Prognosis

Asthma is the third major cause of hospitalization in children under age 15. The condition can be very serious in children, particularly those younger than age 5, because their airways are very narrow.

Degree of Severity

The severity of asthma is graded as mild intermittent and mild, moderate, and severe persistent. A patient in any of these categories, even mild intermittent, can still experience a severe and even life-threatening attack. According to one report, 30% of asthma deaths occur in patients with mild asthma.

Risk Factors for Life-Threatening Asthma

Asthma is rarely fatal in children, with only 176 asthma deaths reported in 1999 in children under age 15. (About 444 fatalities occurred in people between ages 15 and 34.) But even these low numbers are unacceptable, since asthma deaths are largely preventable.

Factors associated with an increased risk of death from asthma in children include:

• Previous life-threatening episodes of asthma
• Lack of adequate and ongoing health care. (Most likely the reason for the higher fatalities rates in minority children.)
• Significant behavioral problems
• Underestimating the severity of an acute attack poses the greatest threat. Unfortunately, one study of children found that nearly 40% of them were unaware of asthmatic symptoms when they occurred.

African American children have more than six times the death rate of Caucasian Americans in the age groups of 4 years and younger and 15 to 24 years. Hispanic children also have a higher risk. A 2002 study suggested that these children tend to be given inferior treatments compared to Caucasian children.

Symptoms of a Life-Threatening Attack

The following signs and symptoms may indicate a life-threatening situation:

• As the chest labors to bring enough air into the lungs, breathing often becomes shallow
• Lacking sufficient oxygen, the skin becomes bluish
• The flesh around the ribs of the chest appears to be sucked in
• The patient may begin to lose consciousness

Asthma often progresses very slowly to a serious condition or may develop to a fatal or near-fatal attack within a few minutes. It is very difficult to predict when an attack will become very serious. Early symptoms or lack thereof do not always reflect the ultimate severity of an attack. Some studies even suggest that people at high risk for fatal or near-fatal asthma attacks are those with poor awareness of their own reduced ability to breathe and who are slow in seeking help. Monitoring peak flow rates is, therefore, an important management component, since it provides a more accurate assessment of lung function than symptoms alone.

Long-Term Outlook

In a 2003 study, researchers followed people with asthma for longer than 30 years. About a third of children had outgrown their asthma in adulthood. In general, the more severe the childhood asthma, the greater the likelihood that it will persist. For example, only 23% of children who experienced wheezy bronchitis (wheezing during respiratory infections) suffered from frequent or persistent asthma in adulthood.

There is now some evidence that severe asthma can cause long-lasting damage and possibly permanent scarring in some patients. The risk for such injury is highest, however, when asthma strikes children in the first 3 to 5 years. There does not appear to be any significant risk for long-term lung damage for children who develop mild to moderate persistent asthma between ages 5 to 12. Children adapt well to living with asthma, however, and even with severe asthma they can function as well as healthy children in virtually all areas of life.

Psychologic Factors

Studies are mixed over the effects of emotional disorders on the severity of asthma. One study indicated that parents of children with asthma may suffer greater psychological stress than their children. A 2000 study, reported that having mild-to-moderate asthma does not significantly affect the psychological well-being of most children aged 5 to 12. Teenagers and preteens have particular difficulty coping with what they perceive as the social stigma of asthma. Often they will deny their condition and refuse to comply with their drug regimen. Parents and older children should not hesitate to seek help from support groups, doctors, friends, or family members. Supporting programs in camp and school may help children to better manage their asthma and may even reduce hospitalization.

Effect on School and Work

Although there have been few studies on the effects of asthma on schooling, a 2000 study reported that nocturnal (nighttime) asthma affected school attendance and performance in children and work attendance in their parents.