ABSTRACT
Recent advances in the understanding of asthma include an appreciation for the significant role of airway inflammation in the pathogenesis of asthma, a new emphasis on preventive treatment, and a focus on establishing risk factors for the development of asthma as well as on identifying appropriate prevention programs ( 1 ). However, improvements in patient outcomes have lagged behind. Mortality has increased in recent decades, and recent research has focused on the causes and on interventions to address this problem. Low income is a significant predictor of bed days and missed schooldays, and there is a significantly higher prevalence of asthma among children living in households below poverty level than among those in higher-income households (2). In the United States, the burden of asthma morbidity and mortality is higher among minorities and people of low income (3). Based on reported symptoms in the 1988 National Health Interview Survey, Taylor and Newacheck (2) estimated that 10% of the children had severe asthma, 32% had moderate asthma, and 59% had mild asthma. Asthma, particularly when defined as moderately severe to severe, has a major impact on child and family adaptation, school functioning, and health care economics (1).
