Ecology and Asthma

  • Barbara P. YawnEmail author


Ecology is the study of patterns of relationships between organisms and their environment (Green et al. 2001). When applied to asthma, investigators have taken several different approaches to the “environment,” usually by studying the effect of the environment on the “organism” defined as people with asthma (Harper 2004; Hart and Whitehead 1990; Stoloff 2000; Lanphear et al. 2001; Gold and Wright 2005; Bousquet et al. 2005; Milton et al. 2004; Parkes et al. 2003; Redd 2002). The exact approach depends on the expertise of the investigator from anthropologist to health services researcher to atmospheric scientist. In each case, the environment is seen through the lenses of the specific scientific discipline. In this regard, few authors have viewed the ‘asthma environment’ through the lens of the patient or family dealing with asthma. Such a view requires knowledge of the social ecology of asthma that has been addressed most commonly in children with asthma as the nested arrangement of family, school, neighborhood, and community (Earls and Carlson 2001; Klinnert et al. 2002). In this chapter, the work published under the key terms of asthma and ecology will be reviewed and when possible integrated into a holistic approach. The perspective of the person (organism) with asthma will be emphasized. It is the patient centered ecology of asthma that becomes pertinent, and highly relevant to the people who live with work with and suffer from asthma (Fig. 5.1).


Health Literacy Health Care Professional Asthma Symptom Medical Expenditure Panel Survey Social Ecology 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Adams RJ, Weiss ST, Fuhlbrigge A (2003) How and by whom care is delivered influences anti-inflammatory use in asthma: results of a national population survey. J Allergy Clin Immunol 112(2):445–450PubMedCrossRefGoogle Scholar
  2. Adams RJ, Wilson DH, Taylor AW, Daly A, Tursan d’Espaignet E, Dal Grande E, Ruffin RE (2004) Psychological factors and asthma quality of life: A population based study. Thorax 59(11):930–935PubMedCrossRefGoogle Scholar
  3. American Lung Association (2005) Epidemiology and statistics unit, best practice and program services. Trends in Asthma Morbidity and Mortality.
  4. Anonymous (2000) Atopic factors in upper respiratory disease: Diagnosing and managing nasal symptoms. Sponsored by Annenberg Center for Health Sciences at EisenhowerGoogle Scholar
  5. Apter AJ (2003) Clinical advances in adult asthma. J Allergy Clin Immunol 111(Suppl 3):S780–S784CrossRefGoogle Scholar
  6. Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K (1996) Use and effectiveness of interpreters in an emergency department. JAMA 275(10):783–788PubMedCrossRefGoogle Scholar
  7. Bearison DJ, Minian N, Granowetter L (2002) Medical management of asthma and folk medicine in a Hispanic community. J Pediatr Psychol 27(4):385–392PubMedCrossRefGoogle Scholar
  8. Becker MH, Radius SM, Rosenstock IM (1978) Compliance with a medical regimen for asthma: a test of the health belief model. Public Health Rep 93:268–277PubMedGoogle Scholar
  9. Bender BG (2006) Risk taking, depression, adherence, and symptoms control in adolescents and young adults with asthma. Am J Respir Crit Care Med 173(9):953–957PubMedCrossRefGoogle Scholar
  10. Bender BG, Bender SE (2005) Patient-identified barriers to asthma treatment adherence: Responses to interviews, focus groups, and questionnaires. Immunol Allergy Clin North Am 25(1):107–130PubMedCrossRefGoogle Scholar
  11. Bender B, Milgrom H, Rand C, Ackerson L (1998) Psychological factors associated with medication nonadherence in asthmatic children. J Asthma 35(4):347–353PubMedCrossRefGoogle Scholar
