Rolling Out Asthma Care

As asthma rates in U.S. urban centers rise, several hard-hit communities are sending in the healthcare brigade to battle the growing epidemic.

By Deborah Gardiner

Something surprising is sending school-age kids in the Bronx to hospitals. This borough of New York City is now home to the highest rate of urban asthma in the United States.

According to the South Bronx Children's Health Center, 23.2 children per thousand in the South Bronx are hospitalized for asthma each year. That is compared with 10.2 per thousand in New York City as a whole and 3.7 per thousand nationwide.

Fortunately, the community is beginning to address urban asthma in the Bronx with initiatives to deliver asthma care and education directly to school kids.

The Asthma Van is one good example.

No more than a Winnebago converted into a doctor's office, the Asthma Van is staffed with a pharmacist, a doctor and two respiratory therapists. The van drives around the Bronx's public schools offering free asthma health care.

Senator Jeff Klein initiated the Asthma Van program in 1998. "The respiratory therapists provide education on how to monitor asthma to the parents of asthma sufferers and the pharmacists show the kids with asthma how to use the inhalers and other supplies," Klein explained.

Each week, the van tours approximately ten of the schools hit with the highest concentration of asthma, treating and advising roughly 35 kids a week. According to Klein, over the past 18 months the van has seen 2,500 kids.

Klein's initiative stems not only from the scary revelation that his constituency hosts one of the highest youth asthma rates in the United States, but also the fact that the Bronx has the lowest elementary school attendance rate in the country.

An area in the South Bronx, which Klein dubbed 'Asthma Alley' because of its hazardous smog levels, has an asthma rate of roughly 26 percent.

"Seven of the borough's 25 worst attended elementary schools are located within Asthma Alley," said Klein. "That means that because of asthmatic conditions, hundreds of students in the South Bronx are missing school every week."

The Asthma Van has been imitated in other parts of the United States as well. The Breath Mobile, an asthma program in Southern California, tours an area where the asthma rate is as high as 20 percent.

"This isn't just a screening. Our Breath Mobile is a comprehensive allergy/asthma clinic. We've treated almost 3,000 kids at 60 schools in the inner-cities covering South, East and Central LA, Hollywood and 20 schools in the Valley," said Dr. Hanley-Lopez, M.D., Disease Management Coordinator for the Breath Mobile Program.

"We've done a lot of quality of life data and seen that the kids are attending school more, the parents report that the child's grades are up and they are more attentive. Seventy percent of the kids we have treated have improved dramatically," said Hanley-Lopez.

Although no one knows exactly why asthma prevails in the Bronx and other high asthma areas like Los Angeles, Klein attributes it to the high level of traffic which raises smog levels. The Bronx's proximity to waste transfer facilities exacerbates air pollution as well.

Casandra Forbes, 35, a full time mom of six in the Bronx, says that smog causes her five-year-old daughter, Eboni's asthma and her eczema. "She definitely wasn't born with it. She's had it just for four years and always gets an asthma attack when she's running around outside. It lasts about 15 minutes," said Forbes. "You can see the pollution in the afternoons. It's smoldering a lot outside then and the chimneys are blowing smoke in the air."

But it's not just outdoor pollutants — indoor hazards play a part.

Low incomes also prevent families from getting the health care they need, she said. And, according to Mclean, poorer people tend to have more psycho-social stresses which in turn can aggravate health problems.

Some skeptics like Miles Weinburger, M.D., Professor of Pediatrics at the College of Medicine at the University of Iowa, think that the Asthma Van is great for raising asthma awareness but doubt the thoroughness of the care offered. Weinburger feels there is the potential for misdiagnosis.

"You have to make the right decisions when dealing with asthma patients," said Weinburger. "We just finished a report which showed that by making the right diagnosis...and using medications in a timely manner, ideally before the asthma turns into an acute episode, has shown a 90 percent decrease in the hospitalization of asthma sufferers."

Nor was Weinburger sold on the idea of liberally handing out asthma inhalers as a means to combat urban asthma.

In 1990, the Journal of the American Medical Association reported that while asthma medications were more widely prescribed, hospitalization rates were going up, not down. "It's important not to just do things for asthma; it's doing things that really make a difference," said Weinburger.

Forbes, the single mom in the Bronx, says that moving away from the Bronx, away from urban asthmatic conditions, is the best cure for asthma. But for families who can't move to cleaner neighborhoods, does outreach make a difference? For Angela Chisolm and her five year old asthmatic daughter, Christina, it really did.

Last fall, Chisolm signed her daughter up for a testing with the Asthma Van when it visited Christina's school, Crotona Elementary School in the Bronx. "We learned that the asthma pumps alone were not enough. Angela has to just sit down and be quiet as soon as the asthma attack begins. She can't just keep on running around," says Chisolm. "Now she doesn't get asthma so much because of the advice the asthma van staff gave her."

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