Childhood Asthma and Prevention Strategies Medicine Essay

Asthma remains one of the most prominent public health problems affecting the U.S. children. In recent years, improvements have been made in asthma treatment and management; however, the mounting prevalence and severity of the disease, judging by the number of fatalities, emergency room visits, and hospitalizations, remain a concern. Although the prevalence of asthma has increased steadily since the 1980s across the U.S. population notwithstanding sex, age, and racial or ethnic differences, African American children are more likely to suffer from asthma and report higher hospitalization rates compared to other children. The paper explores how exposures to environmental pollutants and allergens orchestrate respiratory morbidity and airway inflammation among children with asthma, and suggests ways to minimize asthma morbidity by minimizing exposure to these agents. The paper establishes that effective prevention programs are those that recognize the multiplicity of factors causing childhood asthma, especially the interplay of genetic factors and the physical and social environments. Some of the suggestions proposed for working with children with asthma and their families include (a) encouraging asthma management within the family and community; (b) empowering families to self-manage the asthmatic conditions; (c) instructing families when to pursue emergency care; (d) fostering culturally-sensitive communication with health care practitioners; and (e) executing policies that reinforce health in various environments, including school, home, and community.

Prevalence of Childhood Asthma among African-American Children

Asthma represents a chronic disease characterized by repeated airway obstruction episodes. The Asthma and Allergy Foundation of America (AAFA) estimates that asthma affects over 25.9 million Americans (2015). However, the incidence of asthma is unevenly distributed across the U.S. (Baruchin, 2007). On average, asthma is most common among African-Americans who exhibit worse outcomes, with hospitalization rates being close to four times as high as compared to Caucasians and fatalities from asthma being twice as common (McDaniel, Paxson, & Waldfogel, 2006). Furthermore, asthma is most prevalent among low-income people residing in poor neighborhoods (Arrighi & Maume, 2007). The inner-city living patterns including aspects such as external environment, housing, and disparities in medical care access predispose African-American children, especially those residing in inner-city neighborhoods, to a pronounced risk for asthma. There is no single solution to the challenge of inner-city asthma; addressing the disproportionate prevalence of asthma among African-American children demands recognition of the full gamut of interacting factors.

The paper provides an overview of childhood asthma and suggests strategies to tackle childhood asthma. The paper seeks to undertake a review of the literature outlining the linkages between asthma symptoms and exacerbations and environmental exposures, and presents an alarming portrait of the disproportionate burden faced by African-American children, especially those living in inner-cities and underprivileged neighborhoods. The intervention programs should target the determinants of the disease based on the risk profile informed by the appraisal of the environmental exposures, psychosocial factors, genetic characteristics, disparities in health care access, and exposures to pets or tobacco smoke.

Overview of the Disease

Epidemiology

Asthma incidence in the U.S. has been on the increase since the 1990s. The Asthma and Allergy Foundation of America (AAFA) projects that 9.6% of children aged younger than 18 years have been diagnosed with asthma (2015). The male sex, Americans of African and Puerto Rican ethnicity, and people with low socioeconomic status are linked to the heightened risk of developing asthma (Lara, Akinbami, Flores, & Morgenstern, 2006). Asthma manifests a far-reaching impact on school attendance and health care expenditures (Bope & Kellerman, 2014).

Diagnosis

The diagnosis of asthma concentrates on aspects such as the symptoms frequency, timing, and intensity (Adkinson & Middleton, 2014). In children aged over 5 years, the diagnosis concentrates on the obstructive pattern that is reversible with bronchodilators. However, in children aged less than 5 years, the diagnosis centers on the physical examination, history, and trial of antiasthma medications.

Mechanisms of Asthma

Asthma comprises three core pathophysiologic elements: bronchoconstriction, bronchial hyper-responsiveness, and airway inflammation (Adkinson & Middleton, 2014). Bronchoconstriction stems from bronchial smooth muscle tightening in reaction to the exposure to allergens, stress, irritants, exercise, infection, or certain medications. During the asthma episode, the airways lining swells and becomes more inflamed; the muscles enveloping the airways tighten; and the mucus clogs the airways (Leung, Akdis, Sampson, Szefler, & Bonilla, 2015). The outlined changes narrow the airways rendering breathing difficult and stressful.

