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Significant exposure to tobacco smoke and underuse of controller medications exacerbate asthma symptoms among Head Start children

Preschool-aged children, particularly those who are poor and disadvantaged, are driving the rising rates of asthma-related emergency department (ED) visits and hospitalizations. A recent study of children in an Arkansas Head Start program for disadvantaged preschoolers identified the factors that led to uncontrolled asthma in this population.

The researchers found that four out of five children suffered from persistent asthma, but only one-third of the children received appropriate medication to control it. Many of the children were also exposed to asthma triggers such as cigarette smoke. Exposure to cigarette smoke was reported by 52 percent of the families. Cotinine/creatinine ratios exceeded 20 ng/mg in 27 percent of the sample. This high-risk group could benefit from an asthma case management program, suggest Perla A. Vargas, Ph.D., and her colleagues at the University of Arkansas for Medical Sciences and Arkansas Children's Hospital.

For the study, which was supported by AHRQ (HS11062), the researchers recruited caregivers of 368 children aged 3 to 5 years with asthma who were enrolled in a local Head Start program. They collected data on demographics, health care use and access, medication use, asthma symptoms, and exposure to asthma triggers. Most families were black and impoverished. Because of the Head Start program support services for parents, most children were enrolled in the Medicaid program, which allowed them to complete well-child visits and immunizations and obtain medications.

Overall, the children had poor asthma control. Nearly two-thirds (64 percent) of the children had more than one ED visit for asthma in their lifetime, and nearly one-third (31 percent) had more than one ED visit in the preceding 6 months. Caretakers reported smoking in 37 percent of households. Nearly 4 out of 5 children (79 percent) reported symptoms consistent with persistent asthma.

Seventy-one percent of the children had positive results to skin-prick tests for more than one allergen, and 42 percent had positive reactions for more than three allergens. Only 32 percent of children with persistent asthma were receiving appropriate treatment, that is, had both rescue and controller medications (antiinflammatory medications used to prevent asthma or worsening of asthma).

Details are in "Characteristics of children with asthma who are enrolled in a Head Start program," by Dr. Vargas, Pippa M. Simpson, Ph.D., J. Gary Wheeler, M.D., and others, in the September 2004 Journal of Allergy and Clinical Immunology 114, pp. 499-504.

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