Urban Health Journalism Workshop: Asthma and children

By Loren Bonner
Graduate School of Journalism at CUNY

Asthma has everything to do with where someone lives. So, for this year's Urban Health Journalism Workshop concerning environmental issues and health, one panel honed in on children and asthma.

Independent journalist Irene Wielawski, the panel's moderator, introduced the panel by explaining that asthma disproportionally affects Hispanic and African American children. They have the highest rates of asthma in the United States and tend to live in poor urban areas. Most lack access to quality care, education and healthy environments, some of the factors that contribute to the complications with asthma.

"It's a complex disease that's poorly understood by people in these communities," said Sebastian Bonner, an investigator for the Center for Urban Epidemiologic Studies at the New York Academy of Medicine.

Often, the family doesn't manage their child's asthma correctly because they are uneducated about it. Karen Warman, M.D., a pediatrician at Montefiore Medical Center, said asthma needs to be understood as a chronic disease. She said it is best treated with controller medications such as inhaled steroids – even when there are no symptoms present.

Instead, doctors are treating low-income children with Albuterol, a quick-fix medication. "It's just masking the build-up of inflammation. So the kid crashes and goes to the emergency room," Bonner said.

Warman said 40 percent of asthma patients are not using daily controlled medication. She blames part of the problem on a lack of communication among doctors, parents and patients. Not only do parents and children need to be educated by their doctors on how to manage the disease properly, but they need to trust the steroid treatment as well, she said.

The medical community has been taking notes. The Physician Asthma Care Education program trains physicians on asthma care and management. But it's certainly no cure-all for most low-income communities.  Primary care doctors in these areas simply don't have the time to spend educating their patients.

Ray Lopez, of Little Sisters of the Assumption Family Health Services, tries to make up for this. He spends his days working with Harlem families dealing with asthma. One of the organization's services includes going into patient's homes and addressing the triggers of asthma. This means getting rid of dust, mold, cockroaches, smoke and toxic cleaning products. These triggers not only exacerbate asthma, but can cause it. Lopez lends families tools, such as air purifiers and HEPA-filter vacuums, and teaches them techniques – such as putting food in plastic containers – to ward off roaches.

Environmental changes like the ones Lopez promotes can improve asthma. "Fifty-nine percent of families we visited had fewer ER visits," Lopez said, "but there is a lot we cannot control." There are limitless environmental problems outside of the home, like diesel emissions and air pollution, which are not so easily fixable.

A broken health care system is something else that is not so easily fixable. Bonner said asthmatic children on Medicaid have the worst symptoms and receive the most incomplete care. As a result, these children end up in the emergency room. Asthma accounted for 7.4 percent of all hospital admissions for children and adolescents in 2000. This is only costing the system more, since hospital stays are the most expensive form of medical care.

On a local level, people like Warman, Bonner and Lopez are using more integrated techniques to fight the disease.