Asthma: Out of control in inner-city schools, especially among African Americans

A high prevalence of asthma among urban school children is widely recognized, but the observation that most of these children do not have their asthma under control is a disappointment. That finding, from a survey of 5,417 children in the Little Rock, Ark., school system who have a diagnosis of asthma, probably typifies the plight of urban school children in other parts of the country.

Defining "asthma control" as no symptoms and no use of rescue medication in the four weeks preceding the survey, researchers found that 85% of the Little Rock children surveyed were not in control of their illness. The prevalence of active symptoms was extremely high among urban, minority children. African-American race, Medicaid enrollment, and male gender were independent predictors of asthma risk. Approximately half the children with active symptoms had been treated at an emergency room at least twice in the previous two years and reported that asthma limited their activities. Almost one third reported nighttime symptoms once or more a week, and 17% said they had missed five or more days of school during the year because of their asthma (Ann Allergy Asthma Immunol 2006;96:787).

The Inner-City Asthma Intervention (ICAI), a four-year project at 25 health-care institutions around the country that is funded by the CDC, may be a way in to improving the prospects for these children. The purpose of ICAI? To determine whether an asthma education model developed by the National Cooperative Inner-City Asthma Study-a model that has proved effective in grant-funded clinical trials-could be successfully transferred to a community setting.