Risk Factors

Presently, there exist no clear precipitating factors for the onset of asthma in children; a host of risk factors have been highlighted. Possibly, the strongest connection to the asthma diagnosis is family history of atopy (predisposition), heightened serum immunoglobulin, and the resultant sensitization to aeroallergens (Friis, 2011). Atopic individuals are more inclined to developing eczema, allergies, and asthma. Asthma is more prevalent in urbanized areas of industrialized countries, especially in areas where there is heavy traffic.

Asthma Treatment

The medications to treat asthma can be categorized as either relievers or controllers. Controllers represent medications taken daily on a long-term basis and designed to keep the condition under control essentially through their anti-inflammatory effects (Adkinson & Middleton, 2014). The efficacy of the controllers such as leukotrienes lies in targeting the pathogenesis of asthma, including the biologic activity on bronchoconstriction, inflammatory cell infiltration into the airway, and mucus secretion (Leung, Akdis, Sampson, Szefler, & Bonilla, 2015). Relievers represent medications utilized sparingly as needed and act speedily to reverse bronchoconstriction and relieve its symptoms. Theophylline has proved its efficacy as monotherapy for the reduction of persistent asthma in children linked to its impacts as a bronchodilator, anti-inflammatory and anti-allergic compound (Adkinson & Middleton, 2014).

Definition of Terms

Asthma can be defined based on its physiological, clinical, and pathological attributes. Asthma represents a chronic inflammatory disease of the airways typified by episodic symptoms of breathlessness, wheezing, coughing, and chest tightness (Leung, Akdis, Sampson, Szefler, & Bonilla, 2015). Asthma is an intricate condition with a broad variability in symptoms occasioned by both physiological factors, including bronchial hyperresponsiveness and allergic status, and environmental factors, including differential exposure to tobacco smoke and allergens (Adkinson & Middleton, 2014). Although there is no cure for the disease, asthma can be managed with effective treatment and prevention.

Literature Review

The incidence of asthma is more prevalent and particularly more severe among urban, African-American poor children compared to poor children from other ethnicities. African-American children are more inclined to dying from asthma compared to White or Hispanic children, and have a higher tendency to registering asthma exacerbations (Baruchin, 2007; EPA, 2008). Presently, no scientific or scholarly consensus exists on why asthma severity remains highly problematic for African-Americans, whose rates of fatalities and hospitalization from asthma remain disproportionately high (Arrighi & Maume, 2007). The differential prevalence of asthma among African-American children raises several questions revolving around whether the high levels of poverty fuel the inner-city asthma. In addition, the disproportionately high hospitalization and fatality rates among African-American children raise questions on whether the phenomenon draws from the disproportionate health care access or genetic characteristics (Akinbami, Moorman, Garbe, & Sondik, 2009).

Air pollution levels in most urban areas across the world have been getting alarmingly worse and accompanied by increased morbidity and mortality (Friis, 2011). According to the Asthma and Allergy Foundation of America (AAFA), more than 300 million people around the world are affected by asthma and over 250,000 people die from the disease each year (2015). In the USA, the number of persons with asthma has grown by 42% over the last decade and has doubled since 1980 (AAFA, 2015). AAFA estimates that asthma leads to 2 million emergency room visits yearly and is the third highest cause of hospital stays in children (2015).

Largely, the residents of inner-city areas, especially children, appear to be the most impacted by the condition compared to people who reside in other areas of the city (Ruby, Giorgio, Stephen, & Richard, 2012). Close to one-third of individuals diagnosed with asthma are children; and the condition remains the leading cause of hospitalization among children, the top chronic health condition affecting children, and the principal cause of school absenteeism linked to chronic conditions (McDaniel, Paxson, & Waldfogel, 2006). The ballooning challenge of childhood asthma is prominent to public health given the burden of morbidity and the amount of suffering that this disease inflicts on the lives of children and their caregivers. In the USA, the incidence of childhood asthma differs by socioeconomic status as well as racial or ethnic group (Akinbami, Moorman, Garbe, & Sondik, 2009). African American children residing in low-income neighborhoods register the highest asthma occurrence and morbidity relative to other ethnic and racial groups (Beasley, Semprini, & Mitchell, 2015).

