Navajo Nation children see high asthma burden, exacerbations

Key takeaways:

• Many children who experienced asthma exacerbations did not have a controller medication.
• Exposure to farm animals and dampness increased the odds for an exacerbation.

Asthma exacerbations among Navajo Nation children occur frequently, with over half of those with asthma reporting hospitalizations or urgent care visits, according to a study published in The Journal of Allergy and Immunology: In Practice.

Not much is known about the burden of asthma exacerbations (AE) in Navajo Nation children, Bruce G. Bender, PhD, a pediatric neuropsychologist from the division of biostatistics, department of pediatrics, Center for Health Promotion at National Jewish Health, Denver, and colleagues wrote.

This report drew on findings from the Community Asthma Program and found a significantly high asthma burden among Navajo children that included frequent AEs that may be linked to environmental exposures.

The Community Asthma Program is a 7-year study that aims to develop a program that would improve the health of children living with asthma in the Navajo Nation, a native American reservation the size of roughly 27,000 square miles in the southwestern United States.

Data were derived from the first year of the study, before the COVID-19 pandemic. Sources included medical center databases that had information on the number of visits over a 12-month period for AEs, urgent care visits, hospitalizations and oral corticosteroid (OCS) prescriptions.

Researchers also included caregiver interviews of children aged 7 to 17 years with asthma. Interviews included information on demographics, asthma diagnosis, medications, urgent care visits/hospitalizations and the home environment (heat sources, smoke exposure, mold, pets, pests, insects and domestic animal presence).

Among the data collected from medical center databases, 28.4% of children with asthma experienced an AE, with 20.8% receiving an OCS prescription, 16.2% visiting urgent care and 0.9% having a hospitalization.

According to data collected from parent interviews, 51% of children had an AE, with 44% visiting urgent care and 31% receiving OCS. Multiple urgent care visits and OCS courses (four or more) were required by 7% and 4% of children, respectively. Hospitalizations occurred in 5.6% of children.

Parents also reported that their child had no controller medication (74%), which included 37.5% of children with an ED visit, hospitalization or OCS requirement in the past year.

Among the environmental exposures reported by parent interviews, the most common was the use of an indoor open combustion stove for heating at 73%; however, only three households reporting the use of this stove as its main cooking source. Tobacco use in the home was reported by 10% of households and none of the children with asthma smoked.

Nearly half of the households at 46.4% and 46% reported having a cat or a dog in the home and contact at least once a week with farm animals (horses, sheep, cows, chickens and goats), respectively. The presence of mice was reported by 14.4% of homes, and 21.4% reported standing water, dampness or mold.

Researchers analyzed the potential association between environmental factors and AEs. They found that the presence of standing water, dampness or mold increased the chance of reporting an AE by 2.57 (95% CI, 1.17-5.95), whereas exposure to farm animals increased AE chances by 1.91 (95% CI, 1.03-3.55).

The results of this study show that there is a need for guideline-based training for health care providers, researchers wrote, as over half of the children reported an AE and many did not have a controller medication.

Authors emphasized that future research is needed to build on the findings in this study to gather more information on the associations between indoor and outdoor environmental exposures experienced by Navajo Nation children with asthma.