most disqualifications for mild asthma followed a diagnostic work-up. Krauss (2004) conducted a 5-year study following a cohort of 3,398 active-duty recruits. In a one-year period (2002), just over 5 percent of disqualifications of first-time applicants were for asthma. Those with asthma waivers were more likely to remain on active duty than those without asthma. Of those identified with asthma (17 percent), 70 percent had preenlistment symptoms.

AMSARA data on a cohort followed for five years explored asthma outcomes among Navy recruits and active-duty enlistees who were identified with asthma after enlistment. As part of this effort, Project REMAIN looked at data on the experience of 162 Navy recruits during 9 months (2001) and observed that 66 had asthma. They found that mild asthmatics were more likely to leave active duty soon after diagnosis. Recruits without asthma were more likely than asthmatics to remain in training. However, after training there was no difference in retention rates. Recruits with asthma were 1.4 times more likely to make medical visits. Mild asthmatics were at no additional risk of hospitalization than the general military population.

A REMAIN case control three-year follow-up study was conducted at the Great Lakes Naval Training Center of personnel identified with asthma after enlistment. Findings indicated that 40 percent of mild asthmatics were retained on active duty with no adverse consequences. The greatest frequency of health care use and recruitment loss occurred in basic training. Following training there were no attrition differences between those recruits with or without asthma, although health care costs were higher (relative risk: RR 1.7 for those with asthma). Figure 5-12, using AMSARA accession data (Krauss, 2004), shows that the probability of enlistees in all Services granted a waiver for asthma remaining on active duty was greater over a four-year period than enlistees with no asthma waiver.

Asthma Interventions

Diagnosis and treatment guidelines for asthma have been provided by the National Asthma Education and Prevention Program (National Institutes of Health, 1997). The guidelines discuss interventions that enable individuals with asthma to function more fully and exert optimal control over the disease. Daily use of anti-inflammatory medicine in people with persistent asthma has been associated with reduced symptoms and emergency department use.

Meta-analyses of nonpharmacological interventions for asthma have been conducted. Gibson and colleagues (2002) reviewed self-management



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