Because even mild asthma among young inner-city
children appears to be more unpredictable
than ever, four or more checkups a year after diagnosis is
a wise move as a hedge against dangerous
flare-ups of wheezing and trips to the emergency room,
according to a study from the Johns Hopkins
Children's Center. Current asthma guidelines call for
follow-up of one to six months after diagnosis,
but six months may be too long for many patients,
researchers report in the November issue of
Pediatrics.
Johns Hopkins researchers studied 150 Baltimore City
asthmatic children 2 to 6 years of age
and were surprised, they said, to find that nearly half of
those with the mildest asthma at their first
visit had worsening symptoms as early as three months
later. The changes were so serious that they
required either new drugs or new doses.
"We know asthma is an unstable disease, but we
underestimated just how unpredictably it could
behave over time, especially in inner-city kids," said
Hemant Sharma, a pediatric allergist at the
Johns
Hopkins Children's Center. "Doctors and parents need to
be more vigilant and schedule at least three-
month checkups, even if the child appears to be doing
fine."
The findings also suggest that pediatricians should
shift their focus away from disease severity
at diagnosis to disease control.
"Asthma control appears to be a better barometer of a
child's risk for a flare-up than is initial
assessment of symptoms, a staple that many doctors use as
their yardstick for treatment and follow-
up," said lead investigator Gregory Diette, a lung
specialist at the School of Medicine.
Asthma is the most common pediatric chronic illness,
affecting 6.2 million children in the United
States. Severe illness is most prevalent in inner-city
children, doctors say, because of pollution, poor
access to regular health care and disproportionate exposure
to allergens like mice and cockroaches as
well as to dust, cigarette smoke and automobile fumes.
In the study, researchers found that children with
poorly controlled disease were two to three
times more likely than those with good control to end up at
the doctor's office or in the emergency
department with bad asthma symptoms in the three months
following diagnosis.
The Johns Hopkins scientists defined four levels of
asthma control — mild intermittent, mild
persistent, moderate persistent and severe persistent
— determined by the frequency of coughing,
wheezing, shortness of breath, waking up at night, use of
rescue medications to stop an asthma attack
and limitations on physical activity.
How often children needed medical attention for their
symptoms varied greatly from one level
to the next, researchers found, and each higher level of
severity doubled a child's risk of emergency
medical care.
The study was funded by the Environmental Protection
Agency and National Institutes of
Health.
Other investigators, all from Johns Hopkins, are
Elizabeth Matsui, Peyton Eggleston, Nadia
Hansel and Jean Curtin-Brosnan.
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