ASTHMA
January 16, 2000

Asthma in the Inner City: An Unnecessary Epidemic?

Asthma is under-diagnosed among urban, middle school children and may require rethinking our social priorities.

The prevalence of asthma in the inner city is growing rapidly and may, in fact, be even higher than previously thought, according to new studies. What's even more alarming is that the rising epidemic is happening despite the development of a wide range of newer and better treatments.

‘[A]t least part of the answer may be in rethinking our social priorities.’

What is going on here?

The studies — one from New York and the other from Philadelphia — suggest that part of the answer lies in the fact that many victims, particularly the young, simply do not realize they have this very treatable disease.

To put the problem in a national context, there are about 5,000 asthma−related deaths in the United States each year. The disease affects approximately 15 million people in the United States, five million of whom are children. Nationally, it is estimated that more than seven percent of all American children now have the disease.

In the New York study, however, researchers reported that as much as 18.5 percent of students at one public middle school (i.e., between the ages 11 and 15) had been diagnosed with asthma. And many of those without a diagnosis showed asthma−like symptoms, including wheezing, chest tightness, shortness of breath, and severe coughing. Both groups missed significant amounts of school because of their symptoms, although absenteeism was a much bigger problem among the diagnosed group.

The New York researchers concluded that asthma among middle school children may be substantially higher than in the nation as a whole and expressed concern about the level of under−diagnosed asthma.

The Philadelphia study looked at the asthma problem from the perspective of school absenteeism. It screened children in the 5th and 6th grades with 25 or more absences in the previous school year for asthma. Speaking on behalf of his Philadelphia−based coinvestigators, Uzma Rana, M.P.H., School of Public Health, Hahnemann University, said that the study found "significantly higher asthma prevalence among high−absentee school children, about half of whom were not aware of having the disease. The high prevalence coupled with the unawareness," he said, "suggests the need for mandatory screening of this treatable condition."

Asked to comment on these studies, TheDoctor's Neil Schachter, M.D., Hexter Professor of Medicine, Professor of Community Medicine at the Mount Sinai School of Medicine, and Associate Director of the Pulmonary Division, agrees that there is something wrong with the ability of our health system to deliver asthma treatment, especially in urban areas. "It is ironic," he says, "that while our understanding of this disease and its mechanisms has progressed immensely, and the number of therapeutic options have multiplied, asthma continues to spread and become more virulent." Both studies were presented in October at CHEST 2000, the annual meeting of the American College of Chest Physicians.

As for what we can do about it, Dr. Schachter says that "The association of asthma prevalence and severity with poverty and minorities suggests that at least part of the answer may be in rethinking our social priorities. Education (particularly of young persons with the disease), public health interventions (e.g., immunizations against influenza), and new approaches to treatment that address the problem of compliance with treatment are promising initiatives that are now being explored."


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