Factors Impacting on the Development of Childhood Asthma

Asthma manifests an intricate etiology that features a broad range of factors relating to genetics, sex, obesity,; and environmental factors detailing aspects such as presence of allergens (indoor and outdoor), diet, air pollution (indoor and outdoor), tobacco smoke, and occupational sensitizers. Environmental and lifestyle factors tied to urban living fuel the onset of childhood asthma (Beasley, Semprini, & Mitchell, 2015). The exposure to negative environmental and lifestyle factors connected to underprivileged urban environments alters immune development and elevates the risk for allergic diseases and asthma (Beasley, Semprini, & Mitchell, 2015).

Indoor airborne allergens encompass those stemming from mold, house dust mites, bonfires and fireworks, cockroach antigens, air conditioning and humidifiers, and animal dander (protein particles released by dogs and cats) (Friis, 2011). The degree of dust mite exposure among older children correlates with the heightened level of wheezing and airway hyper-responsiveness. The exposure to certain allergens to which patients are sensitized can yield to allergic inflammation and hyper-responsiveness in the airways (Buu et al., 2014). Although the exposure to industrial chemicals is uncommon, the use of the chemicals at home, coupled with the dust carried home on the clothes by a parent, could sensitize the child to the chemicals (Buu et al., 2014).

A number of diseases of childhood are connected to airway inflammation, wheezing, and bronchitis. Children infected with parainfluenza virus and respiratory syncytial virus (RSV) may develop wheezing, which can evolve into asthmatic syndrome (Adkinson & Middleton, 2014). Genetically susceptible individuals (atopic persons) may experience the onset of asthma after a viral infection, while latent or mild asthma may be aggravated by subsequent viral illnesses (Leung, Akdis, Sampson, Szefler, & Bonilla, 2015; Adkinson & Middleton, 2014).

Income, race, and ethnic origin play far more potent roles in heightening asthma risk compared to physical surroundings (Gern, 2010). As such, living in an urban area is not the exclusive risk factor for asthma; poverty and being Puerto Rican and African American are the most powerful predictors of asthma risk (Lara, Akinbami, Flores, & Morgenstern, 2006). The plain racial or ethnic differences within the incidence of asthma mirror the underlying genetic variations with a substantial overlay of environmental and socioeconomic factors (Gern, 2010). The connection between socioeconomic status and asthma, with the heightened prevalence of asthma in developed countries relative to developing ones, in underprivileged neighborhoods relative to affluent populations, possibly mirror lifestyle variations, including access to health care and exposure to allergens (Gern, 2010; Ruby, Giorgio, Stephen, & Richard, 2012).

Theoretical Considerations

Some of the theories explaining the surge in asthma prevalence include the “hygiene hypothesis.” The theory details that the over-sanitizing of the child’s environment has occasioned a decreased disease resistance among children. The exposure to childhood diseases, bacteria, and domestic animals is perceived to present a protective guard against development of asthma and allergies (Arrighi & Maume, 2007). The environmental theory makes broad use of the concept of reinforcement, representing any event that enhances the frequency or the prospect of occurrence of some behavior.

The environmental theory applies to asthma self-management in the sense that reinforcement of proper behavior enhances the frequency of behaviors potent to control asthma (Gern, 2010). Essentially, reinforcement comprises both outcomes and events that patients avoid, such as signs and consequences of the disease; as well as the events that the patients pursue, the benefits of good health. The minimization of exposure to allergens and environmental tobacco smoke constitutes a behavioral requirement that is central to the management of childhood asthma (McDaniel, Paxson, & Waldfogel, 2006).

The monitoring and asthma attack management may feature a collection of graded steps that give explicit behavioral recommendations based on the severity of the disease. The environmental theory is criticized for being mechanistic and failing to sufficiently account for the intricacy of human behavior. Moreover, the approach fails to take into account the influence of human qualities, including emotion, mood, and thinking. In addition, asthma prevention interventions should draw from changes and learning theories in order to select optimal delivery venues where learning about the disease can be achieved (Beasley, Semprini, & Mitchell, 2015).

