practice, including shifting diagnostic criteria or methods (Gregg, 1983, 1989; Newacheck et al., 1986). It should also be noted, however, that except for an increase in mild asthma among older Caucasian children, a significant increase in prevalence rates has not been seen in the National Health Interview Survey (Weitzman et al., 1992).
Asthma death rates have increased substantially in this country over the past 10 years. In 1988, 4,580 people died from asthma in the United States (NHLBI, 1991). During 1979–1984, the death rate for asthma rose from 1.2 per 100,000 people (in 1979) to 1.5 per 100,000 (in 1983 and 1984). Asthma was reported as the underlying cause of 1,674 deaths in the United States in 1977; this statistic increased to 3,564 in 1984 (Sly, 1988), a trend that runs counter to the decreasing death rates seen between 1950 and 1978 (Sly, 1988). Although the first observed rise was concomitant with a change in coding procedures by the National Center for Health Statistics, the rising trend has persisted during a period of uniformity in coding. The increase in death rates has been seen across ages and races but is particularly notable among African Americans (NHLBI, 1991; Sly, 1988). Increases in asthma mortality have been variously attributed to inadequate medical management (especially among minority patients of low socioeconomic status), underutilization of available health care, neglect of personal health, changes in prescribing practices, inappropriate use of medications, and altered environmental factors,