children’s Colorado is already working to address these factors. Our Step Up Asthma Program, for example, works with public schools to identify kids with poorly controlled asthma and help them stick to a treatment plan. And in our free Just Keep Breathing Program, community health workers visit the homes of kids with uncontrolled asthma and help identify and remove potential triggers in the home.

“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.”

Working together to help kids with asthma

“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.”

This new understanding of asthma management demands new approaches to care — early intervention, careful monitoring, occupational counseling, outreach programs, new treatments and technology. It’s a set of discovered and undiscovered concepts Dr. Deterding calls “the new asthma.”

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.”

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