Case Study on the Prevalence of Childhood Asthma among African-American Children and Other Ethnic or Racial Minorities Living in Inner Cities

Asthma remains the most widespread chronic disease affecting children in the USA. Close to 10% of all children aged 18 years and below have asthma (Baruchin, 2007). Asthma disproportionately affects minorities, especially those of African American and Hispanic (Puerto Ricans) origin who reside in low-income areas (Lara, Akinbami, Flores, & Morgenstern, 2006). Although asthma-based mortality rates have declined steadily since 1999, the fatality rates as a whole have not reduced for minority children (Lara, Akinbami, Flores, & Morgenstern, 2006). The disparity in the prevalence of asthma stems from socioeconomic status, genetic and environmental factors (Arrighi & Maume, 2007).

Research has shown that African American children are 1.6 times more likely to develop asthma compared to Caucasian children (AAFA, 2015). In 2011, the asthma prevalence for African-Americans was 47% higher than for the Whites (AAFA, 2015). According to the U.S. Environmental Protection Agency (EPA), the disparities in the prevalence of asthma have been connected to variations in genetics and socio-economic status (income) (2008). Nevertheless, other factors play a significant role in fueling this inequality given that even when Caucasians and African Americans have the same income level, they still record differential asthma outcomes (EPA, 2008).

Several examples can be highlighted to illustrate the burden of childhood asthma on African American children. According to the Missouri Department of Health and Senior Services (MDHSS), in St. Louis City, African-Americans make 48% of the city’s population according to 2009 population estimates, yet they account for 86% of all asthma emergency department visits and 84% of all asthma hospitalizations among St. Louis City residents (2012). In the case of Kansas City region, African-Americans comprise 31% of the city’s population based on the 2009 population estimates, yet they account for close to 68% of all asthma emergency department visits and 67% of all asthma hospitalizations among the city residents (MDHSS, 2012).

The high prevalence and poor health outcomes of childhood asthma in African-American communities can also be explained by the established beliefs and prejudices that impede the interactions between ethnic or racial minorities and health care practitioners (Baruchin, 2007). Medication noncompliance and family dysfunction yield to an elevated risk of severe, poorly-controlled asthma. Furthermore, social-based factors influence asthma prevalence and outcomes in numerous ways, including violence, stress, and marginalization or segregation (Gern, 2010).

Asthma hospitalizations and morbidity worsen during life stress, anxiety, depression, violence, or compromised mental health, which conspire to compromise the health of children with asthma, especially those residing in inner cities (Gern, 2010). The high level of violence in the majority of African American communities fuels childhood disparities in asthma since violence correlates with poverty. Furthermore, violence in the neighborhood leads to the adoption of destructive habits, such as tobacco smoking and lack of physical exercise, which lead to childhood obesity, a known risk factor of asthma (Gern, 2010). Similarly, the segregation of neighborhoods intensifies the concentration of poverty, which in turn compromises accessibility of health resources to tackle the disease (Gern, 2010).

The physical environment also plays a core role in the high prevalence of asthma and poor health outcomes in African-American children. Inner-city residents are disproportionately exposed to indoor allergens, owing to poor indoor structures that function as the breeding grounds for indoor allergens (Baruchin, 2007). Some of the urban African American communities reside in highly polluted areas characterized by intense traffic pollution and industrial emissions, which heighten susceptibility to allergens (Baruchin, 2007).

Discussion

Globally, asthma presents a severe health challenge. People from all corners of the world and of all ages are affected by asthma, which can impose serious limits on the functioning of individuals and be fatal if uncontrolled (Ruby, Giorgio, Stephen, & Richard, 2012). On average, children breathe more air, drink more fluid, and eat more food relative to their body weight compared to adults, which predispose their immunological, respiratory, and digestive systems to environmental exposures. Although the field of asthma research and management has grown significantly, acute asthma exacerbations persist imposing significant morbidity on patients and burdening the health care system.

