INFLUENCE OF ETHNIC-GROUP ON ASTHMA-TREATMENT IN CHILDREN IN 1990-1 -NATIONAL CROSS-SECTIONAL STUDY

Objective-To examine the extent to which the prescription of drugs for asthma adhered to recommended guidelines in 1990-1 and to assess the influence of ethnic group on prescription. Design-Cross sectional. Set ting-Primary schools in England and Scotland in 1990-1. Subjects-Child ren aged mainly 5-11 years. The representative samples included 10 628 children. The inner city sample included 7049 children, 4866 (69%) fr om ethnic minority groups. For the prevalence estimation 14 490 childr en were included in the analysis (82% of the eligible children). For t he treatment analysis a subgroup of 5494 children with respiratory sym ptoms was selected. Main outcome measures-Prevalence of respiratory sy mptoms and drugs commonly prescribed for asthma, method of administrat ion, inappropriate treatment, and odds ratios to assess the effect of ethnic group on rate of prescription and method of administration. Res ults-Children with respiratory symptoms in the inner city sample were less likely to be diagnosed as having asthma. Of children with reporte d asthma attacks, those in inner city areas had a higher risk of not h aving been prescribed any drug for asthma (odds ratio 1.87 (95% confid ence interval 1.26 to 2.77). Overall, 773 (75%) of these children had received a beta(2) agonist, 259 (25%) had received steroids, 148 (14%) had received sodium cromoglycate, and 194 (19%) had received no drug treatment in the previous year. When prescribed, beta(2) agonists were inhaled in 534 (69%) of cases, and this percentage was even lower in ethnic minority groups. Children of Afro-Caribbean and Indian subconti nent origin who had asthma were less likely to receive beta(2) agonist s, and those from the Indian subcontinent were less likely to receive anti-inflammatory drugs. Antibiotics were less prescribed and antituss ives more prescribed in children from ethnic minority groups than in w hite children. Conclusion-In 1990-1 the risk of underdiagnosis and und ertreatment of asthma was higher in children from ethnic minority grou ps. The implementation of indicators and targets to monitor inequaliti es in the treatment of asthma in ethnic groups could improve equity an d effectiveness in the NHS.