State of Asthma: Q&A with Dr. Cary Sennett of AAFA
“Kids’ Asthma Rates Quiet Down” and “Childhood Asthma Rates on the Decline” were just two of the headlines of hopeful hype that accompanied the recent publication of a significant study on rates of the respiratory disease in the United States. But the study itself wasn’t quite that rosy.
“Trends in childhood asthma have recently stopped increasing,” noted lead researcher Dr. Lara Akinbami of the Center for Disease Control’s National Center for Health Statistics. But she added pointedly: “We found that not all groups of children had the same trends.”
Beyond the reality that 25 million Americans still live with asthma daily, Akinbami’s study, published in late December in the journal Pediatrics, held some sobering news about communities who are seeing neither a decrease nor a plateau in asthma rates. Among children who are living in families with income below the poverty level and those aged 10 to 17, researchers found that asthma rates increased between 2001 and 2013.
That doesn’t mean there aren’t lessons to be learned and good practices that should be supported better, based on the findings, researchers note. It’s just a little too early to draw any conclusions: “More years of data are needed to clarify if asthma prevalence among children will continue to decline, or if it will plateau around current levels,” Akinbami said in a news release.
To better understand what’s encouraging about the study, and what still needs to be done to ensure all communities can better asthma patients’ quality of life and outcomes, Allergic Living speaks to Dr. Cary Sennett, President and CEO of the Asthma and Allergy Foundation of America (AAFA), about the current state of asthma.
What does a drop in prevalence among the very young mean for AAFA and your work?
Dr. Cary Sennett: The things that drive the incidence and therefore the prevalence of asthma are many and complicated, and interactions among them are still being teased out. Probably the most important thing that a change in prevalence might signal is that there’s an opportunity for us to learn a lot more about what it is that causes asthma, and what we can do to try to reduce the rate at which new cases appear.
Yes, we’ve seen a plateau and maybe even a decline in prevalence. But there are some clear differences, and that decline in prevalence is not seen across all sub-populations. Secondly, we have to ask: Are we seeing changes or trends in some sub-populations that may help us to understand something that’s happening there that’s not happening elsewhere? What can we learn from studying that kind of variation?
Is there a danger that a story like this can seem too upbeat?
CS: I see that as a great concern.
How can we make sure people know asthma is still a huge public health issue?
CS: One of the things we are doing is talking to readers like yours, and the asthma community at large, to make sure they are aware. Hopefully people outside of your readership will also learn about this, because it’s not just the asthma community – the broader community needs to understand that we can’t declare victory here.
There are still 25 million Americans with asthma, and close to 7 million kids with asthma, and the prevalence may be declining, but those people and those kids need our help. The last thing we want for the public to think is, “Hey, the problem’s solved!”
The problem is not solved. It requires ongoing attention and ongoing investment.
What is the biggest blind spot about asthma?
CS: People don’t recognize: Kids with asthma die. The Centers for Disease Control estimates that there are some 3,600 deaths a year from asthma. That’s 10 a day. This is a condition that we hope, over time, will disappear. But there’s a very large, very needy population that we can’t abandon. In fact, we have a great opportunity to improve their lives, and we need to continue to focus on investing in the things to be able to do that.
What sorts of things do we need to invest in right now?
CS: We know the things that work for most people. These things are at some level relatively simple, but can also be challenging: Children need access to physicians. They need to be able to access the health-care system, in order to get the treatment and guidance required to manage their asthma. They need to have access to medications, and they need to understand how to use those medications. We need to have the ability to make sure that they are using those medications properly and consistently.
We need to deal with triggers, in the home, in the school and in the city. We need to have additional capacity to assess and remediate the home environment, which is particularly true among disadvantaged populations where some of the things that trigger asthma are the most prevalent.
There also needs to be more favorable reimbursement for things like home assessment and remediation. Cities and communities need to focus more on air quality. They also need to focus on investments in schools that ensure that the school is a safe environment for kids with asthma.
We need to make sure that people have insurance that gives them access to health-care providers, that gives them access to medications. These are things that are proving to be very challenging.
How can we ensure those limited access to resources can control their asthma?
CS: I think there are many physicians and other asthma educators who are very committed not just to providing guidance to the child and their parents, but to trying to ensure that there’s follow-up. But I also appreciate that not every practice may be organized in a way that enables them to offer that kind of assistance.
A lot of our work is helping to prepare the patient, the parent and the family to be more effective partners in the conversation with their physician, recognizing that the family spends so much more time, and is so much closer to the daily reality for a child than the doctor ever will be.
That means that if we can prepare the family, then we’re making important progress towards achieving the best outcomes.
On a practical, day-to-day level, how do we do that?
CS: I think that the emergence of the smartphone and health applications to communicate directly to parents, directly to families, and in some cases, children themselves, represents an opportunity to provide education and tools. That support can help a child and their parents to be more effective at managing their health on their own, and help them interact better with the health care system.
What factors should determine how well a community is caring for people with asthma?
CS: There are the things that are easy to measure: hospitalization rates, the number of emergency room visits, and medication usage rates. These things are important, although they’re imperfect windows on what we really want to know.
Things that really matter to patients, such as quality of life or symptom control, we have a really limited ability to capture those things. We hope to offer that ability. It’s going to take time, and it’s going to take resources.
How can we motivate people to take their meds and practice good self-care around triggers?
CS: We have been reluctant to try to scare people into compliance. There is the scare tactic, but there is also the role model tactic. Individuals who are role models for this population, people who have asthma who have been very successful – Jerome Bettis, for example, an NFL legend and asthmatic, or David Beckham, a household name in the soccer world – can be used to help pull people as opposed to using scare tactics to push them.
We need to remind people that asthma is a potentially lethal disease. We know there are some people who will respond to the positive message, and then there are some people who need to be made fearful. Once we can personalize communications to individuals, we’ll be able to deliver the information that people need, and that’s specifically relevant (to their conditions and lives).
And we’re on that path. We’re not getting there as fast as I’d like, but that’s where we’re headed.