Term Paper: Asthma and ER Utilization

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[. . .] Asthma is more prevalent among African-Americans. The incidences were almost twenty two percent higher than Caucasians. On average, in every state in American, blacks suffered from asthmatic attacks almost eight percent more than whites did. The Hispanic population also suffered a greater number of attacks. (CDC, 2001)

Geographic disparities play an important role in the negative impact of asthmatic attacks. In poorer states, where more residents have difficulties in accessing health care have a greater incidences of asthma. Climatic conditions and states with greater polluting industries pose a greater risk for complaints with asthma. The states of Arizona, District of Columbia, Illinois, Indiana, Maine, Massachusetts, Montana, Nevada, New Hampshire, Ohio, Oregon, Rhode Island, Washington, West Virginia and Wyoming have higher percentages of asthma complainants than other states. The importance of occupational asthma, especially in adults has already been discussed. (CDC, 2002a)

Besides these broad demographics, personal impact is very important. Quality of life from symptoms and chronic bouts of asthma will be discussed in the following subsection. Deaths from asthma are more likely to affect African-American. In some cases, almost three times as much. Visits to emergency rooms number in the millions, annually. African-Americans visit ERs almost four times as whites. Children visited ERs about twice as many times as adults and women were also affected more than men were.

The unfortunate feature of this negative impact is simple preventive measures, to be discussed in a subsequent subsection, can prevent excess recourse to ERs and hospitalization.

Absenteeism from work results in drops in productivity which has long-term and indirect economic impacts. This amount easily runs into the billions of dollars. Several million work days are lost as a result of asthma. Besides loss in productivity in dollar amounts, there is also a loss of income and earnings, which is in the billions of dollars, from illness and death. Direct medical costs also range in the billions of dollars. They strain ERs where free treatment is mandated. The health care system, which is already stressed, is burdened further.

There is hope if the right efforts are made in creating Asthma Management. Short-term costs can realize long-term benefits since research through clinical trials has shown that most of the negative impacts can be easily removed through a simple system of education with efforts made to establish asthma specific clinics. The education and effective medication disbursement plans can actually help patients and positively impact the bottom lines of pharmaceuticals and the health care. (CDC, 2002b) It is imperative in terms of morbidity and mortality that more efforts are made in inner cities where lack of education and lack of preventive maintenance cause most of the problems that can be otherwise easily managed.

Quality of Life Issues

Every attack of asthma produces in the patient the fear that man's most basic involuntary function of breathing is compromised. The inability to take in a breath or expirate with normal force causes significant problems in how a person goes about his daily life. In the previous subsection, we have seen how asthma affects the inability to go to school and learn; or, in the case of adults, the inability to work, especially in the case of occupational asthma. The impacts that we have seen however, reveal only a small part of the problems that a patient faces. Most of the quality of life issues are personal. These problems are exacerbated if the asthma is not managed properly or if the person is clinically or environmentally more vulnerable to the problems. (USDHHS, 2000)

Some of the problems have to do with difficulty in sleeping, disturbed nights, stress and emotional problems. Not only is the patient's life affected, the lives of those around him are impacted negatively almost equally. The patient might be faced with the loss of job. The primary caregivers' jobs are also jeopardized. The loss of jobs if is often accompanied by a loss in benefits such as a higher standard of health care. Cost considerations in obtaining appropriate medication will result in the patient being caught in a vicious cycle, where medication that would treat the condition cannot be acquired.

Extracurricular activities are affected, as is the social life. Physical exercise is significantly hampered. One study showed that forty eight percent of the people reported that asthma affected their recreational activities. Thirty-six percent of the people believed that they could not carry out normal physical activities and twenty five percent reported a problem with social activities. Thirty percent people reported that they could not get a good night's sleep and often awoke from sleep due to breathing problems. (AsthmaInAmerica, 1998) In another study, the results were even worse. Eighty-four percent of the respondents believed that their lives had been negatively impacted. And a large percentage also believed that their asthma affected the quality of lives of their children. The patients were not able to visit friends' home for fear of an attack; or as the previous study, the subjects also reported problems with conducting normal routine or recreational activities. As has been described previously, studies have shown that social and family events have to be cut short and are severely restricted. (ALA, 1998)

Juniper and co-workers have developed a questionnaire to measure the quality of life for asthmatic patients. This is not only important from the standpoint of knowing more about the patients. This questionnaire, used all over the world is an important starting point in choosing patients for clinical trials. Knowing more about the patient is a first step in the beginning of a diagnosis and establishing a treatment method or even a more global asthma management program. (Juniper et al., 1992) The questionnaire consists of thirty two questions. It takes less than ten minutes to complete and is evolutionary. The questionnaire can also be used to measure the changes in quality of life, perhaps after a clinical trial or after a treatment regimen. The questionnaire addresses four basic areas: symptoms, emotions, exposure to environmental stimuli and activity limitation. The questionnaire can be self administered or it can be a part of an interview process.

Socio-Economic Factors in Asthma

The negative impact features and some of the causative asthma triggers have shown that socially and economically disadvantaged patients are more susceptible to asthma than the general population. Factor such as poverty result in inaccessibility to effective medication, which has been proven to be efficacious, is not available to these patients. The lack of education and awareness among the poor is one of the reasons why they cannot access the health facilities that are available. Race is not a consideration in incidences of asthma, per se. All races are equally susceptible. But since the minority races of African-Americans and Hispanic-American overwhelmingly represent the poor in this country. They are more likely to present at ERs or clinics with asthma. The subsection on Effects and Impact shows that minorities and children, and in some cases, women, are also particularly susceptible.

There is a strong variability in asthma presentation and the specific reasons are not known. It is possible that there are several factors that cause asthma. For instance, children in Papua New Guinea have no asthma, though the neighboring Caroline Islands have a 50% incidence among children. We have seen how asthma has risen by sixty percent in children in the United States. Interestingly, asthma has doubled in children in Western Europe during the same time period.

A study of hospitalization of asthma patients that represented specific inner city zip code in New York showed that family income, minorities in the population and children under the age of eighteen were overwhelmingly represented. (Suarez-Varela, Gonzalez, & Martinez Selva, 1999) A 1999 Chicago study found that almost a third of inner city kindergarten children had symptoms of asthma and only ten percent had been diagnosed because their condition was particularly severe.

A cross sectional demographic study based on mortality (from asthma records) showed that blacks were five times as likely to die from complications from asthma. The study also showed that the less educated had mortality levels almost two and a half times that of educated individuals. Also, low income patients were twice as likely to die as those from a higher income level. Even when factors of education and income were taken out of the equation, the study showed that the genetic proclivity for African-Americans to suffer (and/or die) from asthma was higher than Caucasians. (Haan, Kaplan, & Camacho, 1987)

As has been mentioned before, specific studies related to hygiene from inner city living conditions played a critical role in incidences of asthma. Cockroach and dust mite allergens are present in overwhelmingly large amounts in inner city homes. An Atlanta study showed that cockroach allergens were present in the dust of most urban homes, but were not found in twenty six suburban homes. (Ernst, Demissie, Joseph, Locher, & Becklake, 2004)

Preventive Measures for Asthma

Besides the effective treatment methods already established that seek… [END OF PREVIEW]

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