  12. Bender B, Milgrom H, Apter A (2003) Adherence intervention research: what have we learned and what do we do next? J Allergy Clin Immunol 112(3):489–494PubMedCrossRefGoogle Scholar
  13. Bousquet J, Bousquet PJ, Godard P, Daures JP (2005) The public health implications of asthma. Bull World Health Organ 83(7):548–554PubMedGoogle Scholar
  14. Burkhart PV, Rayens MK (2005) Self-concept and health locus of control: factors related to children’s adherence to recommended asthma regimen. Pediatr Nurs 31(5):404–409PubMedGoogle Scholar
  15. Butterfoss FD, Lachance LL, Orians CE (2006) Building allies coalitions: Why formation matters. Health Promot Pract 7(Suppl 2):23S–33SPubMedCrossRefGoogle Scholar
  16. Butz AM, Eggleston P, Huss K, Kolodner K, Vargas P, Rand C (2001) Children with asthma and nebulizer use: Parental asthma self-care practices and beliefs. J Asthma 38(7):565–573PubMedCrossRefGoogle Scholar
  17. Cabana MD, Bruckman D, Meister K, Bradley JF, Clark N (2003) Documentation of asthma severity in pediatric outpatient clinics. Clin Pediatr 42(2):121–125CrossRefGoogle Scholar
  18. Children and Asthma in America (1997–2006) GlaxoSmithKline website
  19. Christakis DA, Mell L, Koepsell RD, Zimmerman FJ, Connell FA (2001) Association of lower continuity of care with greater risk of emergency department use and hospitalization of children. Pediatrics 107(3):524–529PubMedCrossRefGoogle Scholar
  20. Clark NM, Doctor LJ, Friedman AR, Lachance LL, Houle CR, Geng X, Grisso JA (2006a) Community coalitions to control chronic disease: Allies against asthma as a model and case study. Health Promot Pract 7(Suppl 2):14S–22SPubMedCrossRefGoogle Scholar
  21. Clark NM, Friedman AR, Lachance LL (2006b) Summing it up: Collective lessons from the experience of seven coalitions. Health Promot Pract 7(Suppl 2):149S–152SPubMedCrossRefGoogle Scholar
  22. Colland VT, van Essen-Zandvliet LE, Lans C, Denteneer A, Westers P, Brackel HJ (2004) Poor adherence to self-medication instructions in children with asthma and their parents. Patient Educ Couns 55(3):416–421PubMedCrossRefGoogle Scholar
  23. Couturaud F, Proust A, Frachon I, Dewitte JD, Oger E, Quiot JJ, Leroyer (2002) Education and self-management: A one-year randomized trial in stable adult asthmatic patients. J Asthma 39(6):493–500Google Scholar
  24. Cowie RL, Underwood MF, Little CB, Mitchell I, Spier S, Fort GT (2002) Asthma in adolescents: a randomized, controlled trial of an asthma program for adolescents and young adults with severe asthma. Can Respir J 9(4):253–259PubMedGoogle Scholar
  25. Cowie RL, Underwood MF, Field SK (2004) Inhaled corticosteroid therapy does not control asthma. Can Respir J 11(8):555–558PubMedGoogle Scholar
  26. Department of Health and Human Services (2000) Actions Against Asthma. US Department of Health and Human Services. Washington DCGoogle Scholar
  27. DiMatteo MR (2004) Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol 23(2):207–218PubMedCrossRefGoogle Scholar
  28. DiMatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 160(14):2101–2107PubMedCrossRefGoogle Scholar
  29. Doak LG, Doak CC, Meade CD (1996) Strategies to improve cancer education materials. Oncol Nurs Form 23(8):1305–1312Google Scholar
  30. Donahue JG, Fuhlbrigge AL, Finkelstein JA, Fagan J, Livingston JM, Lozano P, Platt R, Weiss ST, Weiss KB (2000) Asthma pharmacotherapy and utilization by children in 3 managed care organizations. The Pediatric Asthma Care Patient Outcomes Research Team. J Allergy Clin Immunol 106(6):1108–1114PubMedCrossRefGoogle Scholar
  31. Earls F, Carlson M (2001) The social ecology of child health and well-being. Ann Rev Public Health 22:143–166CrossRefGoogle Scholar
  32. Farber HJ, Capra AM, Finkelstein JA, Lozano P, Quesenberry CP, Jensvold NG, Chi FW, Lieu TA (2003) Misunderstanding of asthma controller medications: association with nonadherence. J Asthma 40(1):17–25PubMedCrossRefGoogle Scholar
