Neighborhood Organization for Pediatric Asthma Management in the Neighborhood Asthma Coalition: Reasons for Deficits in Basic Care
A major problem for low-income African American audiences appears to be failure to follow very basic components of asthma management. A recent death of an African American child in one of the neighborhoods in St. Louis in which we have been working was attributable to a delay in receiving care because of failure to recognize symptoms, lack of understanding of asthma treatment, and/or inability to obtain such treatment; the child was given only cough syrup to treat asthma symptoms for 2 weeks prior to the further exacerbation of symptoms which ended with death. Previous work has linked deaths from asthma to inappropriate or insufficient treatment. Flovent inhalers comments In five cases of asthma-related deaths in 1987 in the St. Louis area, all were African American and of low socioeconomic status. Lack of prescribed corticosteroids in two decedents with known severe asthma and markedly subtherapeutic or zero serum theophylline levels at the time of fatal episodes in four of the five dramatize the need to promote adequate basic care as well as comanagement to those who may be unaware of its importance or unsupported in its pursuit. A similar pattern characterized 14 pediatric asthma deaths in Brooklyn, NY.
Deficits in basic care appear to reflect a variety of problems, including lack of access to care and economic barriers to purchase needed medications. For instance, asthma mortality is higher in regions with more medical specialists, even after adjusting for region size. Thus, the problem is not simple proximity to good care but other barriers to its use. Other research indicates generally reduced contact with and utilization of formal and professional health services among African Americans. The importance of barriers to care is also suggested by a study in which asthma education alone did not lead to reductions in emergency department visits. The authors concluded that reducing morbidity and excessive reliance on emergency departments requires more than changes in an individual’s knowledge. Standing behind all of these are, of course, economic factors. Within our study population, 10% have no insurance and 65% are covered by Medicaid.