PULMEDIX
ASTHMA CARE CENTER & PFT LAB
8532 W. Capitol Dr. Milwaukee, WI 53222
Ph: (414) 393-4002
Fax: (414) 393-4014
Suite #L100
www.pulmedix.com
The Burden of Asthma in Milwaukee
Milwaukee is one of the worst asthma cities in the U.S.
Milwaukee is plagued by asthma more than almost every other city in
the U.S. and currently is in the midst of an asthma crisis. As recently as
2009, Milwaukee ranked second in the prevalence of asthma, and has
been in the top 10 cities for almost a decade. Statistics for asthma in
America are so high that the CDC (Centers for Disease Control) has
labeled it an epidemic. More alarming is the prevalence of asthma in
racial minorities and lower socioeconomic groups. Given the
disproportionate volume of asthma in Blacks and Latinos, there also exist
a disproportionate number of ER admissions, inpatient hospitalizations
and deaths due to asthma. Blacks and Hispanics have a slightly higher
prevalence rate of asthma than Caucasians (8.5% vs 7.1%), yet they are 3
times more likely to be hospitalized or to die from asthma complications
according to the CDC. This reflects the trend of health disparities that
exist in asthma prevalence, as it does in every other area of health for
racial minorities and lower socioeconomic groups. The asthma crisis in
Milwaukee is substantial and it is getting considerably worse. With
increasing numbers of uninsured asthmatics, overrun free health clinics
and the addition of high premiums for insured recipients, no other health
resource will be available for care other than emergency rooms and urgent
cares. Eventually, the situation will be even more critical, with grave
consequences, if this predicament continues unaddressed.
What causes asthma?
Research has found that the biggest factor for the development of this
condition is primarily genetic. Having one or both parents with asthma,
bronchitis or allergy genetically predisposes the children to the
development of these conditions. Generally, asthma in families exists in
large groups where multiple family members are afflicted. Asthma can
exist anywhere in the family tree line, but if those individuals were never
properly diagnosed with it, you may never know who in your family
actually has it.
Recent data reveals socioeconomic status that dictates geographic
residency location also has a dramatic impact on the development and
prevalence of asthma. Middle and upper income zip codes do not
experience the negative effects of asthma nearly as much as lower income
zip codes, in fact, the lower the income level the higher the presence and
morbidity rate for asthma. If poverty plays a role in asthma development,
one needs to only review the national poverty rating for Milwaukee over
the last two decades and we clearly see a correlation between our poverty
rate and asthma rates in those populations.
Why is poverty linked with asthma?
1) Research has demonstrated that there is a direct connection between
exposure to cockroaches and mice at an early age and the
development of asthma. Mice and cockroaches’ leave behind feces
(protein allergens) that children inhale and can become allergic to.
Mouse or cockroach allergen exposure may increase the risk of
developing allergies which is in turn related to the development of
asthma in children. Homes in the high-asthma communities also had
higher concentrations of the cockroach allergen as well as allergens
associated with mice and cats as reported in the Journal of Allergy
and Clinical Immunology.
1) Nearly 1 in 4 kids living in neighborhoods with high asthma rates
were allergic to cockroaches, compared to 1 in 10 kids living in
areas where asthma is less common.
2) Most low income residents are located in areas with poor air quality
due to a close proximity to expressways and large thoroughfares as
well as industries like WE Energies that refrain from using
expensive pollution control mechanisms when the surrounding zip
codes are low income, mechanisms installed in the plants
surrounded by higher income zip codes.
3) Economic status also affects food choices and nutritional access.
Low income residents may not have the resources to travel to the
closest grocery store and may not be able to afford the healthiest
foods. Areas, far from a grocer, that can only provide local corner
stores with few nutritious options have been described as food
deserts and found to be prevalent in many low income communities.
Food options are generally frozen foods like pizza’s and TV dinners
or junk foods-candy, cookies, soda’s and chips. Sometimes the
dollar menu at McDonald’s appears more appealing than going to
the store, buying groceries and cooking, and after all, it’s only one
dollar. Again research has clearly identified a causative relationship
between poor diet and the incidence of asthma. Typically foods that
lower the incidence of asthma are fruits, veggies and lean meats
especially fish that is rich in Omega-3 fatty acids, not the typical
corner store stock.
4) Another factor that contributes to developing asthma is low birth
weight. Milwaukee is nationally recognized for problems
surrounding pregnancy and birth especially in regards to premature
births and the infant mortality rate. Few cities rank ahead of us in
these categories where we generally lead the nation in poor
outcomes which, again, is highest in minority and low income
populations.
