Underdiagnosed and uncontrolled asthma: Findings in rural schoolchildren from the Delta region of Arkansas

Background: Studies of asthma in school-aged rural children in the United States are limited, and there are no studies of high-risk pediatric populations in rural environments. Objectives: To examine the prevalence of asthma and to evaluate markers of morbidity in 2 rural school districts in the Arkansas Delta region. Methods: Children at risk for asthma were identified by using a cross-sectional asthma case-finding survey. Surveys were distributed to students enrolled in the Marvell and Eudora school districts during the 2005-2006 school year. Results: The response rate was 81% (964 of 1,190). The mean age of the 964 children who completed the survey was 10.3 years (age range, 4-17 years); 85% were African American, and 78% had state-issued insurance. Twenty-eight percent (268 of 964) of the children were categorized as being at risk for asthma by previous physician diagnosis (33%), algorithm diagnosis (16%), or both (51%). Of the 268 at-risk children, 79% reported persistent symptoms and 21% reported intermittent or no current symptoms. In the previous 4 weeks, 59% of the children experienced daytime and nocturnal symptoms and 62% used rescue medications. Activity limitation and treatment in the emergency department or hospitalization for asthma in the previous 2 years were reported by 82% and 49% of the children, respectively. Conclusions: Active asthma symptoms are prevalent in this predominantly minority, low-income, rural population. High rates of undiagnosed and uncontrolled asthma are suggested by frequent asthma symptoms, activity limitation, rescue medication use, and emergency health care utilization. Future studies of pediatric asthma should focus on high-risk populations in rural locales.