Childhood asthma in the United States: Urban issues

Abstract

The prevalence and morbidity of asthma are growing problems that appear to affect urban populations and particularly impoverished centers disproportionately. Poor children are more likely to be hospitalized for asthma than nonpoor children, and are more likely to experience clinical and social dysfunction due to asthma. While guidelines exist for best care of childhood asthma, the neediest children are least likely to encounter the benefits of these recommendations. The relationship between host and environment in both primary causation and disease exacerbation is an area of research and debate. Allergen exposure in early life appears to correlate with sensitization and expression of atopy and asthma. Impoverished households are more likely to be reservoirs for dust mite and cockroach antigen in high concentrations than more affluent settings. Lifestyle factors, including diet and ambient air quality, may be disease modifiers. Suboptimal systems for delivery of healthcare to high-risk populations are obvious targets for blame. Poor children are more likely than nonpoor children to receive sick care in emergency rooms that lack a connection to chronic care providers. Besides the method of delivery, the quality of care is questionable, as poor children are less likely to receive the anti-inflammatory maintenance medications for asthma that evidence-based guidelines recommend. Efforts to correct these problems must take into account such issues as explaining the nature of the disease and the best intervention strategies to people who have a diverse array of cultural backgrounds, belief systems, and life stressors. Efforts to improve the status quo are underway in many communities. Environmental control measures to reduce dust mite and cockroach exposure have met with some success. Models to improve access to care and acceptance of care may improve community outreach maneuvers that connect the medical establishment with families and patients. Examination and assessment of new approaches to facilitate this sort of communication hold promise and are receiving attention as well as research dollars.

Variation in ITGB3 Is Associated with Asthma and Sensitization to Mold Allergen in Four Populations

“…Only half of the Hutterites with asthma or BHR are sensitized to one or more allergen, whereas 70 to 80% of the individuals with asthma in the Chicago samples and all of the Madison individuals with asthma were sensitized to one or more allergen, using roughly the same panel of allergens. The Chicago participants were largely from the inner city, which is in itself a risk factor for asthma prevalence and severity (24) quent development of asthma and allergic disease (25)(26)(27), it remains possible that the different patterns of association between the samples reflect differences (or similarities) in earlylife exposures. Overall, given the heterogeneity between the study samples concerning clinical diagnoses and environmental exposures, it is quite remarkable that we observed associations between variation in the ITGB3 gene and asthma/BHR, and that the asthma-susceptibility allele class was associated with protection against allergic sensitization to mold allergens in four populations.…”

The association between contextual socioeconomic factors and prevalent asthma in a cohort of Southern California school children

“…Lower SEP may act as a proxy for causal environmental effects, such as elevated air pollution exposure (O'Neill, Jerrett, Kawachi, Levy, Cohen, Gouveia et al, 2003) and poor housing conditions (Shapiro & Stout, 2002). Theoretically, geographic variation in asthma may be broken down into pathways operating at the individual level (i.e.…”

The effect of a pediatric asthma management program provided by respiratory therapists on patient outcomes and cost

“…1,2 No other single disease accounts for a larger proportion of health care costs in the United States, and the treatment of acute asthma exacerbations accounts for the majority of this cost. 1,3 Asthma disease management programs (ADMP) have been developed in an attempt to control the disease and reduce the frequency and severity of acute asthma exacerbations.…”