Elevated Asthma Morbidity In Puerto Rican Children: Clinical and Public Health Implications

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Basic research questions regarding the relative contributions, possible interactions, and mutability of the multiple risk factors discussed above undoubtedly remain unanswered. Regardless of the cause of asthma, however, a gap exists between the current capacity to treat the condition and the availability of medical therapies in real world settings, particularly among under-served populations. Clinicians and public health officials can take steps to reduce this avoidable gap in the morbidity of asthma between Latino and non-Latino children.
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The individual clinician can be aware of the increased morbidity among Puerto Rican children and of the environmental risk factors associated with increased morbidity in both these and other children. He or she can make a special effort to keep up-to-date on high quality asthma medical management. The clinician can take additional steps when treating high-risk patients, such as monitoring changes in clinical status, modifying medical therapy more frequently, and facilitating the elimination of detrimental home exposures.

Public health programs for asthma prevention and control are essential given the magnitude of the problem, particularly among Puerto Rican children. Table 3 lists a range of possible primary, secondary, and tertiary prevention strategies.

TABLE 3.—Possible Childhood Asthma Prevention Strategies
Strategy	Primary	Secondary	Tertiary
Health care
Screen for children at risk for asthma	x	x
Provide early treatment
For children at risk		x
For children diagnosed with asthma			x
Improve continuous access to quality care
Provide medications and equipment		x	x
Asthma education		x	x
Mental health services for high-risk families	x	x	x
Physical environment
Reduce early life home exposures for children at risk	x	x
Eliminate current home exposures		x	x
Reduce outdoor exposures	x	x	x
Social environment
Provide financial and other support to high-risk families	x	x	x

Multiple sources of evidence, based primarily on studies of non-Latino children, indicate that morbidity from asthma in children that already have the condition can be reduced through tertiary prevention. Home environments can be modified to reduce or eliminate ongoing detrimental physical exposures, such as tobacco smoke, cockroaches, and mites. The health care available to all children with asthma can be improved to include appropriate medical evaluation and drug therapy by a regular provider. The child and his or her family can be educated, so that they can better manage the child’s asthma care. The personal health system, the public health system, and community-based organizations, such as schools and churches, can establish partnerships for care to support the families of children with asthma. In addition, some evidence suggests that promoting protective social factors, such as close-knit family structures, and ameliorating social risk factors, for instance, by treating psychiatric comorbidities, can also decrease childhood asthma morbidity. buy generic Tramadol

Secondary prevention strategies refer to the early detection and treatment of possible asthma among children who have a genetic predisposition or early signs of the illness. Such strategies would include implementing public health programs geared toward identifying genetic predisposition to asthma early in life, providing early preventive medication therapies, and eliminating or diminishing such exposures in the physical environment as second-hand smoke and cockroaches and such exposures in the social environment as parental mental health problems.

Primary strategies for the prevention of asthma among children are speculative, given the current state of the art. These strategies include screening for genetic predisposition, based on ethnicity or other genetic markers that have yet to be determined, and avoidance of conditions conducive to asthma. For example, preliminary research suggests that eliminating detrimental home exposures and providing mental health and other supportive services to high-risk families can prevent children with a predisposition to asthma from developing early signs of the illness.
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Population-based approaches need not only to address risk and prognostic factors, but be cost-effective and feasible as well. Current evidence suggests that health care and non-health-care factors are important and need to be addressed for effective disease control. Thus, we need to develop and evaluate public health interventions that go beyond the activities solely under the control of the traditional health care system. It appears that collaborative efforts with schools, environmental and housing agencies, and other community-based organizations are necessary to the support of families in the management of a given child’s illness and the elimination of physical environmental exposures conducive to the development of asthma.

Policymakers and analysts evaluating these kinds of programs are also concerned with the equity and efficiency of effective programs. They are interested in evaluating the equity of programs that decrease morbidity across the whole population by ameliorating the disproportionate presence of mutable risk factors in high morbidity populations. Because they have limited resources to meet this goal, however, they are also interested in efficient programs that intervene in areas where the greatest reduction in morbidity is gained at the lowest possible cost.

Summary
The elevated morbidity of asthma among Puerto Rican children has important implications for clinical research and public policy. The clinician taking care of patients needs to be aware of differences in morbidity and take additional steps to optimize medical management for all children, but especially for those in high-risk families. The research community can use asthma in this population as a model to study asthma risk and prognostic factors, as well as the probable interaction of genetic and environmental influences. From a public policy perspective, population-based prevention and treatment programs, together with surveillance systems to track differences in morbidity, are necessary. canadian Celebrex

Asthma is the most common chronic illness affecting children. It affects Latino children differentially and is amenable to medical and environmental intervention. Latino children with asthma serve as a good example of how ethnic-specific differences in risk and prognostic factors can generate substantial differences in the patterns of disease observed between populations. The issues outlined in this paper are not particular to Latinos or to children with asthma and can be applied to any ethnic group with a distinct genetic, geographic, and cultural identity. Lessons learned from this kind of research can help us frame similar questions regarding the physical, mental, and functional health of other Latino and non-Latino children with chronic illnesses. Research and policies related to the health of ethnically diverse populations should be based on robust models that account for the effect of the sociocultural milieu on health.