The challenge of inner-city asthma

Grant, Evalyn N.; Alp, Hande; Weiss, Kevin B.

doi:10.1097/00063198-199901000-00005

Cited by 35 publications

(14 citation statements)

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“…[7][8][9][10][11][12][13] This study showed an association between asthma symptoms and behavioral comorbidity, and a large proportion of children with persistent symptoms experienced behavioral problems across several domains. The combined burden of asthma, behavioral difficulties, and poverty likely has an impact on the quality of life of these children and families.…”

Section: Discussionmentioning

confidence: 65%

“…[4][5][6] In the United States, impoverished children and children from minority ethnic and racial backgrounds suffer disproportionately from asthma. [7][8][9][10][11][12][13] The morbidity associated with asthma is extensive and includes emergency department visits, 6,14,15 hospitalizations, 4,5,16 and cost, 17,18 as well as less traditional factors, including impaired quality of life 19 and absenteeism. 20 In addition, co-existing medical conditions [21][22][23] as well as psychiatric conditions 24,25 now are considered issues that both children and adults with asthma face.…”

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confidence: 99%

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Behavior Problems Among Inner-City Children With Asthma: Findings From a Community-Based Sample

et al. 2006

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OBJECTIVE. Previous studies have suggested a relationship between childhood asthma and behavior problems. However, few studies have used community-based samples to assess the prevalence of behavior problems among urban children with asthma symptoms. The objective of this study was to evaluate the relationship between asthma symptoms and behavior among a population-based sample of inner-city children and to determine the prevalence of behavioral comorbidity among children with asthma symptoms.METHODS. In 2003, parents of children who were entering kindergarten in the city of Rochester completed a detailed survey regarding the child's background, medical history (with specific questions about asthma symptoms), and behavior. We compared children with no asthma symptoms, intermittent symptoms, and persistent symptoms with regard to positive peer social skills (eg, makes friends easily), negative peer social skills (eg, fights with other children), task orientation (eg, concentrates well), and shy/anxious behavior (eg, is withdrawn) (validated scales; range: 1-4). We used multivariate regression to determine the independent association between symptom severity and behavioral outcomes. RESULTS.A total of 1619 children were included (response rate: 80%; mean age: 5.1 year), and 15% had asthma symptoms (8% persistent, 7% intermittent). Average negative peer scores were worse for children with persistent asthma symptoms compared with children with intermittent and no symptoms (mean scores: 1.88, 1.70, and 1.65). Children with persistent symptoms also scored worse than children with no symptoms on the assessment of task orientation (2.85 vs 3.03) and shy/anxious behavior (2.11 vs 1.89). Among children with persistent asthma symptoms, Ͼ20% scored Ͼ1 SD below average on 2 or more scales, compared with 16% of children with intermittent symptoms and 10% with no symptoms.CONCLUSIONS. Urban children with persistent asthma symptoms demonstrate more behavior problems across several domains compared with children with no symptoms. These findings suggest a clear need for an early biopsychosocial approach to care for vulnerable children with asthma. A STHMA IS THE most common chronic illness of childhood, 1-3 and hospitalization rates are increasing. [4][5][6] In the United States, impoverished children and children from minority ethnic and racial backgrounds suffer disproportionately from asthma. [7][8][9][10][11][12][13] The morbidity associated with asthma is extensive and includes emergency department visits, 6,14,15 hospitalizations, 4,5,16 and cost, 17,18 as well as less traditional factors, including impaired quality of life 19 and absenteeism. 20 In addition, co-existing medical conditions [21][22][23] as well as psychiatric conditions 24,25 now are considered issues that both children and adults with asthma face.Several studies have documented the relationship between asthma and psychosocial problems, with the suggestion that significant comorbidity exists for some children. A recent meta-analysis 26 demonstrated...

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Section: Discussionmentioning

confidence: 65%

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confidence: 99%

Behavior Problems Among Inner-City Children With Asthma: Findings From a Community-Based Sample

et al. 2006

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“…24 Asthma in inner-city and rural populations is often regarded differently based on the fact that the underlying etiologies and environmental exposures may vary to some degree. 25,26 However, both populations face similar challenges in terms of multiple barriers to adequate health care including poverty, underinsurance, and less access to health care providers. In this study, we found relatively few significant differences across the 3 sites; children treated at the urban site showed evidence of greater health care utilization, including higher rates of hospitalizations and ED visits in the last year, as well as more frequent regular asthma appointments with their regular asthma care provider.…”

