Many poor asthma sufferers stuck in settings that make their disease worse

January 4, 2017 by Amy Norton, Healthday Reporter

(HealthDay)—Poor Americans with asthma face constant challenges in managing their respiratory disease—from dilapidated housing to neighborhood violence to depression, new research shows.

The study offers a snapshot of the lives of living in inner-city Philadelphia, from the point of view of workers who visited them at home.

It's a bleak picture, and asthma experts called it "eye-opening."

The home visits revealed that most patients were unemployed and often lived in overcrowded homes in a state of disrepair: Major water leaks, mold, rodents and cockroaches—all potential asthma triggers—were common.

People were also frequently dealing with multiple medical conditions, such as diabetes and . And then there was the stress of daily living. Many faced neighborhood violence, had no transportation or lacked family and friends to help them.

"You can see just how desperate these people are," said Dr. Elina Jerschow, an associate professor in the allergy/immunology division at Albert Einstein College of Medicine in New York City.

Jerschow, who wasn't involved in the study, commended the researchers' effort. "They reached out to the patients who are least reachable, who don't come to the clinic, who have the fewest resources, and are the most vulnerable," she said.

In everyday practice, doctors typically focus on prescribing asthma medications, Jerschow noted.

But this study, she said, highlights an important fact: Coping with asthma goes well beyond health insurance and prescriptions.

"This study is truly eye-opening," Jerschow said. "We need to figure out how to better engage with our patients, including addressing the social issues."

How much can health care providers do?

For one, they can help connect low-income patients with social workers or local services that could help them, according to Dr. Tyra Bryant-Stephens, who led the study.

Bryant-Stephens is medical director of the community asthma prevention program at Children's Hospital of Philadelphia.

She said there's also a role for community , like those who were involved in the study.

"They are there in the home," Bryant-Stephens said, "so having them is really important."

Community health workers are specially trained laypeople who help vulnerable patients manage . When it comes to asthma, they might help people learn to use their inhalers, or set goals such as getting more exercise or quitting smoking, for example.

But for now, community health workers are not widely available across the United States, Bryant-Stephens said.

To her, the study throws a spotlight on issues that go beyond health care—particularly the difficulty poor Americans face in finding safe, livable housing.

"Poor housing is a health issue," Bryant-Stephens said. "You can't separate the two. I think the next big push in public health should focus on improving housing."

The study, which was published recently in the Journal of Allergy and Clinical Immunology, involved 301 adults with asthma.

All were living in impoverished Philadelphia neighborhoods and had been prescribed an inhaled corticosteroid to control their asthma symptoms.

When community health workers visited the patients' homes, they found that many were living in conditions that made it difficult or "impossible" to manage their asthma.

According to their reports, people were commonly renting one room in a crowded house—often one that was infested with pests, or plagued by leaks and mold. In many cases, patients either smoked or lived with smokers.

Many of the sickest patients were depressed, and often seemed to have few family members or friends to rely on.

Some descriptions from the health workers' reports paint a sobering picture:

  • "A 44-year-old female who smokes constantly lives in a basement with no windows and no ventilation."
  • "A middle-aged male is paraplegic due to a gunshot wound, has no social support, and is unable to get to the doctor's office."
  • "It's not just the finances, it's the violence, lack of education and job opportunities."
  • "Depression survey seems to trigger a lot of emotions. Often patients are crying as we try to complete it."

Although the study was done in Philadelphia, both Bryant-Stephens and Jerschow had no doubt the same struggles are happening in poor urban neighborhoods throughout the United States.

Jerschow agreed that community health workers could be part of the solution—in part because they can show that someone cares.

"They go to people's homes and let them know they're not alone," she said.

But ultimately, wider social efforts are needed, too, Bryant-Stephens said. "System-level changes have to happen to really improve people's health," she noted.

Explore further: Home visits uncover fuller picture of challenges among low-income adults with asthma

More information: The U.S. Centers for Disease Control and Prevention has an overview on asthma.

Related Stories

Home visits uncover fuller picture of challenges among low-income adults with asthma

December 16, 2016
Nationally, the highest rates of asthma-related deaths and hospitalizations are among low-income minority adults, but most existing research doesn't focus on these patients. In particular, studies may not investigate patients ...

Home remediation in low-income housing shows significant effect on childhood asthma

November 4, 2015
Children with asthma living in low-income, urban public housing had significantly fewer visits to the emergency department (ED), less use of rescue medication, and less disrupted sleep with a program that combines home repairs ...

Study links optimal asthma control with reduced health-care costs

November 10, 2016
In a study of 736 asthma patients in Singapore, good asthma control resulted in a saving of S$65 (US$48) per physician visit. Compared with an average cost of S$214 (US$158) per visit, this reduction represents a cost saving ...

Home-based educational intervention improves asthma among Hispanic children

November 10, 2015
Significant improvements in frequency of asthma attacks and symptoms, hospitalization rates and acute care visits, quality of life, and asthma knowledge were reported among a largely Hispanic population with a high asthma ...

Alternative treatment approaches may be needed for some children with asthma

October 5, 2016
A new study by Henry Ford Health System in collaboration with eight other health systems in large U.S. cities, has identified a group of children with asthma that may require a different treatment approach.

Certain red flags indicate an increased need for intensive care among patients with asthma

June 29, 2016
In patients admitted to the hospital for asthma, illicit drug use and low socioeconomic status were linked with an increased risk of requiring admission to the intensive care unit. Not adhering to asthma prevention medication ...

Recommended for you

Genetic immune deficiency could hold key to severe childhood infections

July 18, 2017
A gene mutation making young children extremely vulnerable to common viruses may represent a new type of immunodeficiency, according to a University of Queensland researcher.

What are the best ways to diagnose and manage asthma?

July 18, 2017
What are the best ways to diagnose and manage asthma in adults? This can be tricky because asthma can stem from several causes and treatment often depends on what is triggering the asthma.

Large multi-ethnic study identifies many new genetic markers for lupus

July 17, 2017
Scientists from an international consortium have identified a large number of new genetic markers that predispose individuals to lupus.

Study finds molecular explanation for struggles of obese asthmatics

July 17, 2017
A large, bouquet-shaped molecule called surfactant protein A, or SP-A, may explain why obese asthma patients have harder-to-treat symptoms than their lean and overweight counterparts, according to a new study led by scientists ...

Team identifies potential cause for lupus

July 14, 2017
Leading rheumatologist and Feinstein Institute for Medical Research Professor Betty Diamond, MD, may have identified a protein as a cause for the adverse reaction of the immune system in patients suffering from lupus. A better ...

Immunosuppression underlies resistance to anti-angiogenic therapy

July 14, 2017
A Massachusetts General Hospital (MGH) research team has identified a novel mechanism behind resistance to angiogenesis inhibitors - drugs that fight cancer by suppressing the formation of new blood vessels. In their report ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.