By Dr. Larry Chiaramonte
A new report on asthma by the Centers for Disease Control is discouraging. It shows that asthma among Americans rose by almost a full percentage point, to 8.2%, from 2001 to 2009, despite improved outdoor air quality and reduced exposure to tobacco smoke.
The numbers for certain groups were even more disturbing, particularly for children. In 2009 non-Hispanic black children, 17% had asthma, up from 11.4% in 2001. Other higher-than-average groups included male children (11.3%), adult women (9.7%), African-American adults (8.7%), individuals living in poverty (10.6%), and residents of the Northeast (8.7%).
The study’s authors are notably circumspect about the reasons for the increase. Fine particulates like those from diesel exhaust and low vitamin-D levels are going to get a closer look. From my perch in Ft. Asthma—the Bronx, both those factors make perfect sense. As my colleague Dr. Sam Deleon and I have both written, we are choking with tractor-trailer traffic. As for vitamin D, kids are getting less sun exposure because of less outdoor play and physical education, and they are probably drinking more cheap soda instead of D-fortified milk. If I had my way I would add vitamins B and C, magnesium and fish oils to the research list.
Still, whatever the etiology of the disease, the biggest problem lies in the fact that proven preventive and control regimens that are part of mainstream guideline medical practice are simply not followed, as these statistics indicate:
• 34.2% of respondents had been given an asthma self-management action plan
• 49.3% had received advice on environmental control
• 33.5% had long-term asthma control medications on hand
• 52.6% of those with asthma had had at least one attack in the previous year
• 11.5% of insured respondents said they could not afford prescription drugs
And the results are depressingly predictable.
• 59.1% of children had missed at least one school day
• 32.7% of adults had missed one or more work days because of asthma
• 26% of respondents had received emergency or urgent care for attacks and 7% had been hospitalized, with higher percentages among children than adults
Exacerbations cost us $56-billion in 2007 from health care expenditures and lost productivity.
For the thousandth time, this is an epidemic that we can manage. It depends on the right medication and the right behavior. When will we spend the pennies it takes to control it to save dollars (and lives)?