Differences in asthma prevalence between samples of American Indian and Alaska Native children.

OBJECTIVES: To better understand the prevalence of asthma among American Indian and Alaska Native (AI/AN) children and to explore the contribution of locale to asthma symptoms and diagnostic assignment, the authors surveyed AI/AN middle school students, comparing responses from metropolitan Tacoma, Washington (metro WA) and a non-metropolitan area of Alaska (non-metro AK). METHODS: Students in grades 6-9 completed an asthma screening survey. The authors compared self-reported rates of asthma symptoms, asthma diagnoses, and health care utilization for 147 children ages 11-16 self-reporting as AI/AN in metro WA and 365 in non-metro AK. RESULTS: The prevalences of self-reported asthma symptoms were similar for the metro WA and non-metro AK populations, but a significantly higher percentage of metro WA than of non-metro AK respondents reported having received a physician diagnosis of asthma (OR 2.33; 95% CI 1.23, 4.39). The percentages of respondents who reported having visited a medical provider for asthma-like symptoms in the previous year did not differ. CONCLUSIONS: The difference in rates of asthma diagnosis despite similar rates of asthma symptoms and respiratory-related medical visits may reflect differences in respiratory disease patterns, diagnostic labeling practices, or environmental factors. Future attempts to describe asthma prevalence should consider the potential contribution of non-biologic factors such as diagnostic practices.

Passive smoke exposure impairs recovery after hospitalization for acute asthma.

OBJECTIVE: To determine if children with chronic asthma hospitalized for an acute exacerbation experienced prolonged clinical recovery after hospital discharge if they returned to a home environment in which they were exposed to environmental tobacco smoke. DESIGN: A prospective longitudinal study. SETTING: Children's Hospital and Medical Center, Seattle, Wash. PATIENTS: Patients admitted to the emergency department of the Children's Hospital and Medical Center with the single diagnosis of asthma (International Classification of Diseases, Ninth Revision [ICD-9] code 493). RESULTS: Twenty-two children with acute asthma were sequentially enrolled in the study and longitudinally observed between February and -June 1994. The tobacco-smoking group (n = 11) was defined as having at least 1 smoker in the home. The nonsmoking group (n = 11) had no environmental tobacco smoke exposure at home. The 2 groups were similar in age, sex, preadmission chronic asthma severity, and immediate predischarge asthma status. Discharge medication use was similar in the 2 groups During a 1 month follow-up period, the tobacco-smoking group had a significantly greater number of symptomatic days than the nonsmoking group (P < .05) Of the children in the nonsmoking group, 9 (82%) had less than 1 symptomatic day per week compared with 3 (27%) in the tobacco-smoking group. beta 2-Agonist bronchodilator use declined significantly (P < .001) during follow-up in the nonsmoking group but not in the tobacco-smoking group, despite similar anti-inflammatory drug therapy in both groups. CONCLUSIONS: Recovery by children after hospitalization for acute asthma is impaired by environmental tobacco smoke exposure when the period of recovery is characterized by persistent respiratory symptoms and use of asthma medication for symptomatic relief. These findings underscore the need to limit environmental tobacco smoke exposure in children with asthma and argue for closer physician follow-up of those children returning to a home environment in which smokers are present.

The lottery of life: should organ transplants be used to even the odds?

Life is not always fair and the advantages of health and well-being are not equally distributed. Unfortunately, children can be the innocent victim of their families' misfortune. In the realm of health care, should a child be denied a specific medical treatment because his or her parents are not capable of providing the care necessary to promote a successful outcome of that treatment? How should we as health care professionals make those difficult choices? The following case and the ethical analysis describes a scenario where there was disagreement if a child's family situation should be considered in the decision to list the child for a liver transplant.