Collaborations of the Center With China

The Center, in collaboration with the Beijing Heart, Lung and Blood Vessel Institute and Capital Institute of Pediatrics, assessed Open Airways, a proven program in enhancing asthma outcomes for American children, in 21 schools in Beijing.  Results showed marked improvements in asthma control for Chinese children.  Through collaborations with colleagues in Beijing, Nanjing and Shanghai, the Center is examining sudden, serious asthma attacks in children who are thought to have very mild and infrequent symptoms.  This situation has not yet been explored in research.

A Trial of Asthma Self-Management in Beijing Schools

This study examined the effectiveness in children in China of an asthma education program adapted from a model developed in the USA.

Six hundred and thirty-nine children in 21 elementary schools in one agricultural and one industrial area participated in a randomized, controlled trial. Data were collected at baseline and 1 year subsequently. The self-regulation-based program addressed topics including preventing and managing symptoms, using medicines, and identifying and controlling triggers.

Positive effects on treatment children v. control children were noted in school performance, absences , and home environment.  Industrial-area children additionally benefited from fewer hospitalizations (odds ratio = 1.96, p = 0.05) and asthma-related concerns of parents.  Agricultural-area parents showed greater improvement in asthma management, and expressed more negative feelings about asthma and asthma concerns.

The program provided overall benefits related to school performance, absences, and home environment. In the agricultural area, where fewer resources were available, benefits were fewer and concerns greater. In the industrial area, where education and income were higher, additional benefits related to healthcare use and parents' quality of life were realized.

Project-related Publications:

Clark, N.M., Gong, M., Kaciroti, N., Yu, J., Wu, G., Zeng, Z., Wu, Z. A trial of asthma self management in Beijing schools.  Chronic illness, 1:31-38, February, 2005.  

Project-related Presentations:

Clark, N.M. and Gong, M. Chinese medication use in school children with asthma in Beijing, China. ALA/ATS International Conference, Orlando, FL, May 2004 (poster session).  

Influences on Childhood Asthma in Low-Income Communities in China and the United States 

For comparison of childhood asthma, the same case-finding survey and parent interview questionnaires were used to collect data from 639 children with asthma in 21 elementary schools in Beijing and 835 children with asthma in 14 elementary schools in Detroit, Michigan. Asthma prevalence in Beijing (7.3%) was more than three times lower than in Detroit (24%) despite a high level of smoking among Chinese parents. Body mass index levels were higher in Detroit but were not associated with persistent asthma in either country. Higher levels of past infection in Beijing and household allergens in Detroit were noted and may be associated with differences in prevalence. Despite less severe disease observed in Beijing, hospitalizations and office visits did not differ from Detroit. This may be partially associated with less use of anti-inflammatory medicine and lower levels of parental asthma management in China.

Project-related Publications:

Clark, N.M., Brown, R.W., Joseph, C.L.M., Anderson, E.W., Liu, M., Valerio, M.A. Effects of a comprehensive school-based asthma program on symptoms, parent management, grades, and absenteeism.  Chest, 125(5): 1674-1679, May, 2004.  

Clark, N.M., Gong, M., Brown, R.W., Anderson, E.W., Yu, M., Valerio, M.A., Joseph, C.L.M., Wu, G., Zeng, Z., Wu, Z. Influences on childhood asthma in low-income communities in China and the United States. Journal of Asthma, 42(6): 493-497, 2005.

Joseph, C.L.M., Havstad, S., Anderson, E.W., Brown, R., Clark, N.M. Effect of asthma intervention on children with undiagnosed asthma. Journal of Pediatrics, 146(1): 96-104, 2005.  

Anderson, E.W., Valerio, M.A., Liu, M., Benet, D.J., Joseph, C., Brown, R., Clark, N.M. Schools' capacity to help low income, minority children to manage asthma. Journal of School Nursing, 21(4): 236-242, August, 2005.  

Project-related Presentations: 

Clark, N.M., and Gong, M. Comparison of factors associated with symptoms in school children with asthma in Beijing, China and Detroit.  Annual Meeting of the American Public Health Association, San Francisco, November 2003.

Clark, N.M. BMI and asthma in school children in Detroit, USA and Beijing, China.  European Respiratory Society Annual Congress, Glasgow, Scotland, September 2004 (poster session).

Clark, N.M., Leo, H.L, Gong, M., and Wang, S. Communication between educators and parents of asthmatic children improves academic and medical outcomes in Beijing and Detroit. AAAAI Annual Meeting, Miami Beach, FL, March 2006 (poster session).

Clark, N.M., Leo, H.L., Gong, M., and Wang, S. Cultural perceptions on identification and treatment of childhood asthma in the US and China.  AAAAI Annual Meeting, Miami Beach, FL, March 2006 (poster session).  

For more information, contact Molly Gong at mgong@umich.edu