Asthma is one of the most common chronic diseases of childhood, and the prevalence, morbidity and mortality due to asthma is greater in blacks than in Caucasians. The goal of this two-phase study is to find and correct factors which increase asthma severity in urban black children. Phase I studies will test the hypothesis that urban black children have greater morbidity due to asthma because of both intrinsic host factors and environmental risks. Subjects will be black asthmatic children recruited from both emergency rooms and office/clinic visits; subjects will be stratified according to gender and socioeconomic status. Using symptoms scores, school absences, emergency visits, and hospitalizations as measures of asthma severity, the relative contributions of host factors (in utero smoke exposure, prematurity, birth asphyxia) and environmental factors (passive/active smoking, poor access to/utilization of health care, socioeconomic status, indoor pollutants, atopy, psychosocial stressors) to asthma severity will be measured. Subjects (and parents) win be interviewed, and spirometry, salivary cotinine, and complete blood cell counts measured. Also, the pattern of health care utilization and features of the prescribed care plan will be examined for factors associated with disease severity. Phase II will incorporate data obtained from Phase I and will investigate reduction in asthma morbidity following provision of a comprehensive asthma management plan. Asthma severity will be measured (by pulmonary function, number of ER visits, hospitalizations and days missed from school) following institution of a standardized treatment plan, including anti-inflammatory and bronchodilating inhaled medications, 24 hour telephone access to medical advice, instruction in simple principles of -self-management, and visitation by a home health facilitator, who will reinforce need for compliance and provide other support. Phase II subjects will be urban, black asthmatic children who-present frequently for emergency treatment of asthma and are not currently cared for by a subspecialist. Children with other than mild disease are targeted for study as they are at greater risk for asthma morbidity and mortality.
