Tropical island asthma in Hawaii

To better understand the increased morbidity and mortality of asthma in Hawaii, a profile was established from questionnaires completed by 76 asthmatics in a residential area and by 204 asthmatics attending emergency rooms. The general profile differed from profiles on other islands and mainland USA in that allergens were more important and exercise less. Variations occurred in the profile in association with ethnicity, time in Hawaii, and prescribing habits. The Chinese did not recognize infection as a trigger; the Filipinos had little familial asthma, less pollen sensitivity, and used few steroids; and the Japanese were sensitive to Kona weather but not to pollen. The newcomers (military) who were sensitive to pollen and less to emotion and exercise, rated their attacks more severe and used more nebulizers and steroids. Certain other relationships emerged such as house dust as a trigger and the increased use of steroids. Asthmatics of two civilian ERs used fewer nebulizers and steroids. In conclusion, Hawaii's increased morbidity and mortality of asthma should be examined further in terms of ethnicity, infection, house dust, and prescribing habits.