IntroductionMost US studies on asthma prevalence have been conducted in urban areas, and few have assessed the prevalence of asthma among residents of rural areas versus urban areas. The objective of this study was to compare the prevalence of asthma among adults living in metropolitan versus nonmetropolitan counties in Montana.

Regional and national surveillance is needed to comprehensively document asthma prevalence in American Indians and other underrepresented minorities in the United States.

These findings suggest that it is feasible to implement a 12-month HV program using local public health resources in a rural area as outcomes improved over this time period.

Evidence-based clinical guidelines emphasize providing asthma self-management education (ASME) to patients at multiple points of care. However, clinical and population-based studies indicate that the provision of ASME is inconsistent. Between 2006 and 2008, the Montana Department of Public Health and Human Services (DPHHS) conducted the Asthma Call Back Survey (ACS), a telephone survey of a representative sample of adults with asthma in the state (N = 767). Based on a control scale algorithm, 54% of respondents with asthma were well controlled and 46% were either not well controlled or were very poorly controlled. Adults with uncontrolled asthma were more likely than adults with well-controlled asthma to report seeing a health care provider in the past year either through a routine checkup for asthma (adjusted odds ratio [AOR], 7.4; 95% confidence interval [CI], 4.8-11.5), to have an urgent care or emergency department visit for asthma (AOR, 18.3; 95% CI, 6.5-51.5), or to have ever taken a class to self-manage asthma (AOR, 3.0; 95% CI, 1.4-6.6). Respondents with uncontrolled asthma were somewhat more likely to use a peak flow meter (AOR, 1.8; 95% CI, 1.2-2.8) and to have been advised to change aspects of their home, work, or school to improve their asthma (AOR, 1.7; 95% CI, 1.1-2.6) compared with those with well-controlled asthma. Adults with uncontrolled asthma were no more likely than adults with well-controlled asthma to report ever being given an asthma management plan (AOR, 1.7; 95% CI, 1.0-2.7) or instructed on how to recognize the early signs of an asthma attack (AOR, 1.3; 95% CI, 0.8-2.1). Our findings suggest that Montana providers may be missing key clinical opportunities to provide and reinforce ASME, particularly among those with uncontrolled asthma. Strategies are needed to increase asthma control and use of ASME.