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ASTHMA IN AMERICAN INDIAN ADULTS: THE STRONG HEART STUDY

¹Anne E. Dixon, M.D., University of Vermont College of Medicine, Patrick 204, 111 Colchester Avenue, Burlington, VT 05401, Phone: 802 656 8812, Fax: 802 847 4187, email: anne.dixon@vtmednet.org ²Fawn Yeh, MPH, PhD, Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma City, OK 73190, 405 271-3090 Fax -4390, Email: fawn-yeh@ouhsc.edu ³Thomas K Welty, MD, MPH, Strong Heart Study, Missouri Breaks Research, Inc., HCR64, Box52, Timber Lake, SD 57656, 928 562-0955, Email: twelty@earthlink.net ⁴Everett R. Rhoades, MD, University of Oklahoma, College of Public Health, PO Box 26901, Oklahoma City, OK 73190, 405 848-2508, Email: Everett-rhoades@ouhsc.edu ⁵Elisa T. Lee, PhD, Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, P. O. Box 26901, Oklahoma City, OK 73190, Elisa-Lee@ouhsc.edu ⁶Barbara V. Howard, PhD, MedStar Research Institute, 6495 New Hampshire Avenue, Suite 201, Hyattsville, MD 20783, Barbara.V.Howard@MedStar.net ⁷Paul L. Enright, M.D., The University of Arizona, 4460 East Ina Road, Tuscon, AZ 85718, 520 577-8254 FAX 5778284, Email: lungguy@aol.com

anne.dixon{at}vtmednet.org

Abstract

BackgroundDespite 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.

MethodsA sample of participants in the third examination of the Strong Heart Study, a multi-center, population-based, prospective study of cardiovascular disease in American Indians, completed a standardized respiratory questionnaire, performed spirometry and had allergen skin testing. Participants were age 50 and older.

ResultsOf 3197 participants in the third examination, 6.3 % had physician-diagnosed and 4.3% probable asthma. Women had a higher prevalence of physician-diagnosed asthma than men 8.2 versus 3.2%. Of the 435 participants reported in the asthma sub-study, 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, 67.2% reported a history of emergency department visits and/or hospitalizations in the last year, yet only 3% were taking regular inhaled corticosteroids.

ConclusionsThe prevalence of asthma among older American Indians residing in three separate geographic areas of the US 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: Spirometry • Epidemiology • Asthma • American Indian • Native American • Oklahoma • Arizona • North Dakota • South Dakota