Asthma is a disease of the respiratory system, which causes swelling and narrowing of the airways. It is also one of the most prevalent of childhood diseases in the United States. It is even more common among children that live in poverty. 9.4% of all children in the U.S. (about 7 million children) have asthma.
Asthma is a national problem among our youth, and one that requires increased prevention and treatment. Most approaches toward healing asthma today are in the form of drug treatments or environmental controls. Due to the complex epidemiology of this disease, there lies a great need for a holistic approach to reach out to these children in need. Asthma is a complex disease with multiple dimensions that need to be addressed in order for widespread shifts in numbers of children afflicted to take place.
Asthma and Depression
Although we primarily think of asthma as a physical impediment, asthma has been proven to be a product of mental and emotional illness manifest in the body. In these cases the study of genomics becomes increasingly informative. A study in Brazil of over 200 mothers concluded that the prevalence of depression was higher among mothers of asthmatic children compared with mothers of non-asthmatic children. Mothers of children with chronic asthma had a higher prevalence of depression than mothers of children with intermittent asthma. This study is the one of the first to study asthma in relation to other chronic mental illnesses. What we see here is a possible genetic link between maternal depression and childhood asthma. However, these early studies must be weighed carefully. As a holistic counselor, I often work with depressed clients. What I have learned is that depression, while it is active in an individual, creates an energetic sludge that can permeate the life, environment and family of the depressed individual. Depressed clients also report more clinging to children for support and happiness, which could possibly account for higher incidents of asthma. As a professional in the field of energy medicine, and a sufferer of childhood asthma myself, I can’t help but wonder how the energy of a sick parent affects the health of their child.
Anxiety, Life Stress and Asthma
Anxiety and life stress also triggers asthma in children. There have been compelling studies done on wild baboons and other primates and how stress affects their body physiologically. These studies found that stress hormones not only raised blood pressure, and were linked to depressive symptoms in the brain, but also had long term effects. Chronic stress impairs the immune system and can lead to clogged arteries and restricted blood flow. Individuals with asthma can be predisposed to hyperactive airways. Stress hormones can send a stream of nerve impulses to the airways causing bronchial inflammation. At this point a person may feel tightness in the chest and difficulty in breathing. The mucous that lubricates the airways becomes thick and sometimes may even plug them up. So, it gets more and more difficult to exhale. The air that was not exhaled, that is, the accumulated carbon dioxide, becomes trapped in the lungs, which leaves little room for fresh air to enter. This is the point when people feel they can’t breathe in because there is hardly any room in the lungs for fresh air.
A study done on 45 ethnic minority children with asthma living in urban environments concluded that stress and life stress were positively associated with anxiety for children who had the highest levels of problem solving efficacy. Positive expectations about the ability to solve problems led to anxiety in stressed at-risk children. Interestingly, in the wild baboon study and a large study in the UK, stress was linked to hierarchy. The higher on the social ladder, the less likely stress affected an individual. These studies highlight the need for additional research in the field. As we learn more about the links between anxiety, stress, depression and asthma it will help us to develop more effective intervention programs and health outcomes for children with asthma.
Asthma and Peer Relationships
Chronic diseases such as asthma can have a significant effect on relationships with peers also. Peer relationships in chronically ill children have been characterized by teachers and children themselves as less frequent and less aggressive then healthy children. Chronically ill children themselves also identify higher levels of social anxiety then healthy children. Chronically ill children are at risk for peer relationship difficulties, and care needs to be taken to support these children in their social relationships. Because self-esteem can serve as a protective factor for children with chronic disease, programs should encourage and empower children through raising self awareness and esteem.(McCarroll, E., Lindsey, E., MacKinnon-Lewis, C., Chambers, J., & Frabutt, J., 2009).
