New York City Asthma Case Study

How does asthma fit into the Healthy People 2020? As it is stated in Health People 2020, the main goal is to, “Promote respiratory health through better prevention, detection, treatment, and education efforts.” Under this goal, Healthy People list several objectives such as, reducing asthma death, hospitalizations, emergency department (ED) visits, activity limitations, and miss school and work days; in addition, increasing education and prevention program (Healthy People 2020, 2014).

It is important to research environmental risk factors that influence asthma in low income neighborhoods to find possible ways to prevent asthma. The study “Urban Asthma and the Neighborhood Environment in New York City” proves that there is a positive correlation between neighborhoods and asthma hospitalizations.2 Children in lower income neighborhoods are more likely to be hospitalized due to asthma. Those living in lower income neighborhoods also tend to be minorities, which implies that African Americans and Latinos are more susceptible to asthma.2 Moreover, minorities are more likely to be living in public housing. The study explains that 11% of all housing units in Harlem is broken down and not suitable for living which proves that there is a positive correlation between the population of minorities and living in run-down housing and asthma related hospitalization.2

To better understand the impact of asthma, a brief overview of the causes (aetiology) and disease progression (pathophysiology) must be shown. As common as asthma is, not much is known about its aetiology, according to findings presented by Subbaroa, Mandhane and Sears (2009, pg. 181-187) in a review from the Canadian

Asthma is a chronic inflammatory disorder of the bronchial mucosa and hyperreactive bronchial tubes. Its etiology has been linked to both genetic and environmental factors. Several genes, including those that influence the production of proteins and cells involved in the immune response (such as interleukins, eosinophils, mast cells) have been linked with asthma. A decreased number of T-regulatory cells is also associated with asthma. Environmental factors linked with asthma include exposure to allergens, urban residence, and smoking (or exposure to secondary smoke). Recurrent respiratory tract viral infections may also contribute to the development of asthma. Decreased exposure to certain infectious organisms during early childhood, and the consequent underdevelopment of the immune response, can also lead to the development of asthma--this is known as the hygiene hypothesis (McCance & Huether, 2014, p. 1263-4).

Since asthma exacerbations in adolescence can lead to emergency room visits, hospitalizations, missed school and diminished health status, there was an evident need for effective asthma management for this population (Quaranta et al., 2014). Unfortunately, these rural adolescents with asthma, and their families, had difficulty determining when their asthma was poorly controlled; and unless the asthma symptoms were disruptive to family life, there was often little motivation for these individuals to seek medical care, thus increasing the risk of poor outcomes (Quaranta et al., 2014, p. 99). According

I met the community outreach programmer Ms. Lisa and I discussed with her about an appropriate evidence-based practice. Ms. Lisa said that there is not education program in Taney County Health Department for asthmatic people. Thus, she asked me to find a successful evidence-based practice, which has been applied in the other Counties or States

This results in Hispanics Americans living in very tightly-knit segregated urban communities, in older housing, and lack access to healthcare that can contribute to asthma exacerbation (Bhan et al., 2015). In the State of Connecticut there is a program called, Putting on AIRS or Asthma Indoor Risk Strategies. This program designed to assess environmental risk in the homes for asthmatic children and families. The hope is to reduce the frequency of asthma-related events by identifying environmental triggers. A public health nurse experienced in asthma management, conducts asthma education in the home. There is also an assessment for environmental asthma triggers in the home such as roach infestation or mold. The program follows participants over a six-month time frame, and has been shown to significantly improve outcomes for asthmatics (Nepaul et al.,

Asthma is a respiratory disease that many people deal with every single day. “According to World Health Organization, approximately 180,000 people die from asthma each year.” (Jardins and Burton 187) Most people never think of asthma as a life threatening disease, but it can be crucial. As the number of people with asthma increases, the more likely you are to come in contact with someone who has been diagnosed with this disease. Asthma is a severe breathing problem that has many complications that is dealt with daily like shortness of breath, chronic cough, tightness of the chest and shortness of breath, my main focus is childhood asthma, allergic asthma, and medication to treat asthma.

In this paper, I will explore asthma prevalence of children living in New York City. Asthma is an existing serious public health concern in inner cities and urban environments. Especially children with asthma from low SES families or minority groups face difficulties accessing health care, receiving high-quality continuous care, and preventative education. In other words, there is a disparity in the asthma prevalence and care in New York City.

As of 2009, studies conducted by the CDC have shown that asthma impacts approximately one in every twelve people, and the numbers only continue to grow (CDC, 2011). Some of the most common symptoms can range anywhere from coughing (especially at night or during exercise), wheezing and chest tightness, to shortness of breath. Asthma is often a chronic condition and while many times it can present itself as being mild, it can also sometimes lead to death if a person suffers an asthma attack. Asthma can be genetic, but it can also be caused, as well as exacerbated by, environmental factors such as air pollution. Studies have shown that children living in the Bronx are experiencing asthma at levels eight times higher than the national average. In addition, rates of death from asthma are a whopping three times higher than the national average, and hospitalization rates at about five times higher.” (Ruppell, 2000). Asthma is not a disease that targets only one group of people, yet the Bronx still exhibits disproportionately high levels of asthma especially in neighborhoods that are poorer areas of the city. In fact, people from these poor areas are 21 times more likely to be hospitalized due to asthmatic conditions compared to people from more affluent parts of the city (Ruppell,

Asthma affects 1 in every 12 Americans. According to the American Academy of Allergy Asthma & Immunology, Asthma is affects “About 1 in 9 (11%) non-Hispanic blacks of all ages and about 1 in 6 (17%) of non-Hispanic black children had asthma in 2009, the highest rate among racial/ethnic groups.” As a mother of child with asthma, I know how scary it can be to deal with asthma attacks and learning how to treat the symptoms and minimize risk factors.

Healthy People 2020 (HP) has set a goal to “promote respiratory health through better prevention, detection, treatment, and education efforts.” One focus is to reduce asthma deaths among children and adults under age 35 years (Healthy People 2000, 2017). HP also recognizes that asthma has many components that can be classified as either genetic or environmental. They are working to both to improve the quality of life for those who suffer from asthma as to reduce the strain ill place on societal recourses. Assessing living situations for environmental triggers is one evidence based practice that can be initialized and then to make modifications that immediately impact the health of an asthma sufferer. Secondly, making sure medical supervision

Throughout the years knowledge about asthma has grown, as well as treating it effectively. Over 300 million people are said to be victims of this disease with another 100 million being estimated by 2025 globally (Currie and Baker, 2012). In the United Kingdom, asthma is increasingly becoming one of the leading disease affecting individual of different age, ethnicity, race and gender. British Lung Foundation (2011) stated that it is more common at childhood stage and can also occur at a later age. According to Asthma UK (2014) asthma in men is less prevalence than it is in women and children troubled more with asthma than adults. Recent data in the UK shows that in children and occupational asthma in adult is on the rise with an estimate

Childhood asthma impacts scores of youngsters and their families. In fact, the bulk of kids develop respiratory illness before the age of

Experts have yet to understand why the rates of asthma are rising by an average of 50% every decade worldwide. According to the Asthma Society of Canada (2016), asthma is now considered to be a major health concern with approximately 235 million suffering from this illness worldwide. Kuhn et al (2015) states that as at 2012, one out of 12 people in the United States had asthma and the number continues to rise. More people have been diagnosed with this disease and in 2007; over 3000 deaths were linked to Asthma. Furthermore, the costs of treating asthma continue to rise with about 56 billion dollars being spent in 2007 compared to $53 billion in 2002 (CDC, 2011). From data gathered in California, which is our area of study, it was estimated that 2.3 million