Studies Assess Asthma Prevalence and Disparities

There are significant racial and socioeconomic disparities to consider when assessing adolescent asthma outcomes, especially since approximately 50% of adolescents with asthma-like symptoms go undiagnosed. Two recent studies, presented at the American Thoracic Society 2018 International Conference, investigated the disparities of adolescent asthma through diagnosis and improving care.

One study¹ used data from a cross-sectional survey of 33,982 high school students from 49 schools that served predominately low-income, Hispanic, or African American students, in order to assess the individual and neighborhood-level factors that are associated with being undiagnosed.

The students involved in the study participated in a case detection survey where they:

1. Reported symptoms using a validated measure to determine if they had probable asthma
2. Indicated if they were ever diagnosed with asthma by a medical provider
3. Provided demographic data (date of birth, sex, race/ethnicity)

Of those with probable asthma, 65% reported never being diagnosed. Additionally, being female and Asian American were associated with increased odds of being undiagnosed compared with males and whites, respectively. Those who identified as black, Hispanic, or other/mixed race/ethnicity were associated with lower odds of being undiagnosed.

“A large proportion of symptomatic, urban, low-income adolescents are undiagnosed, and thus untreated and at risk for asthma-related morbidity and mortality,” concluded the study. “Given the asthma burden, it is critical to connect adolescents vulnerable to being undiagnosed to appropriate care for a clinical evaluation, diagnosis, and treatment.”

Another study² evaluated asthma evidence-based interventions (EBI) that are typically implemented in either the home, school, or primary care setting.

“The West Philadelphia Asthma Care Collaborative’s objective is to design and implement a comprehensive plan, which integrates EBIs and connects the healthcare, community, home, and school sectors in a low-income inner-city community,” the authors wrote.

The study incorporated focus groups of parents, children, school nurses, and clinicians in order to establish the disparities in care and opportunities. A secondary analysis of hospitalizations, emergency visits, and licensing/inspection violations was also completed and using the results, a prospective randomized control trial was designed.

The trial that the researchers designed would include community health workers (CHWs) to provide education, care coordination and home visits for the primary care intervention. In the school intervention, CHWs would coordinate school obtainment of all asthma medications, devices and forms, conduct Open Airway classes, conduct classroom environmental assessments, and assist nurses with School Based Asthma Therapy. The researchers will then compare the asthma control results among 4 different study conditions.

“Strategically located CHWs who provide connections between the home, school, and primary care practice may reduce the burden on caregivers and facilitate asthma management for school-aged children,” concluded the study. “Further, CHWs, as community residents, are knowledgeable about community resources and can help parents make needed connections.”

References

1. Bruzzese J, Kingston S, Bruzelius E, Poghosyan L. Individual and neighborhood factors associated with undiagnosed asthma in a large cohort of urban adolescents. Presented at the American Thoracic Society 2018 International Conference. May 20, 2018; San Diego, California. Abstract A1077/405.

2. Bryant-Stephens T, Kenyon C, Localio R, et al. Reducing asthma disparities by connecting treatment across the sectors where children live, learn, play and pray. Presented at the American Thoracic Society 2018 International Conference. May 20, 2018; San Diego, California. Abstract A1078/406.