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Prevalence of Asthma and Chronic Respiratory Symptoms Among Alaska Native Children^*

^* From the Department of Pediatrics (Dr. Lewis), University of Michigan School of Medicine, Ann Arbor, MI; the Department of Pediatrics (Drs. Stout and Redding, and Ms. Morray and Ms. White), School of Medicine, and the Department of Epidemiology (Dr. Heckbert), School of Public Health, University of Washington, Seattle, WA; and Executive Administration (Dr. Martinez), Alaska Native Medical Center, Anchorage, AK.

Correspondence to: Toby C. Lewis, MD, MPH, University of Michigan Pediatric Pulmonology, L2221 Women’s Hospital, Box 0212, 1500 East Medical Center Dr, Ann Arbor, MI 48109-0212; e-mail: TOBYL{at}umich.edu

Study objectives: To quantify the prevalence and impact of chronic respiratory symptoms among predominantly Alaska Native (AN)/American Indian (AI) middle school students.

Design: School-based prevalence assessment using the International Study of Asthma and Allergy in Children survey, with supplemental video material and added questions about productive cough, exposure to tobacco smoke, and the functional impact of symptoms.

Setting: The Yukon-Kuskokwim delta region of western Alaska.

Participants: A total of 466 children in the sixth to ninth grades, 81% of whom are AN/AI (377 children).

Interventions: No study intervention.

Results: Among the 377 AN/AI children, 40% reported one of the following three categories of chronic respiratory disease: physician-diagnosed asthma, 7.4%; asthma-like symptoms (ALS) without an asthma diagnosis, 11.4%; and chronic productive cough (CPC) without asthma diagnosis or symptoms, 21.5%. Symptom prevalence differed substantially between the largest town in the region and rural villages. After an adjustment for demographic factors, exposure to environmental tobacco smoke, active tobacco smoking, and self-report of atopy, village residents were 63% less likely to have ALS (p = 0.009), and had a twofold greater risk of CPC (p < 0.001) compared to children living in the town. Children with respiratory symptoms experienced sleep disturbances and accessed clinic visits for respiratory problems more often than did asymptomatic children.

Conclusions: Chronic respiratory symptoms are very common among AN children. CPC is an important nonasthmatic respiratory condition in this population. The differing patterns of respiratory illness within this region may help to elucidate the specific risk factors for asthma and chronic bronchitis in children.

Key Words: adolescence • asthma epidemiology • child • Eskimos • North American Indian