**NINR Focus:**

![](media/image1.jpeg){width="2.2930555555555556in"
height="2.533333333333333in"}**Managing Asthma**

*one in a series of focus papers on research directions*

*and NINR-funded research advances*

# ![](media/image2.png){width="1.0in" height="0.5034722222222222in"}*Asthma, a chronic inflammatory disease of the airways, affects over 20 million Americans, and accounts for an estimated \$14 billion in health expenditures and lost productivity per year. It is the most common chronic illness among children. Low-income populations, minorities, and inner-city children suffer disproportionate rates of asthma-related hospitalizations and deaths. Despite advances in our understanding of asthma, 12 million people reported an asthma attack in 2004. Asthma management requires recognition and monitoring of symptoms, lifestyle modifications, environmental changes, adherence to treatment and medication plans, and access to appropriate health care. Preventive efforts and intervention programs targeted towards high-risk populations should be culturally and developmentally appropriate.*

### NINR-Supported Studies on the Management of Asthma

-   **Caregivers of asthmatic children.** In a survey, many caregivers
    of young children with asthma reported that their child suffered
    frequent coughing, wheezing, and shortness of breath. Three-quarters
    of the children had required a recent emergency room (ER) visit,
    despite having regular care from a physician or clinic and
    appropriate prescriptions for asthma medications. While most
    caregivers practiced good asthma management overall, many failed to
    give medications for coughing, which can be an early sign of an
    asthma attack, and only half used a peak flow meter to help assess
    their child's breathing problems. Caregivers may need more education
    on early assessment and management of asthma. *Butz, Johns Hopkins
    University, 2004.*

-   **Asthma care in rural families.** Among rural families of young
    children with asthma, nine out of ten reported having health
    insurance, although in some families only the children were covered.
    Most of the children reported mild to moderate asthma severity, with
    asthma triggers including respiratory infections, weather changes,
    allergies, physical activity, and cigarette smoke. Over the previous
    year, 40% of the children had visited an ER, while 10% had not seen
    a physician at all. While almost all were prescribed a quick relief
    inhaler only half used it properly for episodic symptoms. Parents
    reported a moderate amount of effort to prevent or treat the
    symptoms of asthma at home. Having a peak flow meter for home
    management helped improve preventive and management strategies.
    *Horner, University of Texas, 2003.*

-   **Asthma descriptors among low-income families.** When asked to
    describe their asthma symptoms, a group of children from low-income
    families used many nonstandard descriptive words such as sore
    throat, weakness, dizziness, and feeling frightened, panicked, or
    worried about dying. Their parents also used nonstandard descriptors
    for symptoms they saw in their child, including fatigue, malaise,
    headache or stomachache, stuffiness, itchy throat, paleness,
    sweating, fever, or coldness. Roughly two-thirds of parents whose
    child had moderate to severe asthma reported that they felt their
    child's symptoms were under good control. Asthmatic children and
    their parents use a wide range of symptom descriptors, and parents
    may underestimate the severity of their child's condition. *Yoos,
    University of Rochester, 2005.*

### The *My Asthma Coloring Book^©^* and Asthma Education

As part of a self-management program for children with asthma living in
rural areas, a research team developed the *My Asthma Coloring Book^©.^*
These children have a high prevalence of asthma, but often have limited
access to health care and poor understanding of asthma medications or
preventive strategies. The book presents positive images that allow the
children to focus on specific topics as they read the stories and color
the pictures, and instructs the children in a three-step process to
follow when an asthma attack starts: (1) tell an adult, (2) use a
quick-relief asthma medication, (3) sit down and relax. The book was
used as part of an asthma education program for a group of
rural-dwelling elementary school children with asthma and their primary
caregivers. The children attended classes led by an asthma nurse to
teach them about asthma anatomy, asthma medications, warning signs of an
attack, use of a peak flow meter and a metered-dose-inhaler (MDI), and
factors that could trigger or exacerbate an attack. Their parents also
received instruction, which focused on the early signs of an asthma
attack, levels of asthma severity, medications, how to avoid
environmental triggers, and how to use an asthma action plan. At a
10-month follow-up, children in the education program had a significant
decline in asthma symptoms and an increase in self-efficacy, and the
younger children showed improved asthma knowledge. The parents also
improved their asthma knowledge, especially about the purpose and use of
medications, and use of a peak flow meter. *Huss, Johns Hopkins
University, 2004; Butz, Johns Hopkins University, 2005.*

![](media/image3.png){width="1.8923611111111112in"
height="2.8979166666666667in"}

Revised 2/06

The National Institute of Nursing Research (NINR) supports clinical and
basic research to establish a scientific basis for the care of
individuals across the life span. NINR-supported research seeks to
improve the management of patients during illness and recovery, reduce
the risks for disease and disability, promote healthy lifestyles,
enhance clinical care settings, and ease the problems encountered by
families and caregivers. To accomplish its mission, NINR funds
peer-reviewed research projects from individual scientists; research
training for pre- and postdoctoral nurses; and center grants to
universities and other organizations. NINR also conducts intramural
research and research training on the campus of the National Institutes
of Health. By fostering multidisciplinary/interdisciplinary
collaborations, NINR helps to ensure a comprehensive approach to
research on health promotion, illness, and disabling conditions. NINR
emphasizes the special needs of at-risk and underserved populations,
with the ongoing goal of implementing knowledge to reduce health
disparities.

![](media/image1.jpeg){width="0.8923611111111112in"
height="0.9861111111111112in"}