Columbia University Medical Center

Defining The Inner-City Asthma Patient: A Basis For Change

NEW YORK, N.Y., April 26, 1998–Inner-city residents frequently rely on the emergency room of their local hospital for asthma treatment, a practice that is not only expensive and inefficient but a sign that they are receiving insufficient help in managing the disease on their own. Research presented by Jean G. Ford, M.D., assistant professor of medicine and public health at Columbia University and principal investigator for the Harlem Lung Center’s REACH Study, at the American Lung Association/American Thoracic Society’s International Conference in Chicago, gives a detailed picture of these patients and the difficult challenges they pose. Of 236 participants with asthma in the REACH (Reducing Emergency Asthma Care in Harlem) study, 93 percent were African-American, with a median of 11 years of schooling and a median household income of $ 9,000 to $11,000. Two-thirds of patients reported that they were considerably or severely bothered by asthma in the past year and experienced a median of 11 asthma episodes per year. The mean number of asthma-related emergency room visits during the past year was three for patients with mild asthma, and 12 for patients with severe asthma. Two-thirds of the patients had been hospitalized at some time in their life, 23 percent had lost consciousness, and 23 percent had been intubated because of asthma. Despite the severity of asthma in this group, asthma self-management skills — crucial for patient care — were lacking. Seventy percent of patients rely primarily on the emergency room for asthma management and only 8 percent regularly use a peak flow meter as recommended to monitor their asthma. Moreover, 43 percent of the total sample and 52 percent of those with severe asthma (more than twice the rate for New York state) smoke.
Since knowledge is crucial to self-management, investigators from the Harlem Lung Center’s REACH Project, led by Ilan H. Meyer, Ph.D., assistant professor of clinical public health at the Columbia University, developed a questionnaire to determine how much these same asthma patients know about disease management. Knowledge proved to be uneven. Patients had a relatively good awareness of asthma triggers, but lacked crucial information about the use of medications, the use of inhalers, and when to take rescue action.

The data demonstrate the urgent need for asthma intervention in Harlem. To fill this need the REACH Project is conducting a clinical trial to test the effects of a comprehensive asthma intervention from community health workers. “The purpose of gathering these profiles is to define the appropriate intervention strategy for the individual asthmatic patient, and tailor education to the patient’s needs, in order to optimize adherence to asthma management recommendations and improve outcomes,” says Dr. Ford, chief of pulmonary medicine at Harlem Hospital Center. The study was funded by the National Heart, Lung, and Blood Institute. ###