In recent years, the asthma prevalence trends have plateaued, while the fatality rates have reduced. Although strong measures and innovative approaches have been adopted to minimize the influence of asthma, the disease burden still remains high, with minority children reporting the highest rates of adverse outcomes (Baruchin, 2007). The distribution of childhood asthma is not even across the population, and children who reside in crowded urban neighborhoods register higher rates of asthma and experience greater morbidity as a result of asthma.

Epidemiologic studies from across the U.S. cities have shown that children residing in inner cities report an increased incidence of airway inflammation and respiratory morbidity occasioned by heightened exposure to agents that trigger asthma. However, some studies on the linkage of exposures to environmental pollutants, allergens, airway inflammation, and respiratory morbidity among children with asthma residing in the inner cities highlight that the exposures, pollutants and allergens, do not necessarily cause asthma by overabundance but rather through individual susceptibility (Gern, 2010). Genetic predisposition remains a powerful risk factor for the onset of asthma; however, the speedily growing number of incidences of childhood asthma cannot be exclusively genetic since the genetic composition of the population shifts slowly.

The disparities in the prevalence of asthma chiefly stems from genetic factors and income differences as well as social structures of neighborhoods, environmental impacts of low-quality conditions, and disparities in health care access (Friis, 2011). The degree and severity of inner-city asthma have yielded to what amounts to injustice given that the African-African inner-city children experience twice the prevalence of asthma, visit the emergency rooms and are hospitalized more, and are six times more likely to die from asthma compared to Caucasian children (Arrighi & Mauma, 2007).

The Economic, Health, and Social Burden of Childhood Asthma

Asthma imposes substantial burden on the USA in terms of lost productivity, reduced involvement in family life, and health care costs. Asthma is connected to massive expenditures detailing both direct and indirect costs. The AAFA estimates that America incurs an annual cost of $56 billion from the treatment and management of asthma (2005). The direct costs encompass the resources utilized in the treatment of asthma. Medications and hospitalizations remain the most significant drivers of direct costs, while work and school absenteeism account for the biggest percentage of indirect costs. Asthma remains the most prominent chronic illness of childhood, accounting for more school absenteeism compared to any other chronic illness. Asthma affects the entire family, whereby the level of concern is shaped by aspects such as the nature of illness, prognosis, severity, expenses, and psychological stress (Buu et al., 2014).

Asthmatics incur massive costs in terms of clinic visits, emergency department visits, hospitalizations, and medications. The condition is also linked to the loss of future potential earnings linked to both mortality and morbidity (Buu et al., 2014). The cost of asthma correlates with age, disease severity, and comorbidities. Although there is widespread accessibility of the preventive therapy, the costs connected to asthma are mounting. Several barriers undercut the accessibility, affordability, efficacy, and dissemination of optimal asthma management plans, including poor infrastructure, poverty, and poor education. Asthma management is also undermined by cultural and environmental barriers including tobacco smoking, nutrition, and indoor and outdoor pollution.

Childhood Asthma: Prevention Strategies

To some extent, the prevalence of asthma in America presents a paradox. Despite the improvements witnessed in the understanding of the etiology and pathophysiology of the condition, coupled with the development of a wide range of therapies to treat the condition, the incidence and severity of the disease and the disruptions that the disease causes to children, family, and the community have not reduced substantially. As such, there is a need to institute interventions that facilitate proper management and control of asthma and its outcomes (Akinbami, Moorman, Garbe, & Sondik, 2009).

Early treatment can be regarded as the best strategy for the management of exacerbations. The prevention of asthma should start with the alleviation of sensitization to factors that might subsequently trigger the disease. The most effective asthma prevention strategies are those that exploit a multi-intervention approach utilizing both socioeconomic factors and environmental manipulations. Public health efforts should concentrate on measures that improve the general health of the population by minimizing tobacco smoking and environmental tobacco smoke exposure (Beasley, Semprini, & Mitchell, 2015). The other prevention strategies should concentrate on minimizing indoor and outdoor air pollution, childhood obesity, and respiratory infections, and reducing social and health inequalities.

