Two new studies look at the causes of asthma, and how to reduce the need for medication, which many kids may be misusing anyway!

girl using asthma inhaler on fall day
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Asthma. It's shockingly common, affecting as many as 10 percent of kids in the U.S. Now, in a new report from the American Academy of Pediatrics, experts say that number is closer to 25 percent in some communities, especially poor ones. Why? Because according to the report, which is published in the November 2016 issue of Pediatrics, kids living in poverty have a higher risk of being exposed to environmental allergens and pollutants such as second-hand smoke and dust mites. And incredibly, the report says reducing exposure to these types of pollutants can be just as effective as medication to control the disease.

Of course, every child is different. But the report says exposure to indoor allergens exacerbates the condition. Therefore, those with asthma should avoid certain triggers, including:

  • Dust mites and mold (common to areas with high humidity). Consider that upto 62 percent of kids with persistent asthma are also allergic to dust mites, and about half are sensitiveto mold.
  • Furry pets. Up to 65 percent of children with persistent asthma are allergic to Fido and his canine counterparts.
  • Pests likecockroaches and rodents. Roughly 75 to 80 percent of homes have detectable amounts of mouse allergen; in high-poverty areas, rates can be 1,000-fold more.
  • Second-hand smoke. The use of gas stoves and appliances can also exacerbate asthma symptoms.
  • Household chemicals, like those found in air fresheners and cleaning agents, which we know can be respiratory irritants.

"This is the first report put out by the AAP that provides comprehensive information for pediatricians about how to identify potential asthma triggers and what to recommend to reduce exposure to these triggers," the study's lead author Elizabeth C. Matsui, MD, MHS, FAAP, told She recommends allergy testing for any child with persistent symptoms, or who requires frequent or daily medications for asthma. "The allergy test results help to identify allergens in the home that contribute to the child's asthma symptoms and exacerbations."

"Working with your child's pediatrician to identify you child's asthma triggers through allergy testing and removing the triggers from your home can lead to significant improvements in your child's asthma," Dr. Matsui told us. "These improvements may include less need for daily controller medication or albuterol (rescue medication) and fewer asthma exacerbations."

Some kids will still need medication, of course. But another study published earlier this month found that many kids use asthma inhalers incorrectly, leading to unnecessary asthma attacks, emergency room visits, and hospital admissions.

"We see a lot of children, in fact, who just don't know how to use their inhalers at all," BJ Lanser, MD, a pediatrician and asthma specialist at National Jewish Health in Denver said in a press release. That could be due to never learning how to properly use an inhaler, he added.

According to the study, the problem is that poor inhaler technique fails to deliver medications deep into kids' airways, where they're needed. One of the more common mistakes kids make is using an inhaler without a spacer (a plastic tube attached to the mouthpiece). When a child activates the inhaler, the spacer allows the medication to mix with air, so it can be inhaled more effectively.

"Without a spacer, 70 to 80 percent of the medicine ends up in the child's mouth and never gets deep into the lungs," said Dr. Lanser, adding, "If they continue to make those mistakes dose after dose, their symptoms begin to worsen and often those children end up in the hospital."

He offers these tips to help children get the most out of their asthma medicine:

  • Always stand when using an inhaler. This allows the lungs to fully expand, so the medication can get where it's needed most.
  • Look straight ahead. You want to make sure your child's head is in a neutral position, not leaning forward or backward to help direct the medicine into the airways and prevent it from collecting in the mouth.
  • Before inhaling, exhale. Have your child take some normal breaths and then a big, deep breath, then fully exhale to empty the lungs. That way, when your child inhales, the medicine gets deep into the lungs.
  • Inhale slowly. Even if a child is having trouble breathing, be sure to inhale the medicine slowly. A whistling sound from the spacer means he or she is inhaling too quickly.
  • Close your lips around the mouthpiece. Because the medicine is aerosolized, it can easily escape the mouthpiece. Be sure to make a tight seal with the lips to get all the medication into the lungs.

"Using proper inhaler technique every time you use your rescue or controller medicines is crucial, to ensure that the right amount of medicine gets where it needs to go, deep in the lungs. Talk with your doctor's office to make sure you're using your inhaler correctly, and using a spacer appropriate for your type of inhaler," Dr. Lanser told

Melissa Willets is a writer/blogger and a mom. Find her on Facebook where she chronicles her life momming under the influence. Of coffee.