Factors related to undiagnosed asthma in a sample of inner-city school children

Objectives: To determine the prevalence and severity of undiagnosed asthma in a sample of urban school children and identify potential risk factors associated with undiagnosed asthma.

Methods: 803 students were screened in twelve private New Orleans elementary, middle and high schools in the fall of 2004 using the International Study of Asthma and Allergies in Childhood questionnaire (ISAAC). Undiagnosed was defined either of three ways: (1) Both wheezing and night cough during the previous year without a diagnosis of asthma (PYw/o Asthma) or (2) wheezing only during the previous year without asthma or (3) night cough only during the previous year with Asthma . Supplementary questions included school-lunch status, missed school days, asthma medication, breastfed or not, emergency/hospital visits, maternal asthma, health insurance, smoking in household, number of inhabitants and rooms in the home, and with whom the child resides. Preliminary data analysis was performed using SPSS.

Results: The demographics were as follows: African American (85.9%), female (63.3%), Medicaid (52.1%), school free lunch (59.9%). Using the Chi-square test, we compared healthy students with undiagnosed students (undiagnosed as defined in 1); the latter were more likely to: be younger, be on free lunch, miss school, utilize the ER, live in a smoking household, and have an asthmatic mother. Predicting undiagnosed asthma (undiagnosed as defined in 1), all the variables above were significant predictors in a logistic regression. When undiagnosed (defined as in 3), all the variables above were significant predictors also. However, when undiagnosed was re-defined only through the presence of wheezing (undiagnosed as defined in 2), days absent from school was the only significant predictor.

Conclusion. Undiagnosed asthma was associated with lower SES (as measured by free lunch), increased ER visits and days missed from school, and family history of asthma. Night cough was a major characteristic of undiagnosed.