Grant E N, Daugherty S R, Moy J N, Nelson S G, Piorkowski J M, Weiss K B
Department of Immunology/Microbiology, Rush Medical College, Chicago, Illinois, USA.
Ann Allergy Asthma Immunol. 1999 Aug;83(2):113-20. doi: 10.1016/S1081-1206(10)62621-X.
Asthma mortality rates in poor communities of Chicago are among the highest in the country. Possible explanations include increased asthma prevalence, increased severity, and suboptimal health care.
To estimate the prevalence of asthma and asthma-related symptoms among inner-city kindergarten children, and to characterize their burden of illness, asthma-related health care access, and pharmacologic treatment.
Cross-sectional survey of parents of kindergartners was conducted in 11 randomly selected Chicago elementary schools. A self-administered 16-item questionnaire was given to parents of kindergartners. Parents who reported doctor-diagnosed asthma or at least one of several key asthma-related symptoms were then interviewed with a supplemental questionnaire examining asthma-related health care and medication use.
Based on data from 638 children [mean age 5.7 (SD = 0.6) years], the prevalence of diagnosed asthma was 10.8%. Sixteen percent of the respondents reported that their child had wheezed in the past year. The prevalence of asthma-related symptoms unassociated with a diagnosis of asthma was 30.1%. The children with diagnosed asthma had evidence of a high burden of illness: over 40% were reported to have had sleep disturbance due to wheezing > or =1 to 2 nights/week and 86.6% reported acute care visits for respiratory symptoms in the past year. Self-reported access to medical care was high. Over 40% of the children with doctor diagnosed asthma were reported to have used a beta2-agonist in the preceding 2 weeks, and 12.2% used an inhaled anti-inflammatory.
These data suggest that asthma prevalence in school-aged children in inner-city communities may be higher than US estimates. The burden of illness experienced by these children is substantial. Also, a large proportion of children were reported to have respiratory symptoms consistent with asthma, and no asthma diagnosis, suggesting possible undiagnosed asthma. While measures of health care access appear to indicate that the majority of children with asthma experience no identified barriers to health care, there is evidence to suggest undertreatment.
芝加哥贫困社区的哮喘死亡率在全国居高不下。可能的解释包括哮喘患病率上升、病情加重以及医疗保健欠佳。
评估市中心幼儿园儿童哮喘及哮喘相关症状的患病率，并描述其疾病负担、哮喘相关医疗保健的可及性以及药物治疗情况。
在芝加哥随机选取的11所小学对幼儿园儿童家长进行横断面调查。向幼儿园儿童家长发放一份16项的自填式问卷。对于报告孩子经医生诊断为哮喘或有至少一种关键哮喘相关症状的家长，再用一份补充问卷进行访谈，调查哮喘相关医疗保健及药物使用情况。
基于638名儿童的数据[平均年龄5.7（标准差 = 0.6）岁]，确诊哮喘的患病率为10.8%。16%的受访者报告其孩子在过去一年有喘息症状。与哮喘诊断无关的哮喘相关症状的患病率为30.1%。确诊哮喘的儿童有疾病负担较重的证据：据报告，超过40%的儿童因喘息每周至少有1至2晚出现睡眠障碍，86.6%的儿童在过去一年因呼吸道症状进行过急诊就诊。自我报告的医疗保健可及性较高。据报告，超过40%经医生诊断为哮喘的儿童在之前2周内使用过β2受体激动剂，12.2%使用过吸入性抗炎药。
这些数据表明，市中心社区学龄儿童的哮喘患病率可能高于美国的估计值。这些儿童所经历的疾病负担很重。此外，据报告有很大比例的儿童有与哮喘相符的呼吸道症状但未被诊断为哮喘，这表明可能存在未被诊断的哮喘。虽然医疗保健可及性指标似乎表明大多数哮喘儿童未发现医疗保健障碍，但有证据表明存在治疗不足的情况。
