National Nurses United

Asthma 6/11/06 11:31 AM Page 14 People in areas with elevated crime rates— which were generally poorer areas with high numbers of minorities—tended to lock themselves into their apartments. "If residents feel uncomfortable about walking outside or leaving windows open for fresh air, they may be continually exposed to higher levels of indoor allergens such as dust mites and cockroaches," writes Christopher Browning, coauthor of the study and assistant professor of sociology at Ohio State University. "This may be particularly bad in poor neighborhoods where housing is substandard and there are more allergens such as mold that could trigger asthma." Health professionals say the stress that accompanies poverty can also play a role. "Many of my patients live very chaotic and stress-filled lives trying to survive in school or work, and to foster healthy relationships with their peers," says Nancy Lewis, RN, a family nurse practitioner at the Department of Public Health in San Francisco. "Add to this asthma triggers and a lack of regular checkups with primary health providers, and it sets up patients to end up hospitalized or worse—dead." Brunner also points out that the disease itself creates stress. "It is very disruptive of family life. Parents have to keep getting up in the middle of the night, and everyone still has to go to school or work the next day." The pattern the Ohio State University study uncovered, and its link to income, is repeated across the nation. New York City has twice the national hospitalization rate for asthma as the rest of the country, but East Harlem has nine times the national rate. The depressed community of Bedford Stuyvesant has five times the rate of more affluent Park Slope. The average per capita gross income in the former neighborhood is $7,406, for the latter, $18,666. Both are in Brooklyn. A study by the Heilbrunn Department of Population and Family Health at Columbia University even found that asthma-causing antigens could develop before birth in response to "a significant exposure to cockroaches and mouse antigens and in utero sensitization to multiple indoor antigens." Where you are employed makes a difference as well. According to the American Lung Association, more than one in three adults who suffer from adult-onset asthma can trace their disease to the over 400 substances in the workplace that can trigger asthma. Nursing, food preparation, and clerical work tend to be among the most common 14 REGISTERED NURSE asthma-linked jobs. However, according to Dr. Anne Krantz, toxicology division chief of occupational medicine at John H. Stroger Jr. Hospital in Chicago, the most common problem is "when someone takes a pre-existing asthma condition into a job and the job makes it worse." Krantz says avoiding jobs that either trigger asthma or exacerbate it may be difficult because "income disparity sometimes forces people to take jobs or stay in them though the job gives them asthma or makes it worse." She added that people in poor communities "don't have the economic or social mobility of other populations." Some industries, like ports, are a particular problem. "Diesel pollution is omnipresent on the docks," says Steve Stallone, a spokesman for the West Coast International Longshore and Warehouse Union (ILWU). "It covers all the equipment, the containers, the men's clothes, so you know what they are breathing in. Most longshoremen will tell you they have respiratory problems. They are always short of breath." Diesel particulates stimulate the production of IaE antibodies, which according to a study by the U.S. Department of Health and Human Services, enhances an individual's response to allergens. You don't have to live in a huge city or work in industry to join the asthma fraternity, however. Fresno, in the heart of California's agricultural-centered Central Valley, would hardly seem ground zero for an asthma crisis. But fully 30 percent of the city's schoolchildren have asthma. Figures show Fresno has a worse ozone problem than Los Angeles. Ozone is considered an asthma trigger. From 1999 to 2004, Fresno failed federal air standards 38 percent of the time, but a federal appeals court recently allowed the county to put off meeting federal standards until 2010, according to a January New York Times article. Fresno residents are pressuring local air quality officials to confront the problem, but they are finding it an uphill battle against powerful interests. "It's DOA—development, oil and agriculture," said Susan Britton, an attorney for a group that works to improve air quality standards called Medical Advocates for Health, in the San Francisco Chronicle. "Those are the primary economic drivers in the Valley." Last year the Bush Administration exempted agriculture from pollution conW W W. C A L N U R S E S . O R G trols, even though the industry is responsible for 25 percent of Fresno's problem. I f asthma is a complex disease, what to do about it is equally complex. Education makes a difference, as programs in New York City and Los Angeles have demonstrated. The National Asthma Education and Prevention Program in Los Angeles found that 67 percent of inner-city children with asthma got control of their disease if they were educated and treated by the organization's "breathmobile." Only 10 percent in a control group without access to the breathmobile managed to do so. New York City's Department of Health's intensive, community-based asthma management program found that education and treatment had a dramatic impact in reducing the seriousness of the disease. Hospitalizations were reduced 28.3 percent in the South Bronx; 42.8 percent in Washington Heights; 38.6 percent in Fordham; 36.3 percent in Williamsburg-Bushwick; and 25.8 percent in central Harlem, according to a January Financial Times article. Access to healthcare is clearly a major variable. Many children in these communities are on Medicaid, which studies show means they will have worse asthma and use fewer preventative medicines than children on private health plans. De Calvert, a Kaiser Permanente RN in pediatric asthma, is careful not to over generalize about the access issue, but agrees, "There are more disease management problems with people on welfare or Medi-Cal." JUNE 2006

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