  33. Flores G (2000) Culture and the patient-physician relationship: achieving cultural competency in health care. J Pediatr 136(1):14–23PubMedCrossRefGoogle Scholar
  34. Flores G (2004) Culture, ethnicity, and linguistic issues in pediatric care: urgent priorities and unanswered questions. Ambul Pediatr 4(4):276–282PubMedCrossRefGoogle Scholar
  35. Gallimore R, Weisner RS, Kaufman SZ, Bernheimer LP (1989) The social construction of ecocultural niches: family accommodation of developmentally delayed children. Am J Ment Retard 94(3):216–230PubMedGoogle Scholar
  36. Gautrin D, Boulet LP, Boutet M, Dugas M, Bherer L, L’Archeveque J, Laviolette M, Cote J, Malo JL (1994a) Is reactive airways dysfunction syndrome a variant of occupational asthma? J Allergy Clin Immunol 93(1 Pt 1):12–22PubMedCrossRefGoogle Scholar
  37. Gautrin D, D’Aquino LC, Gagnon G, Malo JL, Cartier A (1994b) Comparison between peak expiratory flow rates (PEFR) and FEV1 in the monitoring of asthmatic subjects at an outpatient clinic. Chest 105(5):1419–1426CrossRefGoogle Scholar
  38. George M, Freedman TG, Norfleet AL, Feldman HI, Apter AJ (2003) Qualitative research-enhanced understanding of patients’ beliefs: results of focus groups with low-income, urban, African American adults with asthma. J Allergy Clin Immunol 111(5):967–973PubMedCrossRefGoogle Scholar
  39. Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, Haywood P, Bauman A, Hensley MJ, Walters EH (2002) Limited (information only) patient education programs for adults with asthma. Cochrane Database Syst Rev (2):CD001005Google Scholar
  40. Gold DR, Wright R (2005) Population disparities in asthma. Ann Rev Public Health 26:89–113CrossRefGoogle Scholar
  41. Green LA, Fryer GE, Yawn BP, Lanier D, Dovey SM (2001) The ecology of medical care revisited. N Eng J Med 344:2021–2025CrossRefGoogle Scholar
  42. Grzywacz JG, Fuqua J (2000) The social ecology of health: leverage points and linkages. Behav Med 26(3):101–115PubMedCrossRefGoogle Scholar
  43. Halbert RJ, Isonaka S, Internal Primary Care Respiratory Group (IPCRG) (2006) Guidelines: Integrating diagnostic guidelines for managing chornic respiratory diseases in primary care. Prim Care Respir J 15(1):13–19PubMedCrossRefGoogle Scholar
  44. Halm EA, Mora P, Leventhal H (2006) No symptoms, no asthma: the acute episodic disease belief is associated with poor self-management among inner-city adults with persistent asthma. Chest 129(3):573–580PubMedCrossRefGoogle Scholar
  45. Halterman JS, Aligne CA, Auinger P, McBride JT, Szilagyi PG (2000) Inadequate therapy for asthma among children in the United States. Pediatrics 105(1 Pt 3):272–276PubMedGoogle Scholar
  46. Harper J (2004) Breathless in Houston: A political ecology of health approach to understanding environmental health concerns. Med Anthropol 23:295–326PubMedCrossRefGoogle Scholar
  47. Hart BJ, Whitehead L (1990) Ecology of house dust mites in Oxfordshire. Clin Exp Allergy 20(2):203–209PubMedCrossRefGoogle Scholar
  48. Hendrika JM, Kristjanson L, Coleman M (2003) The parenting competency framework: Learning to be a parent of a child with asthma. Int J Nurs Pract 9(6):368–373PubMedCrossRefGoogle Scholar
  49. Hung CC, Chen YC, Mao HC, Chiang BL (2002) Effects of systematic nursing instruction of mothers on using medication and on health status of asthmatic children. J Nurs Res 10(1):22–32PubMedGoogle Scholar
  50. Israel E (2005) Genetics and the variability of treatment response in asthma. J Allergy Clin Immunol 115(Suppl 4):S532–S538CrossRefGoogle Scholar
  51. Janson S, Becker G (1998) Reasons for delay in seeking treatment for acute asthma: The patient’s perspective. J Asthma 35(5):427–435PubMedCrossRefGoogle Scholar
