Asthma Management: A Role for Social Work

The Centers for Disease Control and Prevention (CDC) reported that more than 5 million children in the United States have asthma. Between 1980 and 1994, the number of children affected increased 75 percent. Children miss more than 10 million school days each year as a result of the affliction, and treatment costs are in excess of $3.2 billion per year (CDC, 2002). Each of these 5 million children has parents or guardians seeking ways to make breathing easier for their child. They struggle to manage complicated medication regimes and spend sleepless nights watching their child struggle for air. As a chronic disease, asthma has attracted a great deal of attention over the past 10 years. Advances in medical management and treatment of the illness have been dramatic; yet, families remain perplexed about what to do. They agonize over the issues surrounding the disease and search for support to deal with them. What role can social work play in helping these families? This column discusses the need for social work intervention with asthmatic children and their parents, incorporating a review of the literature and a case study to explore and advocate a role for social workers in the treatment and management of asthma. Research is used to identify psychosocial issues and their impact on the management of the disease. The literature was compiled through online searches of Ovid databases and Social Work Abstracts. The case study, represents my experience as a mother of an asthmatic child and serves as an exemplar of the psychosocial issues involved. LITERATURE REVIEW A review of the literature found that the research in medicine and nursing has aggressively focused on the clinical aspects of asthma treatment, as well as the relationship between psychosocial issues and effective asthma management. This research, both qualitative and quantitative, has explored a number of variables, including the effect of stress on children with the disease, the mental health of parents, the barriers in the treatment of asthma, and the cost of mismanagement. Findings show that a child's stress level, and the subsequent response of parents, has an impact on asthma prevention and management (Weil et al., 1999). In brief, the reactions of both child and parents have a direct effect on the success of the asthma patient in staying out of hospitals and emergency rooms. The relationship between child stress and asthma attacks has been investigated in several research initiatives (Sandberg et al., 2000; Weil et al., 1999). Stress has been found to have a negative effect on children's asthma, exacerbating the condition in the weeks following onset. If there are multiple chronic stressors, risks are magnified (Sandberg et al.). Family support has been identified as an important factor in helping children adapt; asthmatic children vary widely in the strength with which they fight the disease. Although the response to the conditions of asthma cut across all socioeconomic levels, families with poor adaptive and coping styles, especially those also dealing with poverty or isolation, have been found to place chronically ill children at greater risk (Gizynski & Shapiro, 1990). The most significant psychosocial factor in predicting asthma morbidity has been shown to be the mental health of affected children and their parents. The latter, as primary caregivers, play an important role in the management of the disease. They must ensure that children follow medication protocols and treatment plans. The psychosocial adjustment of the caretaker is the most significant factor in predicting hospitalizations (Weil et al., 1999). Families of asthmatic children experience frustration in dealing with the health care system. Often feeling that their concerns and observations are discounted, they later learn the importance of their intuitive and commonsense observations (Horner, 1997). Research indicates that time management, financial stress, and family relations are the most significant parental issues (Kurnat & Morre, 1999). …