A current picture of asthma diagnosis, severity, and control in a low-income minority preteen population.
BACKGROUND
Asthma severity, control, type of medical regimen provided, and compliance with it are not well understood in minority patients at the transition stage from childhood to adolescence.


OBJECTIVE
Describe the level of asthma severity and control and the clinical regimens provided to a large population of low-income, African American children at this developmentally significant period.


METHODS
Parents of 1292 children with asthma among 6827 preteens in 19 middle schools in predominantly African American (94%), low-income neighborhoods in Detroit, Michigan, were enrolled in the study. Data were collected through self-administered survey and telephone interviews and were useable for 936 participants. Study queries related to demographics, asthma symptoms, and medication use. Mixed effects models with a random intercept for school were used to determine severity and control and the association of medical regimens to these.


RESULTS
Sixty-seven percent of children with probable asthma had received a physician's diagnosis. Being female was associated with being undiagnosed (p = .02). Forty-seven with no diagnosis had persistent asthma and 10% of these were classified as severe. Sixty-eight percent with a diagnosis and asthma medicine prescriptions were not controlled. Compliant use of controller medicine was associated with poorer asthma control compared to noncompliant controller users (p = .04) and reliever-only users (p < .001). Thirty-nine percent of children had controller medicine; of those 40% were not compliant with controller use; 9% nebulized their controller medicine.


CONCLUSIONS
Care provided low-income minority children at an important stage in their development was not consistent with guidelines for asthma control. Therapy choices for treatment did not account for the actual level of their symptoms. Lack of an asthma diagnosis was significant in the population. Adolescent girls were at risk for not receiving a diagnosis. Patient compliance with asthma regimens was limited. Both clinician and patient education regarding effective asthma management appears needed regarding preteens in low-income minority communities.
Clark
Noreen M
NM
Center for Managing Chronic Disease, University of Michigan, Ann Arbor, Michigan, USA. nmclark@umich.edu
Dodge
Julia A
JA
Shah
Smita
S
Thomas
Lara J
LJ
Andridge
Rebecca R
RR
Awad
Daniel
D
D001741:Black or African American; D000367:Age Factors; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D017028:Caregivers / Q000191:economics / Q000193:education; D002648:Child; D005260:Female; D006306:Health Surveys; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007407:Interviews as Topic; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008913:Minority Groups / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
D018927:Anti-Asthmatic Agents