Vital Signs

Vital Signs: Asthma in Children — United States, 2001–2016

Hatice S. Zahran, MD; Cathy M. Bailey, PhD; Scott A. Damon, MAIA; Paul L. Garbe, DVM; Patrick N. Breysse, PhD


Morbidity and Mortality Weekly Report. 2018;67(5):149-155. 

In This Article


During 2016, asthma affected boys (9.2%) more than girls (7.4%), children aged 5–11 years (9.6%) and 12–17 years (10.5%) more than children aged 0–4 years (3.8%), black children (15.7%) and children of Puerto Rican descent (12.9%) more than white children (7.1%), and children living in families with income of less than 100% FPL (10.5%) more than those living in families with income of ≥250% FPL (250% to <450% FPL: 6.9%; ≥450% FPL: 6.7%). However, current asthma prevalence did not differ significantly by U.S. Census region (Table 1) or metropolitan statistical area (MSA).

Asthma prevalence among children aged 0–17 years increased from 8.7% in 2001 to 9.4% in 2010, and then decreased to 8.3% in 2016. Although not all changes were statistically significant, a similar pattern was observed among all sex, age, and racial/ethnic groups studied, except for Mexican/Mexican-American children, among whom asthma prevalence increased from 5.1% in 2001 to 6.5% in 2016.

In 2013 and 2016, nearly 54% of children with asthma were reported to have had ≥1 asthma attack, 71.1% had routine care visits, 4.7% were hospitalized, 16.7% had an ED/UC visit because of an asthma attack, and 49.0% of school-age children with asthma missed one or more school days (Table 2). Having an asthma attack, missing school days, and having health care visits because of asthma (routine care visits and hospitalizations) did not differ by sex, race/ethnicity, and U.S. census region. However, the prevalence of asthma attacks, hospitalizations, and ED/UC visits were higher among children aged 0–4 years than among those aged 12–17 years and ED/UC visits were higher among black children (22.5%) than among white children (12.2%) (Table 2).

During 2001–2016, the percentage of children with asthma who experienced an asthma attack decreased significantly, from 61.7% in 2001 to 53.7% in 2016 (Figure). A significant decline in asthma attacks was experienced across all sex, age, and racial/ethnic groups.


Percentage of asthma attacks among children aged 0–17 years with current asthma, by year — National Health Interview Survey, 2001–2016

Assessment of asthma self-management education found that 50.8% of children with asthma received an asthma action plan, 11.0% were taking a class to learn how to manage their asthma, 76.0% were taught how to recognize early signs of an asthma attack, 80.0% were taught how to respond to an asthma attack, 50.6% were taught how to use a peak flow meter (a portable, handheld device that is used to measure how well air moves out of the lungs), and 46.4% received advice on environmental control in 2013. Compared with 2003, the percentages of children with asthma who were hospitalized because of asthma and, among school-aged children with asthma, the percentage with missed school days were significantly lower in 2013, while the percentage having an action plan to manage asthma was higher (Table 3). Similar to estimates in 2003, in 2013, 94.4% of children with asthma had health insurance coverage, and 6.4% could not afford prescription medicine during the past 12 months. In 2013, nearly 68% of children with asthma were taking asthma rescue medications and 55.2% had taken asthma control medicine in the past 3 months. In addition, approximately 9% of children with asthma overused rescue medications (i.e., used more than three disks or canisters of quick relief inhaler medication in the past 3 months) and 30.1% were taking asthma control medications every day or almost every day as recommended, with 25.1% reporting taking them less often (Table 3). Having received self-management education and use of asthma control prescription medication did not differ by race/ethnicity. However, among children with asthma who were taking asthma control medicine during the preceding 3 months, the percentage of children using asthma control prescription medicine regularly as prescribed declined significantly from 65.7% in 2003 to 54.5% in 2013 (p<0.01) (Table 3).