Asthma, a chronic lung disease with unclear causes, is characterized by excessive sensitivity of the lung airways to various triggers. Certain environmental triggers, such as be air pollution, exercise, allergens, cold weather, viral infections, excitement/stress and tobacco smoke can exacerbate the disease, which will cause wheezing, coughing, chest tightness and shortness of breath. Asthma can have serious health outcomes, including death. Moreover, asthma in children costs an estimated $27 billion annually for doctor visits, emergency department visits and hospitalizations. Not surprisingly, kids with asthma miss more days of school and also do worse academically.
Because of the impact of asthma on a child’s health and success in school, research on developing interventions to improve health outcomes in this population is abundant. One category of research involves developing pharmaceutical therapies to prevent and treat asthma exacerbations. Another category of research involves educating and training parents and their children on how to use the medications and how to recognize and avoid environmental triggers. A multi-faceted approach is important in chronic diseases, such as asthma, because neither medication nor behavioral changes (i.e., avoiding triggers) alone will improve the health outcomes of children with this disease. Another important component of improving asthma outcomes for children is policy, which unfortunately has not had the same level of resources invested into research and development as the other categories of asthma interventions.
However, there have been some policy efforts nationwide to impact asthma management. For instance, some health insurers have included community-based interventions in their plan, such as home visits by nurses who provide asthma education and inhaler usage trainings, as a covered service. In Massachusetts, MassHealth has included services, such as home visits and supplies, that are traditionally not covered by Medicaid. Examples of covered supplies could be mattress and pillow encasings to reduce dust mites or air conditioner filters to remove air allergens. Some schools have altered their school policy of requiring the school nurse to administer all medications by creating an exception for children with asthma to carry their inhalers while at school. Some schools have also made efforts to coordinate the care of asthmatic children between primary care providers and school health services, and/or provide educational programs for school personnel to increase asthma awareness. Moreover, citywide policies that improve air quality, through decreasing air pollution and prohibiting smoking, can aid in the reduction of the number of asthma exacerbations.
For children who are insured through Medicaid or CHIP, policymakers may also want to consider Value Based Insurance Design (VBID), which involves lowering or removing copayments for asthma medications or offering free physician visits for parents seeking advice on how to prevent their child’s asthma attacks. Studies have found that VBID can increase medication use among adults suffering from diabetes and other chronic illnesses, but additional research focused on children with asthma is required.
The first step to the management and treatment of asthma is access to a primary care provider who can prescribe the necessary medications and develop an asthma action plan. However, if we want to have a significant impact on the negative consequences of this disease on our children, a multi-faceted approach that includes policy is an absolute must.
Quianta Moore, M.D., is a Baker Institute Scholar in Health Policy. Her research focuses on equitable access to health care and improving the health of children through school-based clinics and telemedicine. Moore received a Bachelor of Arts in sociology from Cornell University, a J.D. from the University of Houston Law Center and an M.D. from Baylor College of Medicine.
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