While asthma cases rise nationally at an alarming rate, the suffocating lung disease strikes hardest at African Americans. Blacks are much more likely to be hospitalized for it and die from it.
Blacks and whites younger than age 65 are diagnosed with asthma at about the same rate. But blacks die from the disease three times the rate whites die from it, according to a 1997 national study.
The study also found that blacks were hospitalized for asthma at a rate more than twice the U.S. average.
Why are African Americans suffering more from this illness?
"There are several factors that contribute to those statistics — environmental, sociological and the management of asthma itself," said Tuei Doong, deputy director for the federal government's Office of Minority Health.
"We need to make sure black children understand the use of inhalers. . . . Family members have to understand (the management of asthma) to prevent the factors that could put you in the hospital."
Jean Smith knows what it takes to manage the illness and has experienced the agony of rushing her child to the hospital.
Her son, Sidney, now 9 and a third-grader at Village Elementary School, was first hospitalized for an asthma attack when he was 3 months old. He would need hospital treatment six more times in the next three years.
After a family friend died from asthma, Smith dedicated herself to learning more about the disease.
"It was kind of a wake-up call that this may never go away," she said.
Smith attended an asthma class at the Hessen Cassel branch of the Allen County Public Library, listened closely to her pediatrician and used the Internet to learn more about asthma