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ICD Code: 493. Asthma

ICD Code: 493. Article Review
Title: Grant EN et al; "Prevalence and Burden of Illness for Asthma and Related Symptoms Among Kindergartners in Chicago Public Schools." Annals of Allergy, Asthma, and Immunology; V.83; 8/99; p113
      PEDIATRIC PREVALENCE: Estimates of the prevalence of current childhood asthma in the U.S. range from 4.3% to 6.7%, with evidence to suggest recent increases. In children aged 5 years and under, little epidemiologic data exists describing the prevalence and natural history of asthma and associated symptoms. While wheezing is the most common symptom of asthma, a large prospective study demonstrated that most wheezing during the first 3 years of life is transient and resolves by age 6.
      STUDY DESIGN: The authors conducted a cross-sectional survey of parents of kindergarten children to estimate the prevalence of diagnosed asthma and asthma symptoms, and to obtain information about burden of illness, access to health care and pharmacotherapeutic treatment in a high risk population of young, inner-city children. The Chicago Public School (CPS) System serves 302,000 grammar-school children and is composed of 489 grammar schools. About 80% of the children are low-income. 54.7% are African American, 30.6% Hispanic, and 11.3% Caucasian. This study was conducted in CPS Region III, which spans the central portion of the city. Many of the communities in this region have been shown to have extremely high asthma mortality rates.
      Children were included if they completed kindergarten in June 1996 and a parent or guardian was present at the school at the time of data collection. The study was conducted in mid-June 1996, on the day of kindergarten "graduation," when the majority of parents are present to attend promotion activities. Parents were given a 16-item self-administered respiratory symptoms questionnaire. Children were considered to have "diagnosed asthma" if the respondent answered "yes" to the question, "Has a doctor ever said or diagnosed this child as having asthma?"
      PREVALENCE AND SYMPTOMS: Doctor-diagnosed asthma was reported by the respondent in 10.8% of the sample, and 11.5% responded "yes" to the question, "In the past year, has your child had what you thought was asthma?" 16% of the respondents reported that their child had wheezed in the past year, 12.3% had exercise-induced wheezing, and 34% reported a dry cough at night, the most commonly reported symptom.
      The data help confirm the work of other researchers who studied children ages 0 through 17 living in the Bronx, New York and found the prevalence of asthma to be 14.3% and the prevalence of active asthma (within the last 12 months) to be 8.6%. Direct comparison of these studies is limited by the fact that different surveying methods were used and children of different age groups were studied.
      HEALTH CARE UTILIZATION: Of the respondents who reported children with diagnosed asthma, 95.9% reported having a "regular doctor," with a slightly lower percentage (89.4%) who could actually name the doctor, and 85.4% reported that the child sees the same doctor when sick and when well.
      MEDICATION USE: Beta-2-agonist was the most commonly used medication class, with use in the previous 2 weeks reported for 42.9% of the children with asthma. The majority of the beta-2-agonist use was inhaled. Inhaled anti-inflammatory medication use was reported for 12.2% of the children, all of whom also were reported to have received a beta-2-agonist. No children were reported having used an inhaled anti-inflammatory alone. For children with asthma-related symptoms only, over-the-counter cough and cold medications were the most commonly used class of medication.
      UNDIAGNOSED ASTHMA: Only a few studies have examined the prevalence of undiagnosed asthma in U.S. inner-city areas. One group studied African American grammar school children in Detroit, grades 3 through 5, and found that 14.3% had possible undiagnosed asthma based on either symptoms or bronchial hyperresponsiveness. A study of Hispanic 9- to 12-year-olds in San Diego estimated the prevalence of respiratory symptoms indicating possible asthma to be 13.5%. The Bronx study cited above described wheezing without an asthma diagnosis in 4.2% of the children aged 0 to 17.

Search Criteria: Text - Annals of Allergy, Asthma, and Immunology; V.83; 8/99; p113