Asthma and Socio-Economic Status
Although no major studies have been done to study the connection between socioeconomic status and children with asthma, socioeconomic status gradients of income and education have been connected to poor self-health reports, depression, obesity and suicide attempts. We can therefore infer that children with low socioeconomic gradients of income and education could benefit from health education, interventions and preventative wellness programs. There is also a great call for research in this field. Understanding the sociostructural context and patterning of children’s lives is crucial to clearly understanding health and disease etiology throughout life. (Goodman, 1999)
Asthma and Home Life
The environment of children with asthma is one of the few aspects of life that can be controlled with positive results by parents. The home of a child with asthma is key to his or her respiratory health. Studies have been done that link dust mites within the bedding, on the floor and cockroaches in the homes of patients with asthma to asthmatic symptoms. An effective public health program should consider the use of trained field workers such as medical indoor environment counselors to prevent the progression of allergic asthma and rhinitis. (De Blay, F., Barnig, C., & Ott, M., 2009). There is a great need to continue research on the home environments of children with asthma. Studies have been done on climate, humidity control and pet allergens without significant conclusive evidence. (Singh, M., Bara, A., & Gibson, P., 2002) (Kilburn, S., Lasserson, T., & McKean, M., 2003).Large scale trials are needed to draw conclusions that can be used to educate parents and children about preventative home health measures.
Holistic Evidence-Based Practices
Dependence on expensive drugs, long gaps in between research on emerging nutritional and dietary treatments, and the lack of focus on lifestyle change by the healthcare industry are all barriers to treating chronic disease, and asthma is no different. The field of Functional Medicine treats this through the identification and healing of underlying imbalances of chronic disease, through the focus on use of emerging research and through teaching about lifestyle changes including nutritional changes and changes in physical activity.
Functional Medicine offers the most progressive take on asthma treatment. Chiropractic research has found strong links between people who suffer from asthma and nerve interference from subluxation. Subluxations are when bones in the spine pressure or irritate nerves causing abnormal nerve function. Studies have recently demonstrated the positive effects of chiropractic care on 81 children with asthma. According to Richard Pistolese, research assistant for the International Chiropractic Pediatric Association, “Based upon information currently available, chiropractic care represents a safe non-pharmacological health care approach, that may be associated with a decrease in asthma-related impairment, reduced respiratory effort, and a decrease incidence of asthma attacks.” Pistolese goes further to say, “The correction of vertebral subluxation is a non-invasive procedure, which could reduce or eliminate the need for medication, and potentially ease the severity of the asthmatic condition.”
The field of functional medicine presents a emerging structure of health and disease. This model defines both health and disease as emergent structures that are locked into the potential of our genes and then cells. The way that our cells interact with our environment dictates whether the disease is awakened within the structure of the cell, or whether health is awakened. In the case of childhood asthma, this model is compelling because it forces us to rethink how disease appears and how it can be treated. If disease lives in cells that are dynamic, changing and communicating in every second and holographic in nature, with each cell affecting the other, we can begin to conceptualize more holistic methods of disease treatment.
Successful Prevention Practices & Programs
Many preventative intervention programs targeting asthma that have been implemented in the past have been successful. Studies published by the Canadian Medical Association recommend three levels of individual prevention. The primary recommendations were for families to avoid animals in the home and breastfeed. Secondary recommendations were to avoid tobacco smoke in the environment and to encourage environmental control of dust mites for those sensitive to the allergen. Tertiary recommendations are to identify allergens and develop a systematic program to eliminate or reduce allergen exposure. Although these recommendations only address physical components of the disease, they are a useful starting point, and excellent reference for parents with limited resources.
More intensive technology based interventions may provide insight into the future of asthma prevention and treatment. Computer based educational interventions for children with asthma have resulted in both clinical and psychological improvements. Computer based interventions must include a robust theoretical basis, they must be evidence-based and rigorously evaluated to identify who will benefit most from these packages and they must encourage positive health behaviors and specific skills to teach knowledge of effective self management to equip the child with skills for future self care. Educational interventions utilizing technology are favored due to their flexibility, ability to provide broad access to information and the ability to provide ongoing support and active learning.