The basic asthma prevention strategies tackle the triggers of the disease, while the secondary prevention strategies seek to minimize the morbidity of the disease and prevent the harm to the respiratory system. The foundation of early treatment encompasses the education of the patient and family, centering on following a written asthma action plan, highlighting early signs of exacerbation, suitable intensification of therapy, elimination of precipitating environmental factors, and prompt communication with the physician to discuss the deterioration of the symptoms (Jackson, Sykes, Mallia, & Johnston, 2011).

Asthma education and home management helps avoid delays in therapy, thwarts exacerbation from becoming severe, and improves the child’s and family’s sense of control over the disease. The involvement of the children and their caregivers in the design of the written asthma action plan can be pivotal in empowering patients to recognize and manage escalating symptoms. Asthma management involves the control of the clinical manifestations of the disease (Arrighi & Maume, 2007). Effective asthma control can be attained through treatment intended to get and sustain control for extended periods, with careful attention being paid to the safety of treatment, possible negative effects, and cost implications.

Universal or generic interventions are usually less successful in enhancing asthma patient outcomes due to the failure to establish the risk profile informed by the appraisal of the environmental exposures, psychosocial factors, genetic characteristics, disparities in health care access, and exposures to pets or tobacco smoke. Comprehensive asthma prevention programs should be targeted at underprivileged inner-city communities that face the elevated risk of asthma mortality and morbidity (Arrighi & Maume, 2007). Nevertheless, it is essential not to focus on inner cities as the sole epicenter of asthma since such a move may lead to the overlooking of other emerging hot zones.

The key themes that require attention in the management and prevention of asthma among children residing in inner city neighborhoods include: asthma education, implementation of asthma action plans, broadening access to asthma medication and equipment, reduction of environmental triggers, and elimination of structural impediments to asthma management.

Reduction and Elimination of Environmental Triggers

The bulk of asthma episodes (asthma exacerbations), inclusive of those stemming from hospitalizations, are preventable if asthma is appropriately managed as per the best established medical practices, which involve the reduction of exposures to environmental triggers. Environmental, behavioral, and physiological mechanisms may interact or act independently to direct asthma manifestations (Adkinson & Middleton, 2014). The environment elements impacting on childhood asthma range from social environment to built and natural environment. The natural environment is filled with risks to the child with asthma in the form of possible triggers. In addition, the built environment details possible triggers from airborne pollutants and emissions.
Environmental policies are required to guarantee sustained, effective, and system-wide actions that support families in the management of asthma. Policies to minimize environmental exposures carry the potential to enhance the health of children with asthma, especially those living in inner-city neighborhoods (Arrighi & Maume, 2007). Low-income families face difficulties in accessing smoke-free environments given that parents are more inclined to smoking and have relatives or friends who smoke. In addition, low income families are more likely to reside in small housing units with poor access to the outdoors and ventilation systems.

Policies targeting aspects such as tobacco cessation and pollution control are justified in regard to the health risks occasioned by the inhalation of environmental tobacco smoke (secondhand smoke) and other pollutants. In some of the U.S. cities, such as New York, city-based asthma intervention programs have proved their worth in enhancing awareness among parents and medical practitioners, minimizing exposure to allergens in schools and homes, and improving the care for children with asthma (Beasley, Semprini, & Mitchell, 2015). The creation of healthy environments demands the broadening of the air quality monitoring programs, environmental assessments, and reinforcement and enforcement of air quality standards. It is vital to guarantee indoor and outdoor air quality in and around amenities serving children, such as recreation centers, schools, and childcare centers.

Asthma Education

The asthma-related policies and actions should seek to broaden public awareness on the disease via public education campaigns. Asthma education can be employed to enhance adherence by helping patients understand and manage their asthmatic condition. The engagement of patients in the treatment decisions encourages responsible self-management of their condition (Arrighi & Maume, 2007). Effective communication and development of partnership between health professionals and patients bolsters the success of asthma education.

Surveillance

The literature review highlights that states, schools, and cities must enhance their surveillance of asthma, educate people with asthma and their families, train health professionals, and explain asthma to the public. Surveillance, in this case, represents the study of the distribution and incidence of the disease in the population over some time. Tracking of the prevalence of asthma may involve recording the number of individuals with asthma, the number of persons visiting hospitals or emergency rooms for treatment, and the number of fatalities from the disease. There is a need to establish an asthma surveillance system, which would function as a critical tool for fostering access to quality asthma care and enhancing the health of children with asthma. The surveillance system captures the condition-specific information at state, national, and community levels. The surveillance system gives the accurate appraisal of the magnitude and nature of the childhood asthma crisis and shapes the allocation of resources (Buu et al., 2014).

