Why Asthma Isn’t Diagnosed as Often in Children Who Live in Cities

Asthma is one of the most common chronic conditions pediatricians treat. But thousands of urban teens may be falling through the cracks and are simply not getting a diagnosis. And who those teens are might just surprise you.
That’s according to a new study published this month in the Journal of Urban Health.
Researchers surveyed more than 10,000 New York City high schoolers between 2008 and 2012. The students either had symptoms consistent with asthma or had already received an asthma diagnosis.
“I think one of the most striking results is the prevalence of undiagnosed asthma, which was 20 percent, twice that of the diagnosed rates,” Jean-Marie Bruzzese, PhD, told Healthline. She’s an associate professor of applied developmental psychology at the Columbia University School of Nursing as well as the study’s co-lead author and principal investigator.
Researchers also found that adolescent females were more likely to have undiagnosed asthma than adolescent males.
Compared to white non-Hispanic teenagers, African-Americans and Latinos were less likely to have undiagnosed asthma.
And Asian-Americans, who are traditionally not at high risk for asthma, were at a higher risk of not getting a diagnosis.
“It wasn’t a finding that we expected,” Sharon Kingston, PhD, an associate professor of psychology at Dickinson College in Pennsylvania and the study’s other co-lead author, told Healthline.
“We hypothesized that African-Americans and Latinos were more likely to be undiagnosed than other groups,” Kingston said.
One explanation that could account for that unexpected racial disparity?
Healthcare providers may have screened African-American and Latino teens more rigorously because of the known racial disparities in asthma in those groups.
When it comes to sex differences, the researchers say there are some things we already know.
“In childhood, there seems to be a higher prevalence of asthma in boys, and this reverses itself in adolescence,” Bruzzese said. “Adolescent-onset asthma is greater in females.”
“Teenage girls may not consider their symptoms are asthma because they have this belief that asthma is a childhood disease,” she added.Have medical questions? Connect with a board-certified, experienced doctor online or by phone. Pediatricians and other specialists available 24/7.
Getting the word out
Both the researchers and asthma advocacy groups agree it’s important to educate teens and their caregivers about the signs and symptoms of asthma.
“We tell them if you are short of breath, have a cough that lasts longer than seven days, please speak up. That’s a major red flag, it could be asthma,” Tonya Winders, president and CEO of the Allergy & Asthma Network, told Healthline.
One education project her nonprofit patient education and advocacy group helped launch is the Coach’s Asthma Clipboard Program.
“We go into schools and train school nurses, athletic trainers, and coaches on recognizing the signs and symptoms of asthma,” Winders said.She says they also find that teens and their parents will sometimes use an online search engine to look up information about asthma symptoms. When they land on her group’s website, they find educational video content and will soon find a teen blogger who lives with asthma.“I want to use myself as a platform to reach teens,” Regan Lloyd, the 14-year-old author of the blog Adventures with Asthma, told Healthline.
The avid swimmer, diver, and cheerleader says she hopes to inspire other teens to learn more and get treatment.
“I don’t let asthma get in my way,” Lloyd said. “I want to change the perception.”