In addition to utilizing technological resources to reach out to parents and children, technology is also being used to advance research in the field. Educational websites should also include collaboration from agencies within the United States dedicated to advancing the health of children with asthma. Research data, studies and reports on children, families and new programs must be available in an easy to understand and use format in order to support data providers, policymakers and the public. The information reported on should be updated regularly with the intention of showing trends over time, represent large segments of the population and focus on the important areas of children’s lives including: family environment, social environment, economic circumstances, physical, mental and emotional health care, and education.
A successful prevention program must meet the public on as many levels as possible. The Healthy Children Healthy Homes program was implemented in Catholic elementary schools in South Florida in both English and Spanish. The program consisted of two 90-minute educational sessions and an 8-week diffusion of asthma information to the community, educational sessions with 276 children, and an asthma fair. Data collected reported significantly greater perceived asthma susceptibility and knowledge about common household triggers and fewer asthma misconceptions.
Health Coalitions For Widespread Change
Health coalitions can be a powerful springboard for public health policy and greater health and quality of life for asthma sufferers. Allies against asthma was a national initiative that supported seven community-based coalitions and their efforts to improve the way asthma is managed in their communities. It provides resources and tools to support other asthma coalitions and programs throughout the United States.
Coalitions create policy changes, system changes and positive health outcomes. The policy and system changes as a result of Allies against asthma ranged from changes in practices between and within institutions and organizations to statewide legislation. Children experienced fewer daytime and nighttime asthma symptoms. The quality of life of the parents improved; they reported feeling less helpless, frightened, and angry about their child’s asthma. Community coalitions can successfully achieve system and policy changes and improved health outcomes. Increased core and ongoing community stakeholder participation rather than a higher overall number of participants was associated with more change.
The future for prevention and treatment of childhood asthma is hopeful. With many new frontiers in medicine, the advent of technology in the diagnosis, prevention and treatment of the disease and increasing research we are on the shore of understanding this rampant disease and lessening the hold it has on our communities. However hopeful we may be, it is most definitely not a time to rest. With the projected numbers of children with asthma on the rise due to obesity, air pollution and other environmental factors, we need to remain vigilant in our quest to learn about prevention and improve treatment.
Outcomes of an asthma program: healthy children, healthy homes; Pediatric Nursing.
Centers for Disease Control and Prevention; Faststats asthma.
Policy and system change and community coalitions: outcomes from allies against asthma; American Journal of Public Health.
Prevention strategies for asthma — primary prevention. Canadian Medical Association Journal.
House dust mite control measures for asthma. Allergy.
Federal Interagency Forum on Child and Family Statistics; America\’s children in brief: key national indicators of well-being.
The role of socioeconomic status gradients in explaining differences in US adolescents\’ health. American Journal of Public Health.
Emotional and behavioural problems in subgroups of children with chronic illness: Results from a large-scale population study. Child: Care, Health and Development.
The Institute for Functional Medicine; Our Approach.
Pet allergen control measures for allergic asthma in children and adults. Cochrane Database Of Systematic Reviews.
High prevalence of depression amoungst mothers of children with asthma. Journal of Asthma.
Health status and peer relationships in early adolescence: The role of peer contact, self-esteem, and social anxiety. Journal of Child and Family Studies.
Educational interventions–computers for delivering education to children with respiratory illness and to their parents. Pediatric Respiratory Reviews.
The puzzle of problem-solving efficacy: Understanding anxiety among urban children coping with asthma-related and life stress. Anxiety, Stress & Coping: An International Journal.
Stress: Portrait of a Killer. National Geographic Society.
Cow’s milk protein avoidance and development of childhood wheeze in children with a family history of atopy. Cochrane Database Of Systematic Reviews.
Humidity control for chronic asthma. Cochrane Database Of Systematic Reviews.