School-based identification of asthma in a low-income population

The increase in the prevalence, morbidity, and mortality of asthma among ch ildren over the last decade has been well documented, especially among low- income minority children. Hypotheses for the increases in morbidity and mor tality include limited access to primary care services and the failure to r ecognize the presence and severity of asthma. The University of Miami Pedia tric Mobile Clinic (Mobile Clinic) Asthma Intervention Program is designed to identify underserved asthmatic children at school and offer them cultura lly sensitive care. Nine elementary schools with low income, predominantly Hispanic and African-American populations regularly served by the Mobile Cl inic, were chosen for study participation. All 5,800 students who were enro lled in kindergarten through third grade were given letters at the time of registration by their homeroom teachers about the asthma program. Caretaker s who returned the questionnaire and reported that the student had asthma s ymptoms were invited to have the student undergo a medical evaluation in th e Mobile Clinic. Over a 2-year period, caretakers of 423 students (7.3% of all students) exp ressed an interest in further evaluating their child's respiratory health. Of these, we enrolled and evaluated 154 in the Mobile Clinic's Asthma inter vention Program. The Mobile Clinic physicians identified 145 of the enrolle es as having asthma. These results indicate that in elementary schools serving predominantly low -income minority populations, a large fraction of the asthmatic population (estimated prevalence, 6-10%) can be identified by a school-based letter. F urther, in a subset of asthmatic students (children of interested caretaker s), there is good agreement between caretaker responses and physician diagn osis of asthma. Since school attendance is mandatory, school-based methods may be an effective method for identifying low-income children with asthma. Pediatr Pulmonol, 2000; 30:297-301, (C) 2000 Wiley-Liss, Inc.