5) The incidence of tobacco use is also prevalent in these communities
and smoking or being around smokers during pregnancy is
especially harmful to the child’s lung development. Nothing is
worse for lung maturity than exposure to tobacco smoke during the
formative years of life. Exposing infants and children to second
hand smoke is one of the most dangerous activities a parent can
engage in and will be the most injurious to their respiratory health.
Unfortunately, far too many of our children live in homes with not
only one smoker in the residence but most often multiple smokers.
They are suffering at the hands of the very one’s entrusted to protect
and care for them.
These are the things you should expect from good asthma care:
TO…….
 Have an Asthma Action/Management Plan.
 Have no symptoms or minor symptoms of asthma.
 Be able to take part in daily activities-including exercise or
 playing sports.
 Have normal or near normal lung function.
 Have few or no side effects from asthma medications.
 Have no time off from school or work due to asthma.
 Have no emergency room visits or hospital stays.
 Sleep through the night without asthma symptoms.
 Have a partnership with your health care provider on meeting
your goals for good asthma care.
As mentioned before, asthma has a high degree of variability which
means sometimes you’re fine and other times you’re struggling to
breathe. This switch between the two states is known as variability (as the
symptoms change) and reversibility (from the presence of symptoms to
their absence). Reversibility can occur with or without medical
intervention. When all else fails, and in more extreme cases, professional,
emergency care will be needed in the form of breathing treatments and
oral or IV steroid administration. Life threatening situations may also
involve injections and infusions of drugs such as epinephrine or
theophylline, the addition of extra oxygen and may require the insertion
of a breathing tube into the airway (intubation) and connection to a
breathing machine (ventilator) for life support. Please note that making it
to the hospital and being connected to life support is not always a
guarantee of survival.
How do I know if I have poorly controlled asthma?
A good starting point here is Baylor’s “Rules of Two”. If you take
your quick-relief inhaler more than two times per week, if you wake up at
night with asthma symptoms more than two times per month or refill your
quick-relief inhaler more than two times per year, your asthma may not be
in good control.
You should not have to make frequent visits to the doctor, Urgent
Care, Emergency Room or be admitted often into the hospital, these are
all signs of poorly controlled asthma. What you may not know is that
every one of those visits increases the risk of not surviving this condition.
Studies have shown a direct relationship between the number of ER visits
and hospitalizations and those who die from asthma, in other words, the
greater the number of visits, the greater the risk of not surviving asthma.
What are the risks of poorly controlled asthma?
Death is, of course, the worst possible outcome; however, the risk of
impairment should be as frightening as well. Most people with asthma
experience reversibility, the fluctuation between the presence and absence
of symptoms; however, if not managed properly, this reversibility
component diminishes. This means that symptoms of difficulty breathing
will become more frequent, more intense and will continue for longer and
longer periods of time. At this point, the condition will be more difficult
to manage and will require higher doses of stronger medications that carry
more side effects. A lack of responsiveness to asthma medications reflects
a loss of reversibility and asthma can deteriorate into a more debilitating
condition known as COPD (Chronic Obstructive Pulmonary Disease).
This condition is characterized by frequent, often unrelenting
symptoms that have a corresponding decrease in the person’s ability to
function in a near normal capacity. How well can one function when
struggling to breathe becomes a daily ritual? There are three paths to
COPD: 1) Smoking 2) Uncontrolled asthma and 3) Smoking with
uncontrolled asthma aka the fast track to COPD. If the asthma
medications you take used to work for you but now they don’t, it may be
that COPD has developed inside your lungs.
The onset of asthma can begin as early as birth and management
needs to begin corresponding to the onset of symptoms. The longer
asthma goes unmanaged, the more changes that occur in the lungs that can
be irreversible and irreparable, a process called airway remodeling or a
restructuring of the lung tissue contained in the bronchial tubes.
Unmanaged, poorly controlled asthma can debilitate and disable a person
as early as 30 to 40 years of age. This has a corresponding decrease in
quality of life, would require supplemental oxygen to assist breathing,
pulmonary rehabilitation to retrain breathing and a much shorter life
expectancy as well.
Do I have asthma?
To determine if you have asthma, you first need to do a self
assessment.
1) Are you experiencing any of the four classic symptoms: coughing,
chest tightness, wheezing or shortness of breath?
2) Do the symptoms occur during routine activities such as walking long
distances, carrying groceries, doing laundry or going up and down stairs?
3) Are you ever awakened at night from any of these symptoms?