  52. Janson SL, Fahy JV, Covington JK, Paul SM, Gold WM, Boushey HA (2003) Effects of individual self-management education on clinical, biological, and adherence outcomes in asthma. Am J Med 115(8):620–626PubMedCrossRefGoogle Scholar
  53. Jonasson G, Carlsen KH, Mowinckel P (2000) Asthma drug adherence in a long term clinical trial. Arch Dis Child 83(4):330–333PubMedCrossRefGoogle Scholar
  54. Kean EM, Kelsay K, Wamboldt F, Wamboldt MZ (2006) Posttraumatic stress in adolescents with asthma and their parents. J Am Acad Child Adolesc Psychiatry 45(1):78–86PubMedCrossRefGoogle Scholar
  55. Kelly CS, Meurer JR, Lachance LL, Taylor-Fishwick JC, Geng X, Arabia C (2006) Engaging health care providers in coalition activities. Health Promot Pract 7(Suppl 2):66S–75SPubMedCrossRefGoogle Scholar
  56. Kelso TM, Abou-Shala N, Heilker GM, Arheart KL, Portner TS, Self TH (1996) Comprehensive long-term management program for asthma: Effect on outcomes in adult African-Americans. Am J Med Sci 311(6):272–280PubMedCrossRefGoogle Scholar
  57. Kirsch RE (1993) Clin Res. S Afr Med J 83(10):757–759PubMedGoogle Scholar
  58. Kleinman A, Eisenberg L, Good G (1978) Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med 88:251–258PubMedGoogle Scholar
  59. Klinnert MD, Price MR, Liu AH, Robinson JL (2002) Unraveling the ecology of risks for early childhood asthma amoung ethnically diverse families in the southwest. Am J Public Health 92(5):792–798PubMedCrossRefGoogle Scholar
  60. Krishnan JA, Diette GB, Skinner EA, Clark BD, Steinwachs D, Wu AW (2001) Race and sex differences in consistency of care with national asthma guidelines in managed care organizations. Arch Intern Med 161(13):1660–1668PubMedCrossRefGoogle Scholar
  61. Krishnan JA, Riekert KA, McCoy JV, Stewart DY, Schmidt S, Chanmugam A, Hill P, Rand CS (2004) Corticosteroid use after hospital discharge among high-risk adults with asthma. Am J Respir Crit Care Med 170(12):1281–1285PubMedCrossRefGoogle Scholar
  62. Lanphear BP, Aligne CA, Auinger P, Weitzman M, Byrd RS (2001) Residential exposures associated with asthma in US children. Pediatrics 107(3):505–511PubMedCrossRefGoogle Scholar
  63. Lara M, Cabana MD, Houle CR, Krieger JW, Lachance LL, Muerer JR, Rosenthal MP, Vega I (2006) Improving quality of care and promoting health care system change: The role of community-based coalitions. Health Promot Pract 7(Suppl 2):87S–95SPubMedCrossRefGoogle Scholar
  64. Legorreta AP, Liu X, Zaher CA, Jatulis DE (2000) Variation in managing asthma; Experience at the Medical Group Level in California. Am J Man Care 6(4):445–453Google Scholar
  65. Leickly FE, Wade SL, Crain E, Fruszon-Moran D, Wright EC, Evans R III (1998) Self-reported adherence, management behavior, and barriers to care after an emergency department visit by inner city children with asthma. Pediatrics 101(5):E8CrossRefGoogle Scholar
  66. Levy ML, Robb M, Allen J, Doherty C, Bland JM, Winter RJ (2000) A randomized controlled evaluation of specialist nurse education following accident and emergency department attendance for acute asthma. Respir Med 94(9):900–908PubMedCrossRefGoogle Scholar
  67. Lindberg M, Ahlner J, Moller M, Ekstrom T (1999) Asthma nurse practice – a resource-effective approach in asthma management. Respir Med 93(8):584–588PubMedCrossRefGoogle Scholar
  68. Love MM, Mainous AG III, Talbert JC, Hager GL (2000) Continuity of care and the physician-patient relationship: the importance of continuity for adult patients with asthma. J Fam Pract 49(11):998–1004PubMedGoogle Scholar
  69. Mannino DM (2004) Measuring asthma, respiratory symptoms, and changes over time. Int J Tuberc Lung Dis 8(12):1395PubMedGoogle Scholar
  70. Manson A (1988) Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care 26(12):1119–1128PubMedCrossRefGoogle Scholar
