Transcript for VitalSigns Teleconference: Asthma in Children

OPERATOR: Welcome and thank you for standing by. All participants will be on a listen only mode until the question and answer session of today’s conference. At that time, you may press star then one to ask a question from the phone lines. Also, this conference is being recorded. If you have any objections, you may disconnect at this time. I will now like to turn the call over to your host, Ms. Kathy Harben. Thank you ma’am, you may begin.

KATHY HARBEN: Thank you Katie. And thank you all for joining us today for the release of a new CDC Vital Signs. We are joined by CDC’s Acting Director Dr. Anne Schuchat, and we’re also joined by Dr. Cathy Bailey. She’s Acting Chief of the Air Pollution and Respiratory Health Branch in CDC’s National Center for Environmental Health. Following their brief remarks, Drs. Schuchat and Bailey will take your questions.

ANNE SCHUCHAT: Good afternoon and thank you for joining us today. CDC works 24/7 protecting America’s health, safety, and security. Each month in our Vital Signs report, we focus on a major health threat to tell you what we are doing about it, and how you can help. Today’s Vital Signs contains new information about asthma in children. Now I know that we’re all focused on influenza right now and I want to remind you that flu can be very hard on people with asthma. In fact, of the children who have been hospitalized for influenza so far this season, asthma has been the most common medical condition that we’ve seen. Today’s Vital Signs is reporting on asthma in children based on findings from the National Health Interview Survey for 2001 to 2016. Overall, there are some encouraging trends. Children and caregivers are reporting fewer asthma attacks, fewer missed school days, and fewer hospitalizations. Clinicians, families, communities and schools have contributed to great progress in teaching children how to recognize asthma attacks early and how to respond to them. But not all of the news is good. Severe asthma attacks can be terrifying for children and for their families. Today’s report reveals that in 2016, one in six children with asthma still ended up in the emergency department or urgent care. In 2013, about one in 20 children with asthma was hospitalized. More than half of all children with asthma had one or more attacks in 2016. Today’s Vital Signs report also shows that asthma prevalence among children increased between 2001 and 2010 and then decreased between 2010 and 2016. The percent of children with asthma who had an asthma attack declined from 2001 to 2016. The decline went from 61.7 percent in 2001 to 53.7 percent in 2016. This decline in the percent of children who had an asthma attack was seen among both boys and girls and all ages and races and ethnicities. Children with asthma had fewer missed school days and hospitalizations in 2013 compared with 2003. Clearly, our work is not done. Asthma can’t be cured – but most of the time, we can control asthma symptoms and prevent asthma attacks. To do this, healthcare providers, parents, children, and schools must work together. Healthcare providers play a crucial role in these efforts, working with children and parents on asthma control. For example, we know that children need to use medicine as prescribed to prevent asthma attacks. However, our data show about half or 45.5 percent of children prescribed asthma control medicines do not use them regularly. Why have we seen these improvements? Today’s study was not designed to specifically examine the reasons. But we do have evidence from a number of small projects that show us we have the tools to help children and parents manage asthma, to help them avoid hospital stays, and reduce missed school days. One example we want to highlight comes from Rhode Island, where their home asthma response program showed improved control and reduced cost by a home visit program targeting high risk children. There is no single strategy or magic bullet that prevents asthma attacks. But recent evidence shows that a combination of actions can be highly effective. These actions include using asthma action plans, reducing asthma triggers like pet dander, using medicines properly, self-management education offered at home and in school, and providing guidelines-based care. Also, avoiding second-hand smoke. What’s needed now is to help children have more control over their asthma by scaling up these effective strategies so that children have fewer of these awful episodes. Next, I’m going to turn things over to Dr. Bailey.

CATHY BAILEY: There are many things that can be done to continue and increase the progress we are making with asthma in children. For example, CDC is working with state, territorial, private and non-government partners to support good medical management, asthma-self management education, and, for people at high risk, home visits to reduce triggers and help with asthma management. Doctors, nurses, and other healthcare providers are working with children and parents to assess each child’s asthma, prescribe appropriate medicines, and determine whether home health visits would help prevent attacks. Schools have a large part to play to help children manage their asthma, including having asthma friendly policies about children’s medicine use. Parents and children can reduce triggers in the home, including not smoking. They can make sure children use their medicines as prescribed and let others know about their child’s asthma action plan. Payers/health insurance plans are reimbursing healthcare providers for education of children with asthma, including development of their personalized asthma action plans. By linking the efforts of health systems, state and local health departments, schools, individuals and CDC, we can control asthma in children. Thank you. I’ll turn it back to our moderator now.

KATHY HARBEN: Thank you Dr. Bailey. Katie, we are ready for questions please.

OPERATOR: Thank you. At this time, we would like to begin the question and answer portion of this conference. If you would like to ask a question from the phone lines, please press star then one, unmute your phone and record your name when prompted. If you need to withdraw your question, please press star then two. Once again, to ask a question from the phone line, please press star then one and record your name when prompted. One moment please while questions que up. Our first question comes from Mike Stobbe with the Associated Press. Your line is now open.

