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 5 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
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 Medicaid 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 is asthma?
Asthma is a chronic condition that cannot be cured, yet it can be controlled. Asthma is a disease of
inflammation in which the inner lining of the bronchial tubes become
swollen and inflamed. The inflammation causes narrowing of the
bronchial tubes and produces wheezing and shortness of breath.
Also, part of this process is excess mucous production and tightening of the muscles around the bronchial
tubes, which further narrows the airways and causes coughing and
This chest discomfort has been described as a tightening in the chest or a “heavy pressure”
inside the chest cavity.
The primary symptoms of asthma are cough, wheezing, shortness of breath and chest tightness. These
symptoms are different from person to person and can be different
within the same person from day to day.
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
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.
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.
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.
Other factors that contribute to developing asthma are low birth weight, which is highest in the
African American population which lends to the underdevelopment of
lung tissue, smoking during pregnancy and drug or alcohol use during
Especially harmful to the child’s lung development is 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.
How is asthma managed?
Understanding that asthma is a condition of inflammation (swelling) of the airways in the lungs,
anti-inflammatory therapy is the basis of asthma management. Inhaler
medications for inflammation are (cortico)steroids, a safe and
effective medication that can prevent asthma symptoms from occurring.
This type of steroid that is used is similar to the steroid produced by our own body known as cortisol.
Like all medications, there can be some side effects with asthma
medications but that’s usually rare.
However, the alternative to not using them poses a far greater risk than the adverse effects of the
Another important medication for asthma is the rescue inhaler known as Albuterol, which quickly loosens up muscle bands that squeeze and tighten around the bronchial tubes.
Albuterol, also known by the names ProAir, Ventolin or Proventil, is a fast acting, quick relief asthma
medication and should be on hand at all times. All other asthma
medications are for prevention and control of symptoms and must be
used on a daily basis.
Removal is one of the simplest methods
to use in order to reduce or eliminate asthma symptoms. The
individual can simply remove themselves from the triggering source
such as a cat, a smoker, a room filled with dust or strong chemical
odors like cleaners, paints or perfumes.
When activity is the cause, simply
resting and using slow, controlled breathing can be helpful in
bringing the symptoms under control. If this fails, then a
quick-relief inhaler (albuterol) is self-administered.
Controlling asthma means controlling
contributing conditions, the most outstanding of which is allergies.
You will never be able to manage your asthma if you don’t control
your allergy symptoms.
Reflux is also another prime contributor to constant asthma symptoms and must be controlled as
well to control asthma.
The relationship between asthma, allergy and reflux is such that these conditions trigger each other
and the symptoms imitate each other. For example, allergy symptoms
include post nasal drip, a condition where mucus drains from the back
of the throat into the lungs and triggers asthma symptoms.
Heartburn is a sign of reflux, acid gas that travels back up the esophagus (swallowing tube) and into the
back of the throat, and is then inhaled into the lungs and triggers
The two most effective methods of combating asthma are education and evaluation. In order to properly
manage asthma, you first need to understand what it is, what the
medications are and how they work, what the best self management
strategies are and what you need to do to be free of symptoms.
In order to develop the best management strategy for you, you need to have your asthma thoroughly evaluated
which would include screening for co-morbid conditions such as reflux
and/or allergy and you must have a lung test known as a pulmonary
This test gives an objective measurement of your lung function and can detect changes in your
lungs that you may never know existed.
Environmental control of asthma is also
an important management strategy such as washing bedding and pillows
to reduce the presence of dust mites and eliminating cockroach or
mice infestations in the home.
There are natural alternatives to air fresheners, bleaches and cleaners that clean well without triggering
asthma symptoms. Above all, quitting smoking is probably the single
greatest risk reducer there is and many people with asthma smoke
themselves or expose a loved one with asthma (child, spouse or partner) to secondhand tobacco smoke.
Exercise is another method of strengthening the lungs and reducing the need for asthma medications
one might usually require if they don’t exercise at all.
These are the things you should expect from good asthma care:
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.