title: Exercise-induced wheeze, urgent medical visits, and neighborhood asthma prevalence.
abstract: OBJECTIVE
  Exercise-induced wheeze (EIW) may identify a distinct population among asthmatics and give insight into asthma morbidity etiology. The prevalence of pediatric asthma and associated urgent medical visits varies greatly by neighborhood in New York City and is highest in low-income neighborhoods. Although increased asthma severity might contribute to the disparities in urgent medical visits, when controlling for health insurance coverage, we previously observed no differences in clinical measures of severity between asthmatic children living in neighborhoods with lower (3%-9%) versus higher (11%-19%) asthma prevalence. Among these asthmatics, we hypothesized that EIW would be associated with urgent medical visits and a child's neighborhood asthma prevalence.
  
  
  METHODS
  Families of 7- to 8-year-old children were recruited into a case-control study of asthma through an employer-based health insurance provider. Among the asthmatics (n = 195), prevalence ratios (PRs) for EIW were estimated. Final models included children with valid measures of lung function, seroatopy, and waist circumference (n = 140).
  
  
  RESULTS
  EIW was associated with urgent medical visits for asthma (PR, 2.29; P = .021), independent of frequent wheeze symptoms. In contrast to frequent wheeze, EIW was not associated with seroatopy or exhaled NO, suggesting a distinct mechanism. EIW prevalence among asthmatics increased with increasing neighborhood asthma prevalence (PR, 1.09; P = .012), after adjustment for race, ethnicity, maternal asthma, environmental tobacco smoke, household income, and neighborhood income.
  
  
  CONCLUSIONS
  EIW may contribute to the disparities in urgent medical visits for asthma between high- and low-income neighborhoods. Physicians caring for asthmatics should consider EIW an indicator of risk for urgent medical visits.
authors.affiliation: Division of Pulmonary, Allergy, Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Mainardi
authors.forename: Robert B
authors.initials: RB
authors.lastname: Mellins
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Miller
authors.forename: Luis M
authors.initials: LM
authors.lastname: Acosta
authors.forename: Alexandra
authors.initials: A
authors.lastname: Cornell
authors.forename: Lori
authors.initials: L
authors.lastname: Hoepner
authors.forename: James W
authors.initials: JW
authors.lastname: Quinn
authors.forename: Beizhan
authors.initials: B
authors.lastname: Yan
authors.forename: Steven N
authors.initials: SN
authors.lastname: Chillrud
authors.forename: Omar E
authors.initials: OE
authors.lastname: Olmedo
authors.forename: Frederica P
authors.initials: FP
authors.lastname: Perera
authors.forename: Inge F
authors.initials: IF
authors.lastname: Goldstein
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Rundle
authors.forename: Judith S
authors.initials: JS
authors.lastname: Jacobson
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Perzanowski
mesh_terms: D000553:Ambulatory Care / Q000379:methods; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D001250:Asthma, Exercise-Induced / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D016022:Case-Control Studies; D002648:Child; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D012111:Residence Characteristics; D012135:Respiratory Sounds / Q000175:diagnosis* / Q000502:physiology