Friday Links – North American Asthma Care, Childhood Rates, Emotional Impacts

U.S. Asthma Care: Still Lacking
71% of these study participants had poorly controlled asthma, but 64% of them thought it was well controlled. Clearly, there’s a disconnect here somewhere.

Canadian Kids Have Lowest Asthma Rates in 10+ Years
Good job, my neighbors to the north.

But on the other hand:

Kids in Canada Feel Emotional Fallout of Asthma More
What do you think, Canadian readers? This true for you?

19 responses to “Friday Links – North American Asthma Care, Childhood Rates, Emotional Impacts”

  1. Sarah says:

    Well… I’m not sure. When I was at my sickest, I wasn’t an unhappy kid. That came later, actually after my asthma had improved quite a bit, and I think it was more due to a combination of things, such as lack of anything remotely resembling talent at most sports, bullying, my social awkwardness, and the fact that I was a very, very easy target. And, oddly, my emotions hit an all-time low pretty close to my best overall breathing – when I was about 15.

    But, then again, maybe you could argue that my coordination issues were due to lack of practice when I was younger due to asthma, and certainly I was teased about wheezing and coughing, so that played into the bullying, so maybe it played into it. But really, my happiness or lack thereof as a kid had a lot to do with whether I was bullied and very little to do with my asthma.

    ‘course, that’s my personal experience, and everyone’s different.

  2. Danielle says:

    I had heard the news about the asthma rates, but not about the emotional impact. Yay about falling asthma rates!

    Did you see that the lowest rates were in BC? Funny, because most of the BC population lives in Vancouver and Victoria, where it’s damp as heck! I would have thought there would be more asthma there. Prairie provinces were second best, no surprise there.

    About the emotional thing: I’m not sure. I always felt pressured not to let it show. I don’t know if that’s due to my personality or if there is some sort of social pressure there.

    A lot of asthma education programs here (is it the same in the States?) focus on the fact that you SHOULD achieve symptom-free asthma and be able to play all kinds of sports. As in: “it’s OK to have asthma, but it’s not OK actually be sick from it”. It kind of feels like a huge bummer when you’re not achieving that.

    They make a good point about cold-weather sports. I didn’t feel so great about struggling in cross-country skiing and speed skating (I eventually dropped both sports).

    That being said, those were minor disappointments for me. It didn’t make me sad ALL THE TIME or anything like that. I think I turned out ok and that most asthma kids did too.

  3. Sarah says:

    Danielle: I second what you’re saying about the asthma education program stuff. I get the same thing and I’ve ranted about it on my blog a bit. The absolutist, “there’s no reason you can’t have good asthma control” comes with an implied condemnation of those who don’t have good asthma control: They’re not compliant enough, or careful enough, or whatever. They don’t really acknowledge that you might have what Rick calls “hardluck asthma” and just pulled the short straw in the lung department. Or you might be in my boat where avoiding allergens in your life is impossible. Try avoiding dust in a 100-year-old work building. Try avoiding tree pollen when you’re a pedestrian. Etc.

    That said, I think their intention with those is good: They don’t want people to just chalk up poor control to having bad luck and bad asthma without first trying everything possible to obtain good control. Because if, to use a personal example, you’re a person with a cat allergy who happens to live with two high-shedding cats, of course you’re going to have asthma problems! That’s a problem that has an easy-to-identify solution (albeit a very painful one to implement – nobody wants to give away their pets). So I think they’re so insistant on saying that everyone can obtain good asthma control because they don’t want people settling unnecessarily and it just sounds better to say “Everyone with asthma can…” than “Almost everyone with asthma can…”

    It’s a hard problem, and I’m not sure what the solution is. Do you alienate the few who are actually in the hardluck boat, or do you risk that some people will accept unnecessary limits on their life because they haven’t tried enough strategies for control? I almost sure they considered that when crafting the material for those programs.

  4. Amy says:

    Danielle–Hahahaha. This part of your comment,

    “A lot of asthma education programs here (is it the same in the States?)”

    implies there is some sort of comprehensive asthma ed. program network in my country or something. That’s funny.

    Seriously, I never even heard of asthma education programs until Canadians started commenting on this blog. There are some places in the U.S. that have them, but they’re by no means widespread or even easy to find.

    Sarah–I dunno, I kind of like your “Almost” solution. No, it doesn’t have quite the same ring as the absolutist statements, but it’s probably the most simple way to address the problem.

  5. Sarah says:

    Amy – I don’t know why they don’t have widespread asthma education programs in the US. Apparently, they pay for themselves several times over in terms of improved asthma control, medical costs, etc. I’ve seen estimates of the cost-benefit ratio as low as 1:2, and as high as 1:7. With all the fuss out there about lowering the US cost of health care, you’d think they’d be all over it.

    That said, I’ve seen people up here gripe about the cost of similar programs for other chronic illnesses, pulling out the ol’ personal responsibility yarn (though how they reconcile that learning about your condition and how to manage it is part of personal responsibility, I don’t know)

  6. Amy says:

    Because insurance companies in the U.S. don’t like to prevent health conditions and complications, only treat them. At least, that’s what the evidence suggests. And that’s only if you’re lucky enough to have health insurance. Our system is really screwed up.

    We do seem to be experiencing a greater push towards preventative health care, but not nearly at the level it needs to be.

  7. Danielle says:

    Well this is turning into quite an interesting discussion :) I had no idea that this wasn’t as widespread in the US. I guess I should just shaddup and be thankful. (You have heard me sing the praises of my ashma educator before though)

    Our system is definitely into preventative care, seeing as it works out to be cheaper and, you know, they have to pay for it. When it does work, it’s good for everybody involved.

    I do agree with the message of asthma education programs, namely that you don’t have to live with problematic asthma and your behaviour can be a huge part in changing that. We’d be a lot worse off if we all sat around, not taking our preventer meds, not exercising and getting sicker and sicker.

    On the other hand, I think that they promise “symptom-free asthma” a little hastily. Another strong message is that as long as you take your corticosteroids, you won’t have symptoms. Corticosteroids are extremely effective, but they won’t deal with underlying complicators like gastric problems, allergies, sinus problems or just a bum immune system. It takes years to decipher those nuances.

    So despite their very well-meaning efforts, it sometimes feels like one huge guilt trip. You just have to not take it personally and acknowledge that you’re doing you’re best.

  8. Sarah says:

    I agree with you completely, Danielle.

    Here’s a possibility: Maybe they mean for it to be a guilt trip on the sort of parent that smokes in the house with an asthmatic kid or the kind of asthma patient that doesn’t take their controller unless they’re flaring and wonders why they bounce between feeling good and ER trips all the time, and people like you, me, and Kerri are kind of collateral damage? Maybe they mean it as a wake-up to the types that Rick would call “doofus asthmatics” and the parents of “poor patient” kids.

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