  71. Mansour ME, Lanphear BP, DeWitt TG (2000) Barriers to asthma care in urban children: parent perspectives. Pediatrics 106(3):512–519PubMedCrossRefGoogle Scholar
  72. Maton KI (2000) Making a difference: the social ecology of social transformation. Am J Community Psychol 28(1):25–57PubMedCrossRefGoogle Scholar
  73. Milton B, Whitehead M, Holland P, Hamilton V (2004) The social and economic consequences of childhood asthma across the lifecourse: a systematic review. Child Care Health Dev 30(6):711–728PubMedCrossRefGoogle Scholar
  74. Muntner P, Sudre P, Uldry C, Rochat T, Courteheuse C, Naef AF, Perneger TV (2001) Predictors of participation and attendance in a new asthma patient self-management education program. Chest 120(3):778–784PubMedCrossRefGoogle Scholar
  75. National Heart, Lung, and Blood Institute (1997) National Asthma Education and Prevention Expert Panel report 2: guidelines for the diagnosis and management of asthma. Bethesda (MD): National Institutes of Health Publ No. 97-4051. Available from URL:
  76. Nelson DA, Johnson CC, Divine GW, Strauchman C, Joseph CL, Ownby DR (1997) Ethnic differences in the prevalence of asthma in middle class children. Ann Allergy Asthma Immunol 78(1):21–26PubMedCrossRefGoogle Scholar
  77. Nelson HA, Weiss ST, Bleecker ER, Yancy SW, Dorinsky PM (2006) The Salmeterol Multicenter Asthma Research Trail: a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol. Chest 129(1):15–26PubMedCrossRefGoogle Scholar
  78. Neri M, Migliori GB, Spanevello A, Berra D, Nicolin E, Landoni CV, Ballardini L, Sommaruga M, Zanon P (1996) Economic analysis of two structured treatment and teaching programs on asthma. Allergy 51(5):313–319PubMedGoogle Scholar
  79. Neri M, Spanevello A, Ambrosetti M, Ferronato P, Cagna C, Zanon P (2001) Short and long-term evaluation of two structured self management programmes on asthma. Monaldi Arch Chest Dis 56(3):208–210PubMedGoogle Scholar
  80. Nicholas EA, Dwyer M, Murphy A, Taylor-Fishwick JC, Cohn JH, Kelly CS, Gould C, Di Stefano D (2006) Coalition-Based Approaches for Addressing Environmental Issues in Childhood Asthma. Health Promot Pract 7(Suppl 2):108S–116SPubMedCrossRefGoogle Scholar
  81. O’Donnell J, Birkinshaw R, Burke V, Driscoll PA (1997) The ability of A and E personnel to demonstrate inhaler technique. J Accid Emerg Med 14(3):163–164PubMedGoogle Scholar
  82. Olesen C, Thrane N, Nielsen GL, Sorensen HT, Olsen J, EuroMAP Group (2001) A population based prescription study of asthma drugs during pregnancy: Changing the intensity of asthma therapy and perinatal outcomes. Respiration 68(3):256–261PubMedCrossRefGoogle Scholar
  83. Onyirimba F, Apter A, Reisine S, Litt M, McCusker C, Connors M, ZuWallack R (2003) Direct clinician-to-patient feedback discussion of inhaled steroid use: its effect on adherence. Ann Allergy Asthma Immunol 90(4):411–415PubMedCrossRefGoogle Scholar
  84. Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353(5):487–497PubMedCrossRefGoogle Scholar
  85. Paasche-Orlow MK, Riekert KA, Bilderback A, Chanmugam A, Hill P, Rand CS, Brancati FL, Krishnan JA (2005) Tailored education may reduce health literacy disparities in asthma self-management. Am J Respir Crit Care Med 172(8):980–986PubMedCrossRefGoogle Scholar
  86. Pachter LM, Weller SC (1993) Acculturation and compliance with medical therapy. J Dev Behav Pediatr 14(3):163–168PubMedCrossRefGoogle Scholar
  87. Pachter LM, Weller SC, Baer RD, de Alba Garcia JE, Trotter RT II, Glazer M, Klein R (2002) Variation in asthma beliefs and practices among mainland Puerto Ricans, Mexican-Americans, Mexicans, and Guatemalans. J Asthma 39(2):119–134PubMedCrossRefGoogle Scholar
