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Asthma is a chronic inflammatory disorder of the airways characterized by increased airways hyperresponsiveness and mucus production. Its symptoms of cough, wheeze, shortness of breath, and chest tightness are associated with variable airflow limitation that is at least partly reversible. Asthma is estimated by the World Health Organization to affect 150 million people worldwide,1 and its global pharmacotherapeutic costs exceed $5 billion per year. In children, where asthma remains the leading cause of emergency care and hospitalization, rates continue to rise. The National Asthma Education and Prevention Program recently issued its third Expert Panel Report outlining guidelines for the diagnosis and management of asthma. The importance of inflammation in the pathogenesis of asthma remains recognized and highlighted. The heterogeneity of asthma is also a key feature of the report. The Panel emphasizes the importance of individualizing treatment for patients because of the heterogeneous nature of the disease.


Asthma is one of the leading chronic childhood diseases in the United States and a major cause of childhood disability.1 From 1980 to 1996, asthma prevalence among children 0 to 17 years of age more than doubled, from 3.6% in 1980 to 7.5% at the peak of the trend in 1995. Although the prevalence rate has leveled off since 1995, prevalence remains at high levels, and in 2005, 12.7% of children had been diagnosed with asthma at some point in their lifetime (9 million children), of whom 70% were reported to currently have asthma (6.5 million). Nearly two thirds of these children who currently have asthma reported at least 1 attack in the previous 12 months, highlighting the problem of poorly controlled asthma in the childhood age group. Despite increased overall health care utilization and that there are means to prevent attacks or exacerbations, the majority of children with asthma still suffer from attacks. Furthermore, the burden of avoidable emergency department visits and hospitalizations for asthma is high and has remained resistant to intervention efforts.


Racial Disparities


Racial disparities in childhood asthma are extensive.2 Children of American Indian or Alaska Native descent have current asthma prevalence rates 25% higher, and black children 60% higher, than those in white children. African Americans are 4 times more likely to be hospitalized and 5 times more likely to die of asthma than non–African Americans. When race and ethnicity are considered, Puerto Rican children have the highest prevalence of all groups, 140% higher than non-Hispanic white children. In light of these differing prevalence rates, the lower rate for ambulatory care visits among black children compared with white children suggests that black children may be underutilizing ambulatory care. Rates in adverse outcomes such as emergency department visits, hospitalizations, and death are substantially higher for black children. The disparity in asthma mortality between black and white children has increased in recent years. The relative importance of urban residence, low socioeconomic status, and minority (particularly black and Hispanic) status as independent risk factors for ...

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