The intervention program for asthma in children residing in inner-city areas should incorporate the establishment of the risk profile informed by the appraisal of the environmental exposures, psychosocial factors, genetic characteristics, disparities in health care access, and exposures to pets or tobacco smoke. Every exposure should be evaluated in the light of the child’s allergic sensitivities, and the risk factors should be scored so as to allow the tailoring of the interventions (Beasley, Semprini, & Mitchell, 2015). The adoption of a structured individual intervention approach can prove pivotal in the tackling of asthma symptoms.

Asthma Self-Management

The objective of asthma management centers on the reduction of the impairment of activities as well as reduction of the risk of exacerbations. Asthma control necessitates the participation and engagement of a number of stakeholders ranging from the patient, family, and health care practitioners, to health care institutions, school, and community organizations (Akinbami, Moorman, Garbe, & Sondik, 2009). The initial evaluation of asthmatic condition should concentrate on aspects such as symptoms frequency, impact on activities, and timing to categorize the level of severity. Four core elements of asthma management encompass continual evaluation and monitoring, control of environmental triggers, patient education, and appropriate use of medication.
Successful asthma management, especially among children, involves a team approach to care, detailing partnership among health care providers, patients, and families. Asthma self-management encompasses the systematic approach to educating patients on the control of the disease by averting the condition when possible and minimizing it when necessary. Asthma self-management demands that the patient comprehend the crucial features of asthma such as the physical changes underpinning difficult breathing, asthma causes and symptoms, how to appraise asthma severity, and how to thwart asthma and minimize its exacerbation (Beasley, Semprini, & Mitchell, 2015).

The bulk of asthma self-management programs seek to enhance asthma knowledge and foster asthma control. Patients must be equipped with both asthma knowledge and asthma control in order to successfully manage the disease. Asthma knowledge encompasses aspects such as causes, symptoms, as well as information on the variety of and necessity for asthma medications. In contrast, asthma control concerns the prevention and minimization of asthma. Asthma intervention programs help manage and control asthma symptoms, and in so doing, improve the outcomes of asthmatic children. The intervention programs should be clear-cut, fact-oriented, and readily replicated.

Conclusion and Recommendations

Asthma is a chronic disease with uncertain and possibly multiple causes and triggers. Asthma is a leading cause of childhood hospitalization in the U.S., and it tends to affect persons residing in industrialized areas and places registering high traffic volumes. Cities with the highest rates of asthma in the USA also record high rates of fatalities and hospitalization from asthma. Inner-city neighborhoods report a disproportionately high mortality and morbidity rates from asthma, mirroring a pattern of health inequalities for inner-city residents. The adverse health outcomes and pollution burdens intersect to generate health disparities that largely affect ethnic or racial minority children. Although the high asthma hospitalization rates may be the result of poverty and other socio-demographic factors, the elevated asthma epidemic in the U.S. inner-city neighborhoods also points to a biological or genetic issue.

Asthma education and improved access to medications can be helpful during the management of asthma. Minimizing exposure to indoor allergens, especially among genetically prone children, can lessen the development of allergic sensitization, which in turn may avert childhood asthma and cut the frequency and severity of asthma attacks. Smoking bans on shelter property can also play a significant role in reducing the risk to the onset of asthma. Parents and caregivers should be proactive in limiting exposure to asthma triggers by helping children avoid irritants and allergens that activate asthma symptoms.

There is a need to institute management and support systems for asthma-friendly places, which necessitates identification of the existing asthma needs, resources needed to meet the asthma needs, and the possible barriers to the success of the program. Cities should strive to provide a safe and healthy environment to minimize asthma triggers by controlling or banning tobacco in public places, and minimizing or eliminating allergens and irritants. Future studies should explore the gene-environment interactions as well as environmental strategies needed to enhance the quality of life of children with asthma, especially those living in the low-income neighborhoods.

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