Asthma Can Be Tamed, and It’s No Mystery

Asthma is a silent epidemic across the nation, the Bergen County RECORD has reported. Scientists don’t know why it is becoming so common. However, they do know that air pollution, especially from power plans and vehicles, makes it much worse.

While asthma can’t be cured, it can be managed. With diligence and good care, patients can stay out of the hospital and suffer fewer, less severe attacks.

When Curtis James came close to death one day from an asthma attack, it scared him into changing his habits. He began seeing a lung specialist, Dr. Robert Amoruso, who worked out a treatment plan. Now, Curtis uses preventive medicines every day, monitors his lung capacity, and travels with a nebulizer, a machine that aero-solizes medication, so that it can be inhaled. He hasn’t been to the hospital since Dr. Amoruso stabilized his condition.

The problem in asthma management is that there is a real gap between what many doctors know and can do, and what actually happens in practice. Far too many patients go from crisis to crisis. Follow-up visits to a primary care doctor may not help enough. In surveys, 40% of physicians say they often don’t follow national guidelines for asthma treatment. Specialist care – provided by an allergist of pulmonologist - produces better results. However, many health plans block an individual’s ability to see a specialist.

Regular, daily use of prescription medicine is needed to prevent crises and poor breathing for people with moderate to severe asthma, but many people lack coverage for drugs. In addition, there is no guarantee that individuals will get what they need to manage their disease.

In addition to what doctors can and should provide in preventive care, prevention must also take place in patients’ homes. Lifestyle changes – stopping smoking, ridding the home of pet dander, roaches and dust, and putting dust covers on bedding – are key preventive measures for asthma patients. However, changing behavior requires patient education by health-care professionals, sensitivity to cultural differences, and ultimately a commitment from the patient, and / or a family of the patient. Doctors must help to educate patients on the importance of lifestyle changes.

It has been recognized by many managed care companies that effective asthma management not only saves lives, but it reduces health care costs. Many HMOs and other health insurance companies now have condition management programs, where nurses will contact individuals who have been hospitalized and discuss the management of their disease. AmeriChoice, in a pilot program with 145 severe asthmatics, was able to cut hospital stays for by more than half and ER visits by a quarter.

However, one of the key barriers to preventive care relates to culture. Immigrant communities are the most vulnerable to asthma crises. In addition to the language barriers that often exist, many immigrants’ first instinct is to reach for home remedies rather than Western medicine, said Noreen Clark, director of a University of Michigan program that promotes grass-roots asthma education across the country. Many immigrants use alternative therapies without telling their doctors, and some see doctors only after these therapies do not work.

Doctors, and the health care community at large, need to learn the cultural tendencies of asthma sufferers. Historically, Latinos and Caribbeans tend to mistake asthma for a one-time illness, rather than a lifetime condition that needs constant care. Some Puerto Ricans have been wary of treating asthma with inhaled steroids, fearing they might be addictive or harmful to children.

In order to tame asthma and make it a manageable disease then, focus needs to be on (1) physicians providing preventive asthma medications and patient education about needed lifestyle changes, and (2) the healthcare community’s steady reach into immigrant and poor communities to educate and ensure these populations receive the best education and treatment for their condition.

(Summarized from THE RECORD, Bergen County, NJ; Article by Lindy Washburn and Alex Nussbaum)