ASTHMA: ‘One of the Biggest Mysteries in Modern Medicine’
While the burden of AIDS on the poor and minorities is well documented, asthma, the "other inner-city epidemic," remains an enigma, according to a front-page story in today's New York Times. Asthma claims approximately 5,000 lives per year in the U.S., but the mortality statistics shed no light on a mysterious explosion in asthma cases among the nation's poorest urban residents -- especially children. The number of American asthmatics increased from 6.7 million in 1980 to 17.3 million in 1998, 4.8 million of whom are children. Although the asthma eruption cuts across racial and socioeconomic lines, the disease proves slightly more prevalent among blacks than whites -- a fact that scientists attribute, at least in part, to genetics. But when public health officials measure rates of asthma-related hospital admissions, emergency room visits and deaths, they discover that minorities, and especially the poor, are much more significantly impacted by the disease than are whites. A 1995 Government study revealed that blacks were two to three times more likely to die from asthma than whites; a study from the same year noted that blacks made four times more emergency room visits for asthma-related ailments as did whites.
Physicians note that asthma suffers are able to lead normal, unrestricted lives -- providing that they receive the proper medication and subscribe to daily treatment and monitoring. However, "many patients do not get the medical supervision they need or do not follow their drug regimens properly," and so, despite new asthma treatments, hospital admissions for asthma increased in the 1990s. According to the Times, nowhere are the racial and socioeconomic disparities of the disease more striking than in New York City, where the incidence of asthma-related hospitalizations is 21 times higher for residents of the Bronx and Harlem than in more affluent areas of the city. NYC Public Health associate commissioner Dr. Andrew Goodman notes that, in these neighborhoods, asthma had skewed the perception of health that, "people were accepting a level of symptoms as being, quote, normal." Two years ago, Dr. Goodman's department instituted a childhood asthma initiative, which coordinated efforts of health care providers, educators, housing authority administrators and researchers, and costs taxpayers $6 million annually. As Louise Cohen, the initiative's director, explained, "The traditional way to deal with a disease is to have a doctor and a patient working together to make sure they are on the right medicines and so forth. That is necessary but insufficient around asthma. There is a whole set of social support that needs to be built."
Researchers Focus on Causes
Ten years ago, scientists typically would have agreed that pollution serves as a major cause of asthma, which explains why urban-dwellers are so susceptible. However, current research shows that "asthma cases are surging as pollution levels are declining," sending scientists looking for another causal factor. This month, a team of researchers at Lawrence Berkeley National Laboratory discovered two genes reported to contribute to asthma. Another theory suggests that the rise in asthma is related to improved hygiene -- babies are less likely to be exposed to viruses and bacteria at birth, thus their immune systems are left vulnerable to asthmatic triggers. In the first study of its kind, researchers at Columbia University are working to determine when the sensitization to allergens occurs, focusing their research on 480 expectant mothers. Dr. Frederica Perera, of Columbia's Center for Children's Environmental Health, explains that researchers "are interested in prevention and prevention means going younger and younger until you can stop the process, and not waiting until children are using inhalers at the age of 5 or 6."
In efforts to reverse the growth in asthma, the federal government is "stepping up asthma research." HHS Secretary Donna Shalala announced the department's intention to develop a "strategic plan" for research into asthma causes, which comes in addition to the $118 million in asthma research plans offered by the NIH. President Clinton also included $50 million in grants, earmarked for state programs improving asthma treatments for Medicaid recipients, in his proposed FY2000 budget. Yet, asthma was omitted from Clinton's list of six priority illnesses targeted for the Administration's program to eradicate racial treatment disparities over the next five years. But U.S. Surgeon General Dr. David Satcher explains "One of the real issues is, why are we seeing this increase in asthma? And we don't know the answer to that. Until you understand why you have the increase, and you have documented it, it is very hard to say you have a strategy that is going to make a difference" (Stolberg, 10/18).