The Politics of Asthma

Asthma affects more than 6 million children in the United States – about 7% of all children between the ages of 0 and 17. While the prevalence of asthma is fairly equal across all races, a black child is three times as likely to be hospitalized for asthma as a non-black child. A black child is four times more likely to die of asthma. Among adults, black women are one and a half times more likely to face severe limitations to their daily activities than white women, and black men are nearly twice as likely to die of asthma as white men. While there may be a genetic reason for those statistics, many health experts suggest a more insidious reason for the disparity of those figures – institutionalized racism.

According to national statistics, when preschool children are hospitalized for asthma, 21% of white children are prescribed follow-up medication and aftercare. In comparison, only 7% of black children are prescribed the same care. Black men are far less likely to be referred to specialists for treatment of pulmonary diseases, including asthma. In the year after their first emergency room visit for asthma, black children will return nearly six times as often as white children. By the same token, 70% of the white children visited their primary care physician and 38.8% were referred to a specialist in allergies and asthma, but only 40% of black children were followed by a primary care doctor, and less than 23% were seen by a specialist. If you’re a black, your risk of having your life significantly affected by asthma – or being killed by it – are significantly higher than the risk for any other racial group.

Research points to the fact that this isn’t a genetic difference, but a socioeconomic one, and current initiatives to improve asthma care focus as much on educating and outreach as they do on providing medication. By educating the community about the proper standard of care for asthma, groups like the Center for Disease Control and the American Lung Association hope to narrow the gap between the medical care received by black children with asthma and the medical care received by white children with asthma.

If you or your child has been diagnosed with asthma, the more you know about the condition and its treatment, the better the care you’ll receive. You should expect:

1. A consultation with a doctor to work out a plan for managing your asthma. The plan should include regular visits to your family doctor to monitor the effectiveness of the treatment.
2. It may include a prescription for two to three different medications. One will be a ‘rescue inhaler’, to be used when you have an acute asthma attack. In addition, your doctor will very likely prescribe a daily medication to help prevent acute asthma attacks. For children, it may also include daily nebulizer treatments to deliver medication directly to their lungs.
3. A referral to a specialist if standard medication doesn’t alleviate the symptoms.
4. Education on how to prevent and protect yourself or your child from asthma triggers.

There are some steps you can take to increase the quality of the care that you or your child receives as well.

1. Educate yourself about asthma and its treatment.
2. Follow the doctor’s instructions.
3. If you don’t have a primary care physician, do everything within your power to receive your care from the same doctor. At least that way you’ll have a doctor who can follow your progress because he knows your history.
4. If your current treatment isn’t working, ask to be referred to a specialist.