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Asthma in American Indian Adults^*

The Strong Heart Study

^* From the University of Vermont College of Medicine (Dr. Dixon), Burlington, VT; Center for American Indian Health Research (Dr. Yeh), College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Strong Heart Study (Dr. Welty), Missouri Breaks Research, Timber Lake, SD; College of Public Health (Dr. Rhoades), University of Oklahoma, Oklahoma City, OK; Center for American Indian Health Research (Dr. Lee), College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK; MedStar Research Institute (Dr. Howard), Hyattsville, MD; and University of Arizona (Dr. Enright), Tuscon, AZ.

Correspondence to: Anne E. Dixon, MD, University of Vermont College of Medicine, Patrick 204, 111 Colchester Ave, Burlington, VT 05401; e-mail: anne.dixon{at}vtmednet.org

Abstract

Background: Despite growing recognition that asthma is an important cause of morbidity among American Indians, there has been no systematic study of this disease in older adults who are likely to be at high risk of complications related to asthma. Characterization of the impact of asthma among American Indian adults is necessary in order to design appropriate clinical and preventive measures.

Methods: A sample of participants in the third examination of the Strong Heart Study, a multicenter, population-based, prospective study of cardiovascular disease in American Indians, completed a standardized respiratory questionnaire, performed spirometry, and underwent allergen skin testing. Participants were 50 years old.

Results: Of 3,197 participants in the third examination, 6.3% had physician-diagnosed asthma and 4.3% had probable asthma. Women had a higher prevalence of physician-diagnosed asthma than men (8.2% vs 3.2%). Of the 435 participants reported in the asthma substudy, morbidity related to asthma was high: among those with physician-diagnosed asthma: 97% reported trouble breathing and 52% had severe persistent disease. The mean FEV₁ in those with physician-diagnosed asthma was 61.3% of predicted, and 67.2% reported a history of emergency department visits and/or hospitalizations in the last year, yet only 3% were receiving regular inhaled corticosteroids.

Conclusions: The prevalence of asthma among older American Indians residing in three separate geographic areas of the United States was similar to rates in other ethnic groups. Asthma was associated with low lung function, significant morbidity and health-care utilization, yet medications for pulmonary disease were underutilized by this population.

Key Words: American Indian • Arizona • asthma • epidemiology • Native American • North Dakota • Oklahoma • South Dakota • spirometry