Asthma Case Studies

Overview Asthma is a chronic lung disease. People who have asthma have inflamed, narrowed airways which make it difficult to breathe. They may experience wheezing, chest tightness, shortness of breath and coughing which is often at night. Swollen airways can produce an excess of mucus which can make the airways even narrower (see appendix A). In some cases asthma symptoms are minimal and go away on their own however sometimes they are exacerbated, this is called an asthma attack. Treatment is very time sensitive, its better to treat as soon as possible to avoid severe attacks which can demand emergency care or in extreme cases lead to death. Treatments include long-term control meds and quick relief medicines. Risk factors for asthma
include having parents with asthma, atopy, and exposure to many allergens such as pollution, secondhand smoke, dust and many more. The cause of asthma is still not known however the NHLBI says researchers think genetic and environmental factors combine and cause asthma (2014). Most people with asthma are able to gain control of it and live healthy, long lives however there are a few consequences that come along with the disease. One of which is that every person with asthma will have to have their inhaler on hand at all times and some will have to take their asthma control medicine daily. Another would be that they’ll have to be cautious when it comes to their triggers to avoid an attack. A third is that they can develop lung scarring (Bottrell, 2013). This is caused by frequent asthma attacks that go untreated. Its when tissue lining of the lungs become thicker. This ends up leading to chronic shortness of breath. According to the Department of Health over 1.1 million adults have asthma(2015). Although people of all ages are effected by asthma, children are more. Almost one in 13 children have asthma and most of them are from cities. Asthma symptoms can change over time which is why it is important to follow up with your doctor so they can asses you and create up to date action plans with you.
Population

The populations I will be discussing are neighborhoods within New York City such as parts of the Bronx, Harlem, Brooklyn and Staten Island. According to a report from the NYC Department of Health and Mental Hygiene “the poorest neighborhoods in New York City are in New York City are in the South Bronx, East and Central Harlem, and North and Central Brooklyn, where more than 1 in 3 residents live in poverty”. Their household income is around $23,000 in 1999. The life expectancy in these neighborhoods are 8 years shorter than the wealthy ones. The report also says that most New Yorkers without health coverage don't receive medical care. See appendix D for New Yorkers access to medical care in relation to their income. In addition, people without insurance are more likely to not receive preventative care.
Disparities

More Black and Hispanic New Yorkers are likely to need hospital care due to asthma than White New Yorkers because of poor management of the condition (see Appendix C).
They have poor management because of the lack of medical coverage because of their low income. Most of the residents of these neighborhoods in New York are also part of a minority. Due to the lack of medical coverage they lack preventative care as mentioned above which is really important with asthma because majority of attacks can be prevented with the right education about it and treatment for it. “In New York City, asthma hospitalization and death rates among Blacks and Hispanics were 3-5 times those of Whites, in a study of data from all hospital discharges obtained from the New York State Department of Health” ( Gold, 2005). Golds research also states that people with asthma in poorer neighborhoods are under treated for their asthma (2005). Gold also suggests that prevalence of smoking is high in African American populations which in turn effects asthmatics because smoking is a major trigger for people with asthma (2005). The mortality for asthma is not that high because it is treatable. According to Browne 25.5% of Harlem kids were diagnosed with asthma (2003). Browne’s article suggest that the cities’ pollution can be one of the causes of the high rate of asthma. Due to the neighborhoods having low incomes it is hard to treat the disease. Also there aren't many intervention programs to educate the
families on how to manage the disease either.
Intervention

The CDC created the National Asthma Control Program (NACP) in 1999.
The goal of the NACP is to develop interventions to educate people and provide appropriate care for asthma while reducing the economic burden of the disease. The NACP has been successful, within 12 years costs for asthma decreased by $23.1 billion and mortality has decreased 27% since 1999. The program mostly educates people on asthma and preventative care. Also they work together alongside states to create programs. One being the Asthma Coalition of Long Island which trained 175 nurses to inform 1407 health scare providers on asthma issues. This proved to decrease hospitalizations by 92%. They also provided funding and technical help to states. and created campaigns or funding for various interventions for education as well has health care coverage of asthma. They also promote asthma friendly schools by funding asthma control strategies to urban school districts. (CDC,
2013)