Chronic respiratory symptoms are prominent among Alaska Native children

Chronic respiratory symptoms are prominent among Alaska Native children in the Yukon-Kuskokwim delta (YK delta) region of Alaska, with symptoms varying greatly within the geographic location.

In a study published in the May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians, 40 percent of Alaska Native (AN) and American Indian (AI) children in the YK delta region of Alaska experienced chronic respiratory symptoms, including chronic productive cough, asthma, and asthma-like symptoms. The study also found that respiratory symptoms varied dramatically by location within the YK delta, with children from rural villages experiencing a lower incidence of asthma-like symptoms and a higher prevalence of chronic productive cough than children from the nearby town of Bethel.

“There is limited documentation of these conditions among Alaska Natives and American Indians, so our study is helpful for parents, physicians, and leaders in these communities in understanding the degree to which these conditions are present among AN/AI youth,” said Toby C. Lewis, MD, MPH, University of Michigan School of Medicine, Ann Arbor, MI, who conducted the research with colleagues while at the University of Washington, Seattle, WA. “Health policy makers can also use this information to help develop culturally appropriate educational messages and intervention programs to address childhood respiratory illness in these communities.”

Researchers affiliated with the University of Washington and the YK Delta Regional Hospital in Bethel determined how prevalent asthma and chronic respiratory symptoms were among AN/AI children in Alaska by studying a sample population of middle school students in the YK delta region of Alaska. Students in grades 6 to 9 from Bethel and two rural villages completed an asthma and allergy survey after watching an accompanying asthma video. A question was added to the basic survey to identify children who had frequent productive cough. Of the 466 completed surveys, 377 students identified themselves as AN/AI, from which 40 percent reported chronic respiratory symptoms of some kind and 60 percent reported no symptoms. Of those AN/AI students with symptoms, 7.4 percent reported being physician-diagnosed with asthma, 11. 4 percent reported asthma-like symptoms in the last year, and 21.5 percent were categorized as having chronic productive cough without asthma or asthma-like symptoms.

Geographic location within the YK delta was significantly associated with certain respiratory problems. Productive cough was nearly three times as prevalent in village students than students living in town. Conversely, students living in town were more than two times as likely to suffer from asthma and asthma-like symptoms than students in villages. Overall, students with respiratory symptoms were more likely than asymptomatic students to report respiratory-related sleep difficulties and activity limitations.

“The reasons for variation in respiratory conditions within the YK delta are not clear,” said Dr. Lewis. “There is a well-established, unified health-care system across the region, and, therefore, we do not think these differences are due to lack of access to health care or differences in diagnostic practices. Rather, we suspect there may be differences in environmental conditions that either increase risk or are protective for the children, and that these conditions vary within the region.”

Dr. Lewis notes that chronic productive cough has not been well-studied in the general population and may be an underappreciated form of chronic respiratory symptoms in children. “Other reports are beginning to emerge from Australia and New Zealand of native children having difficulties with chronic productive cough. This seems to be an issue that extends beyond Alaska.”

“More than five million children in the United States are currently diagnosed with asthma, and asthma rates continue to increase each year,” said Paul A. Kvale, MD, FCCP, President-Elect of the American College of Chest Physicians. “With a better understanding of how asthma affects specific populations, such as Alaska Natives, we may gain insight into how asthma can be more effectively managed and prevented.”

CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at https://journal.chestnet.org/. ACCP represents more than 15,700 members who provide clinical respiratory, critical care, and cardiothoracic patient care in the United States and throughout the world. ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication.