Racial Gap in Asthma Management Impacts Health Care, Workplace, Schools

Newswise — A report on the first investigation of a high-risk urban community-based sampling " after adjusting for age, sex, income, education and pharmacotherapy " showed that blacks were 6.3 times more likely to have experienced an Emergency Department (ED) visit and 12.3 times more likely to have been hospitalized compared with whites.

"Uncontrolled asthma is not only placing an unmanageable burden on the emergency health care system in our most impoverished areas, but it's impacting our workforce and our ability to educate the increasing number of asthmatic students in high risk neighborhoods," said lead investigator Evalyn N. Grant, M.D., formerly at Rush-Presbyterian-St. Luke's Medical Center in Chicago during the time of the study.

The study portrays the hidden burden of asthma in terms of activity limitation (fair amount or a lot: 19.4 % whites, 31% blacks), inability to perform activities more than once per week (18.6% whites, 20.7% blacks), and missed work or school one day per week (10.8% white, 7.1% blacks).

According to nationwide estimates, asthma results in 478,000 hospitalizations and 100 million days of restricted activity annually. Direct medical expenditures associated with asthma, including hospital care, physicians' services and medications, are estimated at $9.4 billion annually. Indirect medical expenditures, including lost work days for adults suffering from asthma or caring for children with asthma and lost future earnings from premature deaths associated with asthma, total $4.6 billion annually.

"Our investigation of 152 adults and children with active asthma in the greater Chicago metropolitan area is a benchmark on how, a decade after national guidelines were released, a large gap remains between the goals of asthma therapy and appropriate treatment," Dr. Grant said.

The investigation is published in this month's issue of Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI). According to the authors, no published population-based studies have examined the burden of asthma on the residents of a particular high-risk area. The key strength of the study is that the sampling is community-based, rather than clinic, hospital or health plan-based.

Asthma, a serious chronic condition that affects more than 14 million people in the United States, occurs when the airways become inflamed and swollen and muscle spasms constrict airflow to the lungs. An "asthma attack" is characterized by labored or restricted breathing, a tight feeling in the chest, coughing and wheezing. The condition can develop quickly and may vary in severity from mild discomfort to life-threatening attacks in which breathing stops altogether. Sometimes a chronic cough is the only symptom, and many cases of the disease go undiagnosed.

Triggers that can initiate an asthma attack include allergens such as pollen, dust, animal dander, drugs and food additives, as well as viral respiratory infections and physical exertion. Weather conditions such as extremely dry, wet or windy weather can worsen an asthma condition.

Although there is yet no cure and the cause of asthma remains a mystery, many treatment options are available to control and reverse this chronic inflammatory obstruction of the lungs' airways. Patient information on allergic diseases including asthma is available by calling the ACAAI toll free number at (800) 842-7777 or visiting its Web site at http://www.acaai.org.

The ACAAI is a professional medical organization comprising nearly 5,000 qualified allergists-immunologists and related health care professionals. The College is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care.

Citation: Grant EA, et al. Asthma morbidity and treatment in the Chicago metropolitan area: one decade after national guidelines. Ann Allergy Asthma Immunol 2005;95:19-25.