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High Rate of Uncontrolled Asthma Among Inner-City Schoolchildren from Pittsburgh Region
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Erica Butler, BS,CCRC, Nicole Pleskovic, BS, Jennifer Paden Elliott, PharmD, Paige E. Dewhirst, MPH, Tricia Morphew, MSc, David P. Skoner, MD, Deborah A. Gentile, MD
Rationale: Pediatric asthma is a public health concern in the inner-city of Pittsburgh. Uncontrolled disease impacts upon school attendance/performance, physical activity and socialization.  The purpose of this study was to determine the rate of disease control among school children with documented asthma.    

Methods: This study was approved by the Allegheny Singer Research Institute-Allegheny Health Network Institutional Review Board. Informed consent/assent was obtained from all subjects prior to participation.  Fifth grade students with asthma were enrolled from twelve Pittsburgh schools.  Parents were surveyed using an abbreviated, validated survey to assess asthma control.  Relationships between potential contributing  factors, including poverty (public health insurance), outdoor air pollution (black carbon),  tobacco smoke exposure (salivary cotinine), psychological stress (salivary cortisol), and obesity (BMI) were explored using logistic regression analyses.    

Results: 108 subjects were enrolled (41.7% African American, 49.1% female,  50.5% public insurance).  Results demonstrated that  45.4%  had uncontrolled asthma .  Black carbon exposure was the only unadjusted factor that influenced odds of uncontrolled disease (OR=4.9 first vs third quartile; p<0.05). Adjusted analysis showed that risk of uncontrolled asthma was higher in those with public vs private insurance and no tobacco smoke exposure (OR=5.9; p<0.050), and overweight females vs males (OR= 21.1; p< 0.05). 

Conclusions: Results indicate a high rate of uncontrolled asthma among school children from the inner-city of Pittsburgh.   Identified contributors to uncontrolled disease include outdoor air pollution, public health insurance in those not exposed to tobacco smoke and overweight/obesity in females.   Future studies need to focus on improving asthma outcomes in at-risk populations.