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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.
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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.
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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 ...