MIKE STOBBE: Hi, thank you for taking my call. If I could ask two questions. I was wondering regarding asthma prevalence among children, the report says it increased from 8.7 percent in 2010 and then back to 8.3. I was wondering between 2001 and 2016, the 8.7 to 8.3, was that change statistically significant or does it basically stay the same between those two points of time. And my second question, about the fewer asthma attacks, you all mentioned smoking. I was wondering to what extent you think smoking rules about indoor smoking and other things might have contributed to that decline. Thank you.

ANNE SCHUCHAT: Thanks for those questions Mike. The changes over time were significant. The increase and then the decrease were both statistically significant. This change in asthma attacks, you know, certainly the reduction in secondhand smoke is a good thing. Whether that accounts for all of this progress, I think it’s unlikely. We do know that from some of these smaller scale demonstration projects, that the community efforts, the school efforts, the home visits probably have quite a lot to do with it. Part of that of course is talking to the family about the triggers in the household whether it’s the family pet or the household smoking. So I think addressing multiple effort is needed. We can’t attribute all of this progress to secondhand smoke reduction. Operator, next question.

OPERATOR: We are currently showing no questions in queue. If you would like to ask a question from the phone line, please press star then one and record your name when prompted. One moment please while questions queue up. Our next question comes from Tom Corwin with the Augusta Chronicle. Your line is now open.

TOM CORWIN: Hi thanks for taking my question. I noticed from the report that just over half of the children have an asthma action plan and I wonder if that is, in your minds, might also be responsible for the poor asthma medication adherence. Thanks.

ANNE SCHUCHAT: We do think that having an asthma action plan is important, but we do think it takes multiple efforts to make sure kids are under good control. The plan alone is not enough, so in addition to that we recommend assessing the home environment for those triggers. And self-management education can be helpful, but the action plans, we’d like to see more of those. We saw that advice on environmental control was present in only 46 percent of the kids, so we think there are a number of efforts to where higher uptake could reduce the asthma attack.

TOM CORWIN: If I could ask a quick follow-up, where do you feel like that maybe this isn’t being done? Is this in the routine doctor visit? Is this follow-up from ER visits? Where do you think this is falling through?

ANNE SCHUCHAT: You know, I think this is an area where we need multiple interventions. We need the docs, or the nurses or the team in the office to help reinforce the appropriate use of medication and the self-management. We want the schools to have information about the asthma action plan. We know that parents have a huge role in how children manage their asthma and other caregivers as well of children. This is one of those areas where it takes a village to reinforce the asthma help that a child has, but we have good data now emerging from one of those smaller interventions and we’d really like to see it go broader in all states and communities. We don’t think that children need to be hospitalized for asthma. We’d like to really reduce that number from what’s it been. We know that the progress we are reporting today is just the beginning. We hope we can see a lot more progress in the future.

OPERATOR: Our next question comes from Marie Rosenthal with PPN.

MARIE ROSENTHAL: Hi, thanks for taking my call. Can you talk a little about the disparities in asthma prevalence based on race?

ANNE SCHUCHAT: Yes, thank you. The statistics from the National Health Interview Survey show that there are some differences in asthma among children. Boys are more likely to have asthma than girls. Children over five are more likely to have asthma, although it can be more severe in the children under five. We saw that non-Hispanic Black children and children of Puerto Rican descent were more likely to have asthma than those who were non-Hispanic white or other race ethnicity groups. The issue though with the trend in declining asthma attacks is that we saw that in all race ethnicities. There wasn’t any race ethnicity difference for medication use or self-management, so what we see is sort of a baseline difference in prevalence, but with improvements in the asthma attacks in all groups. Thanks for that question.

OPERATOR: Our next question comes from Mike Stobbe with the Associated Press. Your line is now open.

MIKE STOBBE: Thank, sorry I’m going to throw one more in if you don’t mind. Dr. Schuchat, you said in the beginning, the thing about asthma being the most common medical condition we’ve seen in children hospitalized with the flu. Did you mean generally or are there some statistics from this particular season that you can share with us? How many children are hospitalized with the flu and what proportion of them have asthma? Thank you.

ANNE SCHUCHAT: Yeah, the surveillance that we have for hospitalizations is just in a sample of states, in counties within 13 states. But in that so far this year we have data on underlying conditions on 180 children who were hospitalized with influenza and about half of the children did not have a medical condition, but about 24 percent of them had asthma. That was the most common underlying condition. Year in and year out this is pretty much what we see. That a number of otherwise health kids get hospitalized with influenza, but among those who have a medical condition, asthma is the leading one. We know that when you have asthma a respiratory virus can be really hard for you to fight off. It can trigger your asthma getting worse, as well as, of course the influenza being potentially severe. Those numbers I gave you were for this season, but it’s been the same in years past. And we recommend everybody with asthma get an influenza vaccine every year and of course we now have universal recommendation for everybody six months and up because we know it’s just so much harder to fight the flu when you have an underlying condition like asthma.

KATHY HARBEN: Thank you very much. Thank you Drs. Schuchat and Bailey for joining us today, as well as reporters. For follow-up questions, call the press office at 404-639-3286 or send an email to media@cdc.gov. Thank you for joining us; this concludes our call.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES