Inner-City Asthma

The Epidemiology of an Emerging US Public Health Concern

¹ The Departments of Health Care Science and Medicine, George Washington University Medical Center and Center for Health Policy Research, George Washington University, Washington, D.C.
² The Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda
³ The Department of Pediatrics, Albert Einstein College of Medicine, Division of General Pediatrics (Emergency Medicine), Bronx Municipal Hospital Center

We have presented some findings from the epidemiologic literature that document an emerging problem of excess asthma morbidity within inner-city populations. In doing so, areas for further investigation present themselves. Future research must attempt to provide causal links between risk factors that are associated with poverty and living in the inner city and asthma morbidity. Special attention must be paid to factors that both account for a considerable proportion of the morbidity and are susceptible to intervention. Although several educational intervention programs have demonstrated success in this high risk population, the success has been limited and requires a relatively substantial investment of resources.

In addition to educational efforts, new clinical interventions will have to be explored and developed, based on our knowledge of how to intercede early in this chronic illness in order to begin to prevent asthma morbidity. Also, it seems clear that future efforts should examine the relative effectiveness of community- and health-system-based interventions. The new efforts undertaken by both the National Cooperative Inner-City Asthma Study of the National Institute of Allergy and Infectious Disease, and the Control of Asthma among black and Hispanic Children Program initiated by the National Heart, Lung, and Blood Institute are solid first steps to developing the much needed programs to improve this emerging public health problem.