The Unanticipated Risks of Childhood Asthma
As I’ve learned from the kids in Asthma Pals, being a kid with asthma isn’t easy. Even though asthma is common, and medicine can help us live normal lives, there are additional risk factors for asthma to look out for. For kids, these often include food allergies, eczema, knowing where your medicine is, and just not wanting people to be worried about you—and wanting friends to understand you.
Unfortunately, there are other big childhood risk factors for asthma that are less anticipated. Research has indicated a number of difficulties that may be faced by children with asthma more often than children who don’t have the disease. And some of these unanticipated risks of childhood asthma are pretty surprising.
While probably the most anticipated of the lot, it’s hard to believe that children with asthma identify as potentially having fewer friends than those without asthma. One study in Australia noted children with asthma were more likely to be treated for mental health problems, express unhappiness at school, experience frequent absences, and be less likely to have a group of friends to play with.1 The preceding factors could certainly play into children expressing they didn’t feel as if they fit into a peer group, as it can be difficult to be “fun” and socialize when you are not breathing well!
The study also noted that children from lower-income households were more likely to have asthma, which could also exclude them from other social activities.1 Though asthma may be a child’s normal, they are aware of (and frustrated by) the limitations they may experience because of asthma.2
Children with asthma are more likely to be obese than their peers.3 This is potentially a cyclic effect of avoidance of activity due to asthma, and increased difficulty breathing due to abdominal weight restricting respiration and decreasing respiratory efficiency. In some cases, particularly in children with severe asthma, oral steroid medications can lead to insatiable hunger that precedes weight gain. Research has also documented that children who are obese may have reduced sensitivity to inhaled corticosteroids, leading to poorer asthma control.3
Medical intervention can, indeed, assist children who are obese in achieving control of their asthma.4 In part, inaccurate stereotypes may impact children too, as they may think they cannot or should not exercise because of their asthma, rather than experiencing positive reinforcement from the many elite (and non-elite!) athletes who participate in sport and physical activity with asthma. Obesity in childhood can have life-long effects on not only a person’s physical health as they get older, but their mental health—such as self-esteem and confidence—as well, so this risk can impact a person throughout their life in more ways than we might consider.5,6
Reduced literacy/reading skills
While this article from Reuters is from 2010, I think it’s still important to highlight this older research, which noted children with asthma were about 15% more likely to be behind in reading than their peers when developing reading abilities.7 The same deficits did not occur in math, however. The article considers that children with asthma may have more difficulty controlling their breathing while reading aloud, which is how reading ability is assessed.7
I speculate, based on this, that children with asthma could thus appear to be more hesitant by lacking breath control, not purely due to their ability to read. Oh, and being able to read well—and reading for fun—is documented to predict a person’s success in life as a whole. So, reading is pretty important!
However, I’ve not found any more recent research into this topic. If it is indeed true children with asthma are more likely to struggle with reading, this could indeed contribute to our next unanticipated risk.
Reduced academic performance
Reading is, of course, a precursor to being able to succeed academically.8 While just one part of academic success—in addition to school attendance, positive social pressures, and effects both inside and outside of school—children or young people who have difficulty with this basic skill may struggle through the rest of their academic career.
The same is overall true of asthma. A study published in March 2019 and featured on Science Daily “found associations between poorer asthma status, poorer asthma control, lower lung function, more asthma symptoms, and decline in academic performance”, amongst urban children, stated the researcher.9
Another study noted that schools receiving Title I funds from the government (schools in poorer areas) had higher rates of asthma, affirming the role socioeconomic status can have, underscoring the link to chronic stress in children.10 Asthma control overall was most significantly correlated with academic outcomes, "teacher reports of academic performance”, absences, and standardized test scores.9 This means asthma, in some cases, may be used to identify students who could be at risk academically.
The incidence of asthma among those incarcerated in the US is 14%, as opposed to 10% in the general population  (that is, the public, not the prison type of general population). Here are some facts surrounding asthma and crime:
- Children with a father who is incarcerated are more likely to develop asthma, at a rate of 30%.12
- One study stated “Increased risk for asthma was observed in schools receiving Title I funds compared with those without funding […] and residing in communities with higher rates of larceny crime.10"
- A 2010 Chicago study correlated areas to have higher rates of violent crime to also have greater incidence of asthma.13
- Incarcerated persons are more likely to have low literacy abilities and not to have had graduated high school.14
These issues link to the points outlined above. While the correlation is not clear, it can be considered that the frustration of having difficulty keeping up to the world around you, textually and verbally, can lead to frustration—in turn, potentially leading to criminal activity.14
The relationships are correlative, not causal: these factors are not predictive, of course, that children with asthma are more likely to commit crimes. However, it is important to consider the social factors that surround asthma, and which populations are more likely to have asthma.
Final thoughts on childhood risk factors for asthma
While many other factors such as socioeconomic status weigh into each of these unanticipated risks children with asthma face, it is important to realize the profound impact asthma can have on kids. Any of these struggles can impact a child through their adult life, so the more readily we can identify children who may struggle, the more efficiently interventions can take place and the better we can help them thrive.
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