More than a quarter of fifth graders in Philadelphia's poor neighborhoods report having asthma, and being around tobacco smoke seems to be part of the reason, according to a study of 1,600 public school students.

Students with asthma were more likely than those without the lung disease to be living in homes where people smoked and also were more likely to have tried smoking themselves, the researchers found. Dr. Salvatore Mangione, a Thomas Jefferson University pulmonologist who led the study, said the results helped underscore the role that tobacco played in the epidemic of asthma in the United States. "If you grow up in an environment where folks smoke, it has a tremendous impact on your respiratory health," said Mangione, who will present his results today at a meeting here of the American College of Chest Physicians. The study is part of an ongoing educational project in Philadelphia that involves sending a converted double-decker London bus to schools around the city to teach children about asthma. Students who board the bright red "Asthma Bus" are taught how to recognize and treat the lung disease. They complete a video-guided questionnaire that asks if they have experienced the wheezing, coughing, and shortness of breath typical of asthma, and whether they specifically have ever had asthma. Mangione said data collected from 1,642 fifth graders at 18 middle schools in predominantly poor, minority communities around the city found that 27 percent reported being aware they had asthma. When he added in those students who reported symptoms suggesting undiagnosed asthma, Mangione concluded that about a third likely have the disease. "Many kids don't know they have asthma," he said. There has been a dramatic rise in asthma among both children and adults in this country over the last two decades, and the disease is hitting particularly hard among the urban poor. According to the U.S. Centers for Disease Control and Prevention, the number of people with asthma doubled from an estimated 6.7 million in 1980 to 17.3 million in 1998. Nearly 5 million children are believed to have the disease. David Mannino, a CDC epidemiologist, said the self-administered survey may have led the Philadelphia study to overestimate the prevalence of asthma among the students. But the results are not out of line with surveys in some other urban areas. "Asthma is a problem in Philadelphia," he said, "just like it is everywhere else." Asthma is a chronic inflammatory disease in which the lungs' airways become temporarily constricted, causing breathing difficulties and, in extreme cases, death. Various things can trigger asthma attacks, including exposure to dust, cockroaches, certain chemicals and tobacco smoke. The study of Philadelphia schoolchildren specifically explored the connection between asthma and smoking. Of those students who reported having asthma, nearly 69 percent said they were exposed to tobacco smoke at home, compared with 61 percent of students without asthma, Mangione said. Sixteen percent of the fifth graders with asthma said they experimented with smoking themselves, compared with fewer than 13 percent of those without the disease. Mangione, who helped develop the Asthma Bus concept, said the study results suggested that educational efforts aimed at increasing asthma awareness should also focus on smoking prevention. Schools in Philadelphia and elsewhere have become increasingly interested in asthma education programs, because the illness is a big reason why children stay home sick from school. Mangione also studied absenteeism data from three middle schools in the city and found that a third of children with more than 25 absences reported having asthma. Philadelphia is one of four school districts in the nation with CDC funding to develop asthma education programs. Bettyann Creighton, a curriculum specialist in health education, said the district was hoping to establish after-school clubs for students with asthma. "The goal is to have everyone with asthma managing their disease," she said.

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