Asthma is the most common chronic pediatric illness in the United States. It is not something that we frequently see listed in the medical histories of internationally adopted children. Asthma is a condition that is caused by airway inflammation and constriction, obstructing the flow of air in the lungs. Air gets trapped and causes the lungs to overinflate and sometimes you can hear a wheezing sound when they exhale or frequent dry coughing. Occasionally what is called asthma on preadoption medical records is more reflective of Bronchopulmonary Dysplasia (BPD). BPD is usually the result of under developed lungs in premature babies. It is a separate process that interferes with normal lung functioning but sometimes is confused in the translation or terminology from other countries.

Asthma is very common and estimates are that 300 million people are living with asthma worldwide. How much asthma affects someone’s life depends on environmental factors and while it can be very serious, it is usually very manageable with medications and there are good, current guidelines to help determine what care your child will need.¹ Some people only need medications occasionally when there is an exacerbation and other people require daily medications to help keep their asthma in check. Genetics and family history play also play a role.

Other risk factors include^2,3

• Black race
• Parent with asthma
• Allergic symptoms
• Viral illnesses
• Exposure to tobacco smoke
• Air pollution

A few proposed factors that decrease asthma risk are:

• Infections: Tuberculosis, measles and Hepatitis A ⁴
• Rural settings ^5,6
• Childcare or multiple children present ⁷
• Decreased antibiotic use
• Air conditioning ⁸

Many internationally adopted children come from rural areas and are exposed to increased infections with decreased antibiotic availability. Also, institutionalization acts as a 24 hour daycare setting and all of these factors may actually reduce the risk of asthma for our population. If a child does have asthma or BPD, a family may need to be ready to help with frequent physician visits and/or medications. In addition, children with asthma or BPD can become sicker than other children when they have colds or respiratory viruses. These exacerbations are readily addressable by medications and management options through their general pediatrician, pediatric pulmonologist, or pediatric allergist.

• Not common in international adoptions, but is seen worldwide in pediatrics
• Breathing problems that are due to airway constriction
• Can be due to prematurity or other environmental triggers
• Can need medications but with generally excellent long term outcomes

1. National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Allergy Clin Immunol. 2007;120(5 Suppl):S94-138. 10.1016/j.jaci.2007.09.043.

2. Kercsmar CM, Dearborn DG, Schluchter M, et al. Reduction in asthma morbidity in children as a result of home remediation aimed at moisture sources. Environ Health Perspect. 2006;114(10):1574.

3. Iossifova YY, Reponen T, Ryan PH, et al. Mold exposure during infancy as a predictor of potential asthma development. Annals of Allergy, Asthma & Immunology. 2009;102(2):131-137.

4. Matricardi PM, Rosmini F, Riondino S, et al. Exposure to foodborne and orofecal microbes versus airborne viruses in relation to atopy and allergic asthma: epidemiological study. BMJ. 2000;320(7232):412.

5. Asher M, Keil U, Anderson H, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. European Respiratory Journal. 1995;8(3):483.

6. Yemaneberhan H, Bekele Z, Venn A, Lewis S, Parry E, Britton J. Prevalence of wheeze and asthma and relation to atopy in urban and rural Ethiopia. The Lancet. 1997;350(9071):85-90.

7. Krämer U, Heinrich J, Wjst M, Wichmann H. Age of entry to day nursery and allergy in later childhood. The Lancet. 1999;353(9151):450-454.

8. Vesper S, McKinstry C, Haugland R, et al. Development of an environmental relative moldiness index for US homes. Journal of occupational and environmental medicine. 2007;49(8):829.

This article was generously shared by Dr. Judith Eckerle of the University of Minnesota,   Adoption Medicine Clinic. Child referrals are becoming increasingly complex, and adoption medicine professionals are identifying many more children with special needs from all countries that participate in intercountry adoption, as well as from the United States. To help families prepare for these changes, Dr. Eckerle and other medical specialists are writing a book: Health Topics For Preadoptive Families.