  88. Parkes M, Panelli R, Weinstein P (2003) Converging paradigms for environmental health theory and practice. Environ Health Perspect 111(5):669–675PubMedCrossRefGoogle Scholar
  89. Patel R, Potter SJ (2004) Ten puffs to many. Arch Dis Child 89(12):1129PubMedCrossRefGoogle Scholar
  90. Pearlman DN, Zierler S, Meersman S, Kim HK, Viner-Brown SI, Caron C (2006) Race disparities in childhood asthma: Does where you live matter? J Natl Med Assoc 98(2):239–247PubMedGoogle Scholar
  91. Persky VW, Slezak J, Contreras A, Becker L, Hernandez E, Ramakrishnan V, Piorkowski J (1998) Relationships of race and socioeconomic status with prevalence, severity, and symptoms of asthma in Chicago school children. Ann Allergy Asthma Immunol 81(3):266–271PubMedCrossRefGoogle Scholar
  92. Peterson JW, Lachance LL, Butterfoss FD, Houle CR, Nicholas EA, Gilmore LA, Lara M, Friedman AR (2006) Engaging the community in coalition efforts to address childhood asthma. Health Promot Pract 7(Suppl 2):56S–65SPubMedCrossRefGoogle Scholar
  93. Peterson-Sweeney K, McMullen A, Yoos HL, Kitzman H (2003) Parental perceptions of their child’s asthma: management and medication use. J Pediatr Health Care 17(3):118–125PubMedGoogle Scholar
  94. Powell H, Gibson PG (2006) Options for self-management education for adults with asthma. The Cochrane Database of Systematic Reviews 2006 Issue 4. Copyright © 2006 The Cochrane Collaboration. Published by John Wiley and Sons, LtdGoogle Scholar
  95. Rand CS (2005) Non-adherence with asthma therapy: more than just forgetting. J Pediatr 146(2):157–159PubMedCrossRefGoogle Scholar
  96. Rand CS, Butz AM, Kolodner K, Huss K, Eggleston P, Malveaux F (2000) Emergency department visits by urban African American children with asthma. J Allergy Clin Immunol 105(1 Pt 1):83–90PubMedCrossRefGoogle Scholar
  97. Rastogi D, Shetty A, Neugebauer R, Harijith A (2006) National Heart, Lung, and Blook Institute guidelines and asthma management practices among inner-city pediatric primary care providers. Chest 129(3):619–623PubMedCrossRefGoogle Scholar
  98. Redd SC (2002) Asthma in the United States: burden and current theories. Environ Health Perspect 110(Suppl 4):557–560PubMedGoogle Scholar
  99. Riekert KA, Butz AM, Eggleston PA, Huss K, Winkelstein M, Rand CS (2003) Caregiver-physician medication concordance and undertreatment of asthma among inner-city children. Pediatrics 111(3):e214–e220CrossRefGoogle Scholar
  100. Risser AL, Mazur LJ (1995) Use of fold remedies in a Hispanic population. Arch Pediatr Adolesc Med 149:978–981PubMedGoogle Scholar
  101. Rosenthal MP, Butterfoss FD, Doctor LJ, Gilmore LA, Krieger JW, Meurer JR, Vega I (2006) The coalition process at work: Building care coordination models to control chronic disease. Health Promot Pract 7(Suppl 2):117S–126SPubMedCrossRefGoogle Scholar
  102. Ryckman KA, Bercaw DM, Ellis MR, Wolf DG, Elgert S (2006) Clinical inquires. What predicts a successful smoking cessation attempt? J Fam Pract 55(9):816–819PubMedGoogle Scholar
  103. Rydman RJ, Sonenthal K, Tadimeti L, Butki N, McDermott MF (1999) Evaluating the outcome of two teaching methods of breath actuated inhaler in an inner city asthma clinic. J Med Syst 23(5):349–356PubMedCrossRefGoogle Scholar
  104. Rydstrom I, Dalheim-Englund AC, Segesten K, Rasmussen BH (2004) Relations governed by uncertainty: part of life of families of a child with asthma. J Pediatr Nurs 19(2):85–94PubMedCrossRefGoogle Scholar
  105. Scarfone RJ, Capraro GA, Zorc JJ, Zhao H (2002) Demonstrated use of metered-dose inhalers and peak flow meters by children and adolescents with acute asthma exacerbations. Arch Pediatr Adolesc Med 156(4):378–383PubMedGoogle Scholar
  106. Shanawani H (2006) Health disparities and differences in asthma: concepts and controversies. Clin Chest Med 27(1):17–28PubMedCrossRefGoogle Scholar
