Asthma is a common lung disease that remains a great challenge to health care management systems in several countries. Particularly in US there is an evident disproportionality in its prevalence. Asthma is more common among minorities especially African-Americans compared to others, and its control seems to be complicated by several socio-economic factors. In this paper, these are discussed in detail.
Disease and Symptoms
A lung disorder characterized by reversible obstruction of the respiratory tract is known as asthma. This obstruction occurs due to inflammation in response to allergens such as pollen, dust or smoke, stress, exercise or changes in environmental conditions. Asthma is also an example of a type I hypersensitive disorder in which, the body’s immune system reacts in an exaggerated manner to an antigen or allergen, thereby triggering a series of allergic reactions. During an asthmatic attack, a person experiences shortness of breath, tightening of chest muscles, wheezing and coughing (American Lung Association, 2010). But, these symptoms could vary in severity based on an individual’s sensitivity to a particular allergen that triggered the response. Also, there is no cure for asthma and if appropriate control methods are adopted, its incidence can be prevented.
Factors Affecting Asthma Vulnerability in Minorities
In America, the disease is more prevalent among certain races especially the minorities. According to the American Lung Association’s report, for every 1000 Americans the prevalence rate of asthma was 105.5 for African-Americans and only 78.2 for Caucasians. Asthma associated death rates were also more among African-Americans (2010). According to United States Environmental Protection Agency (EPA), African-American children have two times the current rate of asthma as Caucasian children. Increased prevalence among a certain race or ethnicity is either attributed to genetic or environmental factors. Additionally, there is a close association between the disease’s prevalence within a certain population and its demographics.
Genetic factors
It has been established through research that polymorphism of certain genes coding for proteins involved in immune response could be the reason behind increased susceptibility to asthma. So, certain races may be more vulnerable to asthma due to their specific genetic makeup and treatment can be done only to alleviate the symptoms. However, environmental factors associated with the disease are well identified and can be easily modified.
Environmental factors
Most African-Americans affected by the disease belong to the low-income group of the population. They do not have access to proper health care or live in unhygienic surroundings and lack social support. Tobacco smoke, cockroach allergen, obesity and higher air pollution levels are common factors that have a direct relationship with the disease’s prevalence among African-Americans (Silvers and Lang, 2012).
Mode of Transmission and Control Measures
The disease is not communicable and is not transmissible through any route. Also, no pathogenic microorganisms are known to cause asthma. Allergens or irritants that are inherently non-pathogenic trigger inflammation of the airways and the symptoms are mainly caused due to body’s own reaction to those external stimuli. Only the environmental conditions have to be improved, and exposure to the allergens should be minimized, in order to prevent the disease. In a closed environment, it is essential to maintain air conditioning, heating and cooling systems properly, to ensure there is proper ventilation and reduced exposure to air pollutants. In an open environment, appropriate personal protective equipment such as masks could be used to prevent exposure to the causative agents. Also, strict regulations to reduce air pollutant emissions from vehicles and industries, use of clean alternative fuels as well as mandating regular emission checks could help to a great extent.
Conventional & Alternative Treatment Options
Inhalers or pills with corticosteroids or other therapeutic compounds are available, and these medicines usually relieve the congestion in airways and facilitate breathing. Asthma treatment involves only minimizing the symptoms, and the disease is not completely curable. However, inhalable corticosteroids (ICS) are not available to the minority, vulnerable races due to its cost, lack of health insurance coverage as well an inherent lack of belief in treatment (Silvers and Lang, 2012). According to Asthma and Allergy Foundation of America (AAFA) “unproven” alternative treatment methods are adopted to alleviate asthma symptoms. These include acupuncture, Ayurveda or other herbal supplementation, massage and relaxation therapy, hypnosis, music therapy, exercise, yoga as well as lifestyle changes. These treatment methods have been useful in minimizing allergic symptoms but still there is very less scientific evidence on their effectiveness against asthma (AAFA, 2005). But, people with less access to proper health care facility, due to their socio-economic status often choose cheaper alternatives and somehow cope up with asthma.
Community Health Promotion and Wellness Strategies
Several efforts are taken by Governmental agencies to minimize the incidence of asthma, especially in children belonging to minority races, who are highly vulnerable. African-Americans show reluctance in approaching health care providers, even if they do, there is inadequate follow up and they receive only suboptimal level of care. Also, African-Americans respond in a different manner to treatment with ICS when compared to Caucasians. The National Institute of Health (NIH) has thus come up with “Best African American Response to Asthma Drugs (BARD) study,” an effort to minimize disparities in asthma treatment outcomes. This study involves clinical trials in 500 asthma patients, comprising of African-American children as well as adults from 14 different states in US (NIH, 2014).
According to EPA’s fact sheet, on “Children’s environmental health disparities” several important actions have been taken by US government to protect children from Asthma. These include air quality monitoring tools for schools, homes, environmental checklists and other community based programs. EPA’s indoor air quality tools for schools program helps school managements keep track of their air environment quality and prevent exposure of children to potential allergens. Asthma home environment checklist helps identify asthma triggers at home, and community education programs help families make proper assessments of their home environment as well as take appropriate steps to minimize indoor air pollution. Community programs organized by federal governments also aim at minimizing fossil fuel usage and shifting to cleaner alternatives with minimal emissions.
Conclusion
On the whole, asthma prevalence among minority races can only be controlled by combined efforts from the government as well as the community. Early detection, proper communication with health care providers and continued cooperation to treatment can improve the present situation. Environmental and socio-economic reasons can be completely eliminated, and it is the government’s responsibility to ensure all members of the society receive equal care without disparities. Educational and awareness programs, especially those involving children, can help in completely eliminating the disproportionality in asthma prevalence, in the near future.
References
AAFA. (2005). (chap. Alternative TherapieAsthma and Allergy Foundation of America Information About Asthma) Retrieved Jun. 4, 2014, from http://www.aafa.org/display.cfm?id=8⊂=16&cont=4
American Lung Association. (2010, Month. Day ). In State of Lung Disease in Diverse Communities 2010. (chap. Asthma) Retrieved Jun. 4, 2014, from http://www.lung.org/assets/documents/publications/
EPA. In Children’s Environmental Health Disparities: Black and African American Children and Asthma. Retrieved Jun. 4, 2014, from http://www.epa.gov/epahome/sciencenb/asthma/HD_AA_
NIH. (2014, Feb. 12). In NIH study seeks to improve asthma therapy for African-Americans. (chap. News and Events) Retrieved Jun. 4, 2014, from http://www.nih.gov/news/health/feb2014/nhlbi-12.ht
Silvers, Stacy. K, and David. Lang. (2012). Asthma in African Americans: What can we do about higher rates of disease?. Cleveland Clinic Journal of Medicine, 79 (3), pp. 193-201. Retrieved Jun. 5, 2014, from http://www.ccjm.org/content/79/3/193.full.
