CHARACTERISTICS OF INNER-CITY CHILDREN WITH ASTHMA - THE NATIONAL COOPERATIVE INNER-CITY ASTHMA STUDY

Asthma morbidity has increased dramatically in the past decade, especi ally among poor and minority children in the inner cities. The Nationa l Cooperative inner-City Asthma Study (NCICAS) is a multicenter study designed to determine factors that contribute to asthma morbidity in c hildren in the inner cities. A total of 1,528 children with asthma, ag es 4 to 9 years old, were enrolled in a broad-based epidemiologic inve stigation of factors which were thought to be related to asthma morbid ity. Baseline assessment included morbidity, allergy evaluation, adher ence and access to care, home visits, and pulmonary function. interval assessments were conducted at 3, 6, and 9 months after the baseline e valuations. Over the one-year period, 83% of the children had no hospi talizations and 3.6% had two or more. The children averaged 3 to 3.5 d ays of wheeze for each of the four two-week recall periods. The patter n of skin test sensitivity differed from other populations in that pos itive reactions to cockroach were higher (35%) and positive reactions to house dust mite were lower (31%). Caretakers reported smoking in 39 % of households of children with asthma, and cotinine/ creatinine rati os exceeded 30 ng/mg in 48% of the sample. High exposure (>40 ppb) to nitrogen dioxide was found in 24% of homes. Although the majority of c hildren had insurance coverage, 53% of study participants found it dif ficult to get follow-up asthma care. The data demonstrate that symptom s are frequent but do not result in hospitalization in the majority of children. These data indicate a number of areas which are potential c ontributors to the asthma morbidity in this population, such as enviro nmental factors, lack of access to care, and adherence to treatment. I nterventions to reduce asthma morbidity are more likely to be successf ul ii they address the many different asthma risks found in the inner cities. (C) 1997 Wiley-Liss, Inc.