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Emergency room visits for asthma more frequent for Missouri’s poorest children

About nine million children in the United States have asthma.
National Institutes of Health
About nine million children in the United States have asthma.

Audrey Collins’ two daughters were diagnosed with asthma as infants. When they had trouble breathing, she would use a nebulizer machine with a tiny attachment for their faces.

“And if it didn’t get better, I’d take her to the emergency room. And we were in there a lot,” Collins said, during a recent visit with her daughters to a mobile asthma clinic parked outside their pediatrician’s office in north St. Louis.

One in five children in north St. Louis city and north St. Louis County are diagnosed with asthma; pediatricians here say it’s their top issue of focus. Poor air quality, restricted access to preventive care and low socioeconomic conditions all appear to be exacerbated in those areas, making pediatric asthma rates twice as high as the statewide average, according to new numbers from the Missouri Hospital Association. When children’s asthma gets out of control, they often wind up in the emergency room, creating an emotional (and often financial) toll on their families.  

Today, Collins’ daughters are 9 and 7, and managing their symptoms well. They have Medicaid coverage to pay for medication, visit their doctor regularly, and keep action plans for asthma emergencies.

“I just catch it in the beginning, and I haven’t been in the hospital since,” Collins said.

"10-year Trends in Pediatric Asthma Emergency Department Visits by Payer in Missouri," from June 2015 report.
Credit Missouri Hospital Association
"10-year Trends in Pediatric Asthma Emergency Department Visits by Payer in Missouri," from June 2015 report.

Over the past ten years, the number of annual emergency department visits for children with asthma has increased by about 15,000 in Missouri. The increase was particularly dramatic among children insured through Medicaid, which covers people who are poor or disabled. Last fiscal year, children in the program visited the emergency room at a rate of 63 per 1000 visits, three times as often as kids covered by all other forms of insurance.

A second MHA paper, highlighting prevention efforts, is availablehere

Experts weigh in: Why is the disparity getting worse?

Dr. Rob Strunk, a pediatrician at St. Louis Children’s Hospital, said he sees two main causes for the trend: Poverty and climate change. Environmental stressors like dust, mold and rodent droppings can all exacerbate a child’s asthma, and families may not have the means to get it out of their home. Climate change has lengthened allergy seasons and increased pollen counts in the St. Louis area, another common asthma trigger.

“What we see are a lot of children who are clearly disadvantaged in their living situations. Their parents are under more and more economic stress, which impacts the family and their ability to get timely medical care,” Strunk said.

In a St. Louis American editorial this spring, local pediatrician Dr. Huldah Blamoville highlighted the impact of climate change on her patients with asthma. Blamoville is the president of the Mound City Medical forum.

“In this part of the Midwest, we have seen the ragweed pollen season increase by about two weeks. This, coupled with high ozone air pollution, is why the St. Louis area has been named a climate-vulnerable zone,” wrote Blamoville, citing a new report from the Natural Resources Defense Council.

Mathew Reidhead, the author of the study for the Missouri Hospital Association, speculated that statewide, children have had less access to primary care providers over the past fifteen years.  

“During the period evaluated we also experienced the largest economic downturn since the great recession, which made more children eligible for [Medicaid.] At the same time, we saw a shift toward fewer health care providers accepting Medicaid, which unfortunately led many low-income families to hospital emergency rooms for access to much-needed primary care,” Reidhead wrote in an email.

In Missouri, children qualify for Medicaid coverage if their parents make less than 300 percent of the federal poverty level, or about $72,700 for a family of four. Parents qualify if their incomes are below 18 percent of the FPL.

How families can help

According to Strunk, greater statewide prevention efforts could help reduce the number of children having severe asthma attacks. Mobile asthma clinics in St. Louis visit children in schools throughout the region, and the state legislature approved an appropriation intended to fund asthma home assessments this year.

But Strunk said many prevention efforts, likeasthma coaching over the phone, have a harder time getting funded.

“We know how to do it, we’ve done it, we’ve shown it works,” Strunk said. “It’s very discouraging.”

In the meantime, Strunk said parents can help manage their children’s symptoms by learning how to catch the early signs of asthma: lethargy and appetite changes, which progress to mild coughs and wheezing.

For more health and science news from St. Louis, follow Durrie on Twitter: @durrieB