Section: Discussionmentioning

confidence: 99%

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

et al. 2006

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OBJECTIVES. Asthma is one of the more common reasons for children's visits to the emergency departments (EDs). Many studies show that the level of asthma care and self-management in children before an ED visit for asthma is often inadequate; however, most of these studies have been conducted in the inner cities of large urban areas. Our objectives were to describe asthma care and management in children treated for asthma in 3 EDs located in an urban, suburban, or rural setting.METHODS. We studied a prospective patient cohort consisting of children aged 2 to 17 years who presented with an acute asthma exacerbation at 3 EDs in western Michigan. An in-person questionnaire was administered to the parent or guardian during the ED visit. Information was collected on demographics; asthma history; usual asthma care; frequency of symptoms during the last 4 weeks; current asthma treatment, management, and control; and past emergency asthma care. A telephone interview conducted 2 weeks after the ED visit obtained follow-up information. The 8 quality indicators of asthma care and management were defined based on recommendations from national guidelines.RESULTS. Of 197 children, 70% were enrolled at the urban site, 18% at the suburban site, and 12% at the rural site. The average age was 7.9 years; 60% were male, and 33% were black. At presentation, nearly half (46%) of the children had mild intermittent asthma, 20% had mild persistent asthma, 15% had moderate persistent asthma, and 19% had severe persistent asthma. One quarter of the children had been hospitalized for asthma, and two thirds had at least 1 previous ED visit in the past year. At least 94% had health insurance coverage and 95% reported having a primary care provider.Less than half of the children had attended at least 2 scheduled asthma appointments with their regular asthma care provider in the past year. Although only 5% of the subjects reported that the ED was their only source of asthma care, at least 30% reported that they always went directly to the ED when they needed urgent asthma care. Only 3 in 5 children possessed either a spacer or a peak-flow meter, whereas ϳ2 in 5 reported having a written asthma action plan. Among those with persistent asthma, there was considerable evidence of undertreatment, with 36% not on either an inhaled corticosteroid or a suitable long-term control medication. Only 20% completed a visit with their regular asthma care provider within 1 week of their ED visit. Despite very high levels of health care coverage and access to primary care, the overall quality of asthma care and management fell well short of that recommended by national guidelines.A STHMA IS ONE of the more common reasons for children's visits to emergency departments (EDs). 1-3 National health surveys and utilization rates of hospital services for asthma treatment indicate that the burden of asthma in US children has increased dramatically in the past 2 decades. 4,5 The number of ED visits for asthma in children Յ14 years of age increased ϳ14% in the Un...

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“…Emergency department visits and hospitalisation for asthma seem to be related to several psychosocial factors, such as lower socioeconomic status [2], inaccessibility of medical care [2] and co-existing psychiatric diseases [3]. In addition, patient characteristics that are associated with severe life-threatening asthma attacks include female sex, older age, smoking and noncompliance with recommended therapy [4][5][6][7].…”

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confidence: 99%

Risk factors of frequent exacerbations in difficult-to-treat asthma

Brinke

Sterk²,

Masclee³

et al. 2005

Eur Respir J

431

304

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Recurrent exacerbations are a major cause of morbidity and medical expenditure in patients with asthma. Various exogenous and endogenous factors are thought to influence the level of asthma control, but systematical data on the involvement of these factors in the recurrence of asthma exacerbations are scarce.In this study, 13 clinical and environmental factors potentially associated with recurrent exacerbations were investigated in 136 patients with difficult-to-treat asthma. Patients with more than three severe exacerbations (n539) in the previous year were compared with those with only one exacerbation per year (n524). A systematic diagnostic protocol was used to assess 13 potential risk factors.Factors significantly associated with frequent exacerbations included: severe nasal sinus disease (adjusted odds ratio (OR) 3.7); gastro-oesophageal reflux (OR 4.9); recurrent respiratory infections (OR 6.9); psychological dysfunctioning (OR 10.8); and obstructive sleep apnoea (OR 3.4). Severe chronic sinus disease and psychological dysfunctioning were the only independently associated factors (adjusted OR 5.5 and 11.7, respectively). All patients with frequent exacerbations exhibited at least one of these five factors, whilst 52% showed three or more factors.In conclusion, the results show that recurrent exacerbations in asthma are associated with specific co-morbid factors that are easy to detect and that are treatable. Therapeutic interventions aimed at correcting these factors are likely to reduce morbidity and medical expenditure in these patients.

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The challenge of inner-city asthma

Cited by 35 publications

References 55 publications

Behavior Problems Among Inner-City Children With Asthma: Findings From a Community-Based Sample

Behavior Problems Among Inner-City Children With Asthma: Findings From a Community-Based Sample

Asthma Care and Management Before an Emergency Department Visit in Children in Western Michigan: How Well Does Care Adhere to Guidelines?

Risk factors of frequent exacerbations in difficult-to-treat asthma

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