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By Lisa Rapaport (Reuters Health) - Childhood asthma rates appear to have stopped rising among many U.S. groups, but not among the poorest kids or children aged 10 and older, a study suggests.

Overall, asthma prevalence among kids under 18 had been rising for decades, until it peaked at 9.7% in 2009. Then it held steady until 2013, when it dropped to 8.3% from 9.3% the previous year, researchers reported online December 28 in the journal Pediatrics.
"International data on asthma prevalence over time shows that trends appear to be leveling off in many countries, and suggests that the trend in the United States seems to be following a general pattern,” said lead study author Dr. Lara Akinbami of the U.S Center for Disease Control and Prevention’s National Center for Health Statistics in Hyattsville, Maryland.

Even though the recent decline is statistically meaningful, it’s too soon to tell whether the decrease from 2012 to 2013 might be the start of another plateau or the beginning of a meaningful decline in asthma cases, Akinbami said by email.

In addition to the scant number of years to assess a shift in asthma trends toward the end of the study period, it’s also possible that changes in the way U.S. researchers collected survey data on childhood asthma might have influenced the results.

“It also doesn’t clearly identify which factors underlie changes in trends,” Akinbami added. “There is likely a complex story on why asthma prevalence has apparently stopped increasing.”

Part of the complexity stems from variations in rates of asthma based on age, income, region or race and ethnicity, the study found. There was no change in asthma prevalence from 2001 to 2013 for white or Puerto Rican children or for kids living in the Northeast or West. Over the same period, prevalence rose for kids aged 10 to 17, poor children, and residents of the South. Disparities in asthma between white and black children stopped increasing, and Puerto Rican kids continued to have the highest prevalence.

For low-income children in particular, it’s possible that environmental risk factors like tobacco exposure, poor housing and poor indoor air quality, and indoor dust mite and cockroach exposure may make asthma more likely, said Dr. Avni Joshi of the Mayo Clinic in Rochester, Minnesota.

“There is a vicious cycle of poverty and obesity which may also contribute to the risk of development and persistence of asthma,” Joshi, who wasn’t involved in the study, said by email. “In addition, children in poor households experience higher psychosocial stress, which is another risk factor for asthma.”

If there’s a silver lining in the study results, it’s that a plateau or decrease in asthma suggests that newer medicines and more aggressive management of the disease may be making a difference, noted Dr. Todd Mahr of Gundersen Health System in La Crosse, Wisconsin.

“It appears that progress is occurring in decreasing the asthma epidemic,” Mahr, who wasn’t involved in the study, said by email.

This article can be found at: http://www.huffingtonpost.com/entry/childhood-asthma-rates-are-leveling-...
NPR segment on the same topic can be found at: http://www.npr.org/sections/health-shots/2015/12/28/460845335/childhood-...

Changing pO₂licy: The Elements for Improving Childhood Asthma Outcomes was authored in 2010 by health policy researchers at The George Washington University (GW) School of Public Health and Health Services. The report was funded by the Merck Childhood Asthma Network and the RCHN Community Health Foundation. 

GW identified five essential elements that are key to improving asthma outcomes and provided practical and evidence-based recommendations about how to bring these elements to life to improve childhood asthma outcomes: 

1.Stable and continuous health insurance

− Make continuous Medicaid and CHIP enrollment a part of every eligible child’s asthma treatment plan developed by the child’s health care provider team.

− Encourage all states to expand Medicaid and CHIP to at least 300 percent of the federal poverty level and to adopt new options to fully cover legally resident children.

− Encourage all states to adopt Medicaid and CHIP enrollment and retention reforms, especially reforms aimed at making enrollment and retention activities possible through community health care providers, schools, and other locations where children and families can easily apply for and renew coverage.

− Make enhanced asthma treatment and management a specific focus of quality performance improvement in Medicaid and CHIP.

2. Provide high quality clinical care and case management for children whose asthma is hard to manage or control, and reach all children regardless of whether they have health insurance coverage

- Create an HHS-led, cross-agency, Administration-wide national plan for changing childhood asthma outcomes, involving: CMS, HRSA, CDC, IHS, ONCHIT, ED, HUD and EPA.

- Make performance improvement in childhood asthma a key program aim for community health centers and the Indian Health Service, which together are health care homes for over 7.5 million of the nation’s most at risk children.

3. Continuous information exchange and monitoring, using heath information technology (HIT) as much as possible

- Enhance asthma monitoring through model registries and target use of comprehensive integrated HIT systems to promote clinical reporting as well as coordination and communication among care providers, public health agencies and schools.

4. Asthma trigger reduction in homes and communities

- Encourage public health agencies, housing authorities and environmental agencies to promote evidence-based interventions and services that are essential to reducing the many environmental asthma triggers that lie beyond the control of any one family and fall outside of traditional “health care” interventions.

5. Learning what works and increasing knowledge

- Promote a strengthened and diversified Administration-wide research agenda to include basic, clinical and translational/ implementation investigations. 

It's time to overcome the heavy burden of childhood asthma. Although we don't have all the pieces of the childhood asthma puzzle, we know enough to better manage this chronic condition and help millions of families across America.