4) Do certain environments create these symptoms such as being around
pets, strong odors, outdoor allergens, dust or tobacco smoke?
5) Are any of the symptoms triggered by anxiety, stress or strong
emotional expression such as laughing, crying, yelling or anger?
If you answered yes to any of the above, then the final question you need
to ask is:
6) Do any family members have asthma, allergies, bronchitis or any other
lung disorders. They may not have been properly diagnosed but if they’re
using an inhaler, that’s your first clue.
I answered yes to the asthma questions. Now what?
These are the identifying elements of determining if you should
have your breathing investigated to confirm if asthma is your problem.
Investigating means evaluation with testing and a detailed symptom
history. The sooner evaluation and treatment is sought, the better the long
term outcomes will be. This is also true for infants and young children
who doctors are often reluctant to diagnosis with asthma. However, it is
less important what they call it and most important that it is treated
appropriately and within a timely manner. Too often preventative
treatment is delayed due to age and the results are frequent office, ER and
Urgent Care visits due to increasing symptom frequency, duration and
intensity. Breathing is designed to be effortless in its’ resting state. If your
baby or child does not appear to be breathing with ease at rest AND there
is a definitive family history of allergy and/or asthma, you need to talk to
a specialist. If one parent has asthma/allergy, the likelihood of the child
developing asthma is around 40%. If both parents have asthma/allergy,
that figure rises to above 80%, so you should be aware of these factors
even before your child is born to know what to look for and what to do in
the event your child is positive for some breathing disorder.
Asthma and You-How You Can Make a Difference
Asthma has affected the poor and racial minorities more than
any other groups in Milwaukee with higher inpatient hospitalization rates
and ER visits. A large part of the problem lies within the structure of the
healthcare system; poor health care delivery systems, lack of access to
adequate insurance coverage and lack of motivation of providers to
change the current model of managing these populations so poorly.
However, we must make it incumbent upon us to do our part to survive
and thrive without succumbing to a very manageable condition.
We need to be educated about the condition so that we know what
questions to ask our providers. We need to stop crisis management or
episodic treatment of this condition, in other words, we need to continue
our treatment even when we’re feeling fine and there are no symptoms.
We need to be honest with providers about any concerns we have with the
medication plan. Don’t agree to do something that you do not plan to do.
Don’t try to fool your provider by telling them you’re following the
medication plan and you’re not. If you have concerns about the
medications in your plan, tell your provider and see what other options are
available. We need to take care of our breathing to keep us out of the ER’s
and hospitals that are robbing us of a higher quality of life so
unnecessarily.
We need to stop making the excuse of not having time to manage
asthma. What is on your to do list that is more important than breathing? I
recognize that some of the problems are with the system not playing the
role of health care provider but I also see many of us not keeping our
doctor appointments, not picking up medications from pharmacies, and
worst of all, the number of asthmatics that continue to smoke is alarming.
The Costs of Asthma, Is There A Better Way?
The health care system is designed to take care of you when you’re sick,
they profit on you being sick and should probably be called a sick care
system instead. Our numbers in the hospitals reflect the success of their
strategy. If our health care system was truly committed to your health, it
would invest in the measures that would prevent numerous ER visits and
hospital admissions for asthma. Because asthma primarily affects the
poor and minorities, these populations are most likely to be found on
Medicaid. The cost of asthma care in hospitals then is astronomical. We
are using taxpayer money to fund the most expensive form of care that
produces the worst outcomes for patients and we have been stuck in this
rut for over two decades. This is a truly broken system that works for no
one, everybody loses.
The financial impact goes beyond just the massive cost of
expensive care, but it extends into education and the workforce. Asthma
is the number one cause of school absenteeism causing vast numbers of
school age children to either miss a lot of school days or be unproductive
at school because of the difficulty they have breathing. They miss sports,
gym and other extracurricular activities that are essential to the normal
development and well being of children. Parents miss work to care for
children, schools miss funding when children are absent and the entire
educational system is disrupted. People with asthma are losing jobs
because of the frequency of their asthma attacks and the high number of
sick days they must use as a result of their condition. While racial
minorities and lower socioeconomic groups are facing the greatest
number of obstacles to employment and education, asthma is one hurdle
that has the best chance of being removed.
If we could move education and evaluation to the forefront of
asthma management, it would save millions of dollars, improve the lives
of millions of people and provide a system that would actually benefit all
parties involved.
It’s time we make a stand for ourselves and show the world we
can combat this menacing disease and see life in a new light.