Prevalence and burden of illness for asthma and related symptoms among kindergartners in Chicago public schools

Background: Asthma mortality rates in poor communities of Chicago are among the highest in the country. Possible explanations include increased asthma prevalence, increased severity, and suboptimal health care. Objective: To estimate the prevalence of asthma and asthma-related symptoms among inner-dry kindergarten children, and to characterize their burden of illness, asthma-related health care access, and pharmacologic treatment. Methods: Cross-sectional survey of parents of kindergartners was conducted in 11 randomly selected Chicago elementary schools. A self-administered 16- item questionnaire was given to parents of kindergartners. Parents who repo rted doctor-diagnosed asthma or at least one of several key asthma-related symptoms were then interviewed with a supplemental questionnaire examining asthma-related health care and medication use. Results: Based on data from 638 children [mean age 5.7 (SD = 0.6) years], t he prevalence of diagnosed asthma was 10.8%, Sixteen percent of the respond ents reported that their child had wheezed in the past year. The prevalence of asthma related symptoms unassociated with a diagnosis of asthma was 30. 1%. The children with diagnosed asthma had evidence of a high burden of ill ness: over 40% were reported to have had sleep disturbance due to wheezing greater than or equal to 1 to 2 nights/week and 86.6% reported acute care v isits for respiratory symptoms in the past year. Self-reported access to me dical care was high. Over 40% of the children with doctor diagnosed asthma were reported to have used a beta(2)-agonist in the preceding 2 weeks, and 12.2% used an inhaled anti-inflammatory. Conclusions: These data suggest that asthma prevalence in school-aged child ren in inner-city communities may be higher than US estimates. The burden o f illness experienced by these children is substantial. Also, a large propo rtion of children were reported to have respiratory symptoms consistent wit h asthma, and no asthma diagnosis, suggesting possible undiagnosed asthma. While measures of health care access appear to indicate that the majority o f children with asthma experience no identified barriers to health care, th ere is evidence to suggest undertreatment.