Avoid The Fall Asthma "Epidemic"

By Amy Brandt, MPH – Chronic Respiratory Disease Epidemiologist, Indiana State Department of Health

Fall can be a dangerous season for children with asthma. In Indiana, 9.5% of children currently have an asthma diagnosis.As shown in the graph below, hospitalizations and emergency department (ED) visits for asthma in school-age children have peaked during the fall season for the past three years. In 2011, the October rates of ED visits and hospitalizations were 8.1 and 1.5 per 10,000 children aged 5 to 17, respectively.2 While there has been an overall decline in asthma ED visits, the fall season is a time when these admissions spike. 

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Age-Specific Rates of ED Visits and Hospitalizations by Month and Age for School-Age Children (5-17 years), Indiana, 2009–20112


Some documented explanations pointing to this increase include the return to school, decreased use of medications during summer and viral infections.3 Children are exposed to a multitude of triggers in school buildings, including dust mites, mold, animal dander, and pests. Daily exposure to these irritants and allergens can exacerbate asthma symptoms and result in emergency situations if the child or school personnel are not properly trained.   

The etiology of the fall asthma epidemic has been linked to viral infections, predominantly rhinovirus. These infections are common in early fall, and children with asthma are at increased risk of asthma exacerbations and complications as a result. One study observed that respiratory viruses were found in 62% of children presenting to the ED during September, with rhinovirus being the most common.4 The cases were also less likely to have a prescription for controller medications than the controls who were similar children with asthma from the same community but did not have an ED visit. 

To keep children with asthma out of the hospital during the fall months, they should have a routine back-to-school wellness visit. During that visit, the physician should assess the child’s asthma control, self-management skills, level of exposure to triggers and discuss medication usage. Additionally, physicians can work with their school-age patients and patients’ caregivers to create an asthma action plan to share with school personnel, including the school nurse.

The Indiana State Department of Health Asthma Program’s website has more information for health care providers on preparing students with asthma for school. To see more data on Indiana’s asthma seasonality, view the Asthma in Indiana PowerPoint presentation. For more information on asthma in Indiana, contact Barbara Lucas, Asthma Program Director, at barlucas@isdh.in.gov

References

  1. 1.Centers for Disease Control and Prevention and Indiana State Department of Health Data Analysis Team [ISDH DAT]. (2013). Behavioral Risk Factor Surveillance System Prevalence Data, 2012
  2. 2.ISDH DAT. (2012). Indiana Hospital Discharge Data Files, 2009-2011.
  3. 3.Sears, M. R. & Johnston, N. W. (2007). Understanding the September asthma epidemic. The Journal of Allergy and Clinical Immunology, 120(3), 526-529.
  4. 4.The September epidemic of asthma exacerbations in children: A search for etiology. The Journal of Allergy and Clinical Immunology, 115(1), 132-138.