  107. Stokols D (1996) Translating social ecological theory into guidelines for community health promotion. Am J Health Promot 10(4):282–298PubMedGoogle Scholar
  108. Stoloff S (2000) Current asthma management: The performance gap and economic consequences. Am J Manag Care 6(Suppl 17):S918–S925 discussion S925–S929Google Scholar
  109. Stoloff SW, Boushey HA (2006) Severity, control, and responsiveness in asthma. J Allergy Clin Immunol 117(3):544–548PubMedCrossRefGoogle Scholar
  110. Suissa S, Ernst P (2001) Inhaled corticosteroids: Impact on asthma morbidity and mortality. J Allergy Clin Immunol 107(6):937–944PubMedCrossRefGoogle Scholar
  111. Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B (2000) Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med 343(5):332–336PubMedCrossRefGoogle Scholar
  112. The World Health Report 2006 – working together for health. Geneva Switzerland. Available from URL
  113. Van Sickle D, Wright AL (2001) Navajo perceptions of asthma and asthma medications: clinical implications. Pediatrics 108(1):E11CrossRefGoogle Scholar
  114. Wandersman A, Valois R, Ochs L, de la Cruz DS, Adkins E, Goodman RM (1996) Toward a social ecology of community coalitions. Am J Health Promot 10(4):299–307PubMedGoogle Scholar
  115. Weinberger M, Murray MD, Marrero DG, Brewer N, Lykens M, Harris LE, Seshadri R, Caffrey H, Roesner JF, Smith F, Newell AJ, Collins JC, McDonald CJ, Tierney WM (2002) Effectiveness of pharmacist care for patients with reactive airways disease: a randomized controlled trial. JAMA 288(13):1594–1602PubMedCrossRefGoogle Scholar
  116. Weinstein AG (2005) Should patients with persistent severe asthma be monitored for medication adherence? Ann Allergy Asthma Immunol 94(2):251–257PubMedCrossRefGoogle Scholar
  117. Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A (1998) Inadequate literacy is a barrier to asthma knowledge and self-care. Chest 114(4):1008–1015PubMedCrossRefGoogle Scholar
  118. Williams LK, Pladevall M, Xi H, Peterson EL, Joseph C, Lafata JE, Ownby DR, Johnson CC (2004) Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma. J Allergy Clin Immunol 114(6):1288–1293PubMedCrossRefGoogle Scholar
  119. Woloshin S, Bickell NA, Schwartz LM, Gany F, Welch HG (1995) Language barriers in medicine in the United States. JAMA 273(9):724–728PubMedCrossRefGoogle Scholar
  120. Yawn BP (2003a) The impact of childhood asthma on daily life of the family. GPIAG 12(3):82–85Google Scholar
  121. Yawn BP (2003b) The impact of childhood asthma on daily life of the family – a qualitative study using recurrent thematic analysis. Prim Care Respir J 12(3):82–85Google Scholar
  122. Yawn BP (2004) Participatory research in rural primary care. Minn Med 87(9):52–54PubMedGoogle Scholar
  123. Yawn BP, Bushy A, Yawn RA (eds) (1993) Exploring rural medicine: Issues and concepts, Publications, Inc., Thousand Oaks, CAGoogle Scholar
  124. Yawn BP, Yunginger JW, Wollan PC, Reed CE, Silverstein MD, Harris AG (1999) Allergic rhinitis in Rochester, Minnesota residents with asthma: frequency and impact on health care charges. J Allergy Clin Immunol 103(1 Pt 1):54–59PubMedCrossRefGoogle Scholar
  125. Yawn BP, Wollan P, Kurland MJ, Scanlon P (2002) A longitudinal study of asthma prevalence in a community population of school age children. J Pediatr 140(5):576–581PubMedCrossRefGoogle Scholar
  126. Yawn BP, Mainous AG III, Love MM, Hueston W (2001) Do rural and urban children receive similar therapy for asthma? J Rural Health 17(1):32–39Google Scholar
  127. Yawn BP, Fryer GE, Phillips RL, Dovey SM, Lanier D, Green LA (2005) Using the ecology model to describe the impact of asthma on patterns of health care. BMC Pulm Med 5:1–7CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Olmsted Medical CenterRochesterUSA

Personalised recommendations