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October 2000

Remembering the Patient

Arch Pediatr Adolesc Med. 2000;154(10):977-978. doi:10.1001/archpedi.154.10.977

ASTHMA CONTINUES to be a vexing problem. The 5 reports in this issue of ARCHIVES remind us of that. The complexity of the problem seems to increase everyday. A MEDLINE search using asthma as the subject found more than 3000 published articles in the English language for 1999. How can one make sense of all this information?

To begin with, we need to ask the question, What do we know about asthma in the United States? The burden of asthma continues to rise in the United States.1 While the poor and minorities bear a disproportionate share of the burden,2 no group in society has been untouched by this rise in asthma prevalence. The role of atopy and underlying inflammation are now recognized as vital components of asthma. Both genetic and environmental factors have been shown to have a role in asthma.3 Many theories have been set forth to explain this rise. The asthma increase has been attributed to a change in diet4; the use of less aspirin among children5; exposure early in life to indoor antigens, such as the dust mite,6 or to antibiotics7; or exposure (or lack of exposure) to certain infections.8 None of these theories can explain all the data or offer much to guide us in stopping this increase.

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