Search tips
Search criteria 


Logo of bmjThe BMJ
BMJ. 1996 July 20; 313(7050): 148–152.
PMCID: PMC2351536

Influence of ethnic group on asthma treatment in children in 1990-1: national cross sectional study.


OBJECTIVE--To examine the extent to which the prescription of drugs for asthma adhered to recommended guidelines in 1990-1 and to assess the influence of ethnic group on prescription. DESIGN--Cross sectional. SETTING--Primary schools in England and Scotland in 1990-1. SUBJECTS--Children aged mainly 5-11 years. The representative samples included 10628 children. The inner city sample included 7049 children, 4866 (69%) from ethnic minority groups. For the prevalence estimation 14490 children were included in the analysis (82% of the eligible children). For the treatment analysis a subgroup of 5494 children with respiratory symptoms was selected. MAIN OUTCOME MEASURES--Prevalence of respiratory symptoms and drugs commonly prescribed for asthma, method of administration, inappropriate treatment, and odds ratios to assess the effect of ethnic group on rate of prescription and method of administration. RESULTS--Children with respiratory symptoms in the inner city sample were less likely to be diagnosed as having asthma. Of children with reported asthma attacks, those in inner city areas had a higher risk of not having been prescribed any drug for asthma (odds ratio 1.87 (95% confidence interval 1.26 to 2.77). Overall, 773 (75%) of these children had received a beta 2 agonist, 259 (25%) had received steroids, 148 (14%) had received sodium cromoglycate, and 194 (19%) had received no drug treatment in the previous year. When prescribed, beta 2 agonists were inhaled in 534 (69%) of cases, and this percentage was even lower in ethnic minority groups. Children of Afro-Caribbean and Indian subcontinent origin who had asthma were less likely to receive beta 2 agonists, and those from the Indian subcontinent were less likely to receive anti-inflammatory drugs. Antibiotics were less prescribed and antitussives more prescribed in children from ethnic minority groups than in white children. CONCLUSION--In 1990-1 the risk of underdiagnosis and undertreatment of asthma was higher in children from ethnic minority groups. The implementation of indicators and targets to monitor inequalities in the treatment of asthma in ethnic groups could improve equity and effectiveness in the NHS.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.0M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Speight AN, Lee DA, Hey EN. Underdiagnosis and undertreatment of asthma in childhood. Br Med J (Clin Res Ed) 1983 Apr 16;286(6373):1253–1256. [PMC free article] [PubMed]
  • Hill RA, Standen PJ, Tattersfield AE. Asthma, wheezing, and school absence in primary schools. Arch Dis Child. 1989 Feb;64(2):246–251. [PMC free article] [PubMed]
  • Warner JO, Götz M, Landau LI, Levison H, Milner AD, Pedersen S, Silverman M. Management of asthma: a consensus statement. Arch Dis Child. 1989 Jul;64(7):1065–1079. [PMC free article] [PubMed]
  • Bauman A, Young L, Peat JK, Hunt J, Larkin P. Asthma under-recognition and under-treatment in an Australian community. Aust N Z J Med. 1992 Feb;22(1):36–40. [PubMed]
  • Anderson HR. Increase in hospital admissions for childhood asthma: trends in referral, severity, and readmissions from 1970 to 1985 in a health region of the United Kingdom. Thorax. 1989 Aug;44(8):614–619. [PMC free article] [PubMed]
  • Vollmer WM, Osborne ML, Buist AS. Temporal trends in hospital-based episodes of asthma care in a health maintenance organization. Am Rev Respir Dis. 1993 Feb;147(2):347–353. [PubMed]
  • Gergen PJ, Weiss KB. Changing patterns of asthma hospitalization among children: 1979 to 1987. JAMA. 1990 Oct 3;264(13):1688–1692. [PubMed]
  • Mitchell EA. International trends in hospital admission rates for asthma. Arch Dis Child. 1985 Apr;60(4):376–378. [PMC free article] [PubMed]
  • Kun HY, Oates RK, Mellis CM. Hospital admissions and attendances for asthma--a true increase? Med J Aust. 1993 Sep 6;159(5):312–313. [PubMed]
  • Phin S, Oates RK. Variations in the treatment of childhood asthma. Med J Aust. 1993 Nov 15;159(10):662–666. [PubMed]
  • Mitchell EA. Racial inequalities in childhood asthma. Soc Sci Med. 1991;32(7):831–836. [PubMed]
  • Garrett JE, Mulder J, Wong-Toi H. Reasons for racial differences in A & E attendance rates for asthma. N Z Med J. 1989 Mar 22;102(864):121–124. [PubMed]
  • Warner JO. Review of prescribed treatment for children with asthma in 1990. BMJ. 1995 Sep 9;311(7006):663–666. [PMC free article] [PubMed]
  • Rona RJ, Altman DG. National study of health and growth: standards of attained height, weight and triceps skinfold in English children 5 to 11 years old. Ann Hum Biol. 1977 Nov;4(6):501–523. [PubMed]
  • Rona RJ, Chinn S. National Study of Health and Growth: social and biological factors associated with height of children from ethnic groups living in England. Ann Hum Biol. 1986 Sep-Oct;13(5):453–471. [PubMed]
  • Hill RA, Standen PJ, Tattersfield AE. Asthma, wheezing, and school absence in primary schools. Arch Dis Child. 1989 Feb;64(2):246–251. [PMC free article] [PubMed]
  • Strachan DP, Anderson HR, Limb ES, O'Neill A, Wells N. A national survey of asthma prevalence, severity, and treatment in Great Britain. Arch Dis Child. 1994 Mar;70(3):174–178. [PMC free article] [PubMed]
  • Peat JK, Salome CM, Sedgwick CS, Kerrebijn J, Woolcock AJ. A prospective study of bronchial hyperresponsiveness and respiratory symptoms in a population of Australian schoolchildren. Clin Exp Allergy. 1989 May;19(3):299–306. [PubMed]
  • Bosco LA, Gerstman BB, Tomita DK. Variations in the use of medication for the treatment of childhood asthma in the Michigan Medicaid population, 1980 to 1986. Chest. 1993 Dec;104(6):1727–1732. [PubMed]
  • Carr W, Zeitel L, Weiss K. Variations in asthma hospitalizations and deaths in New York City. Am J Public Health. 1992 Jan;82(1):59–65. [PubMed]
  • Wissow LS, Gittelsohn AM, Szklo M, Starfield B, Mussman M. Poverty, race, and hospitalization for childhood asthma. Am J Public Health. 1988 Jul;78(7):777–782. [PubMed]
  • Balarajan R, Yuen P, Soni Raleigh V. Ethnic differences in general practitioner consultations. BMJ. 1989 Oct 14;299(6705):958–960. [PMC free article] [PubMed]
  • Wilson SR. Patient and physician behavior models related to asthma care. Med Care. 1993 Mar;31(3 Suppl):MS49–MS60. [PubMed]
  • Gill PS, Johnson M. Ethnic monitoring and equity. BMJ. 1995 Apr 8;310(6984):890–890. [PMC free article] [PubMed]
  • Burney PG. Strategy for asthma. BMJ. 1991 Sep 7;303(6802):571–573. [PMC free article] [PubMed]

Articles from The BMJ are provided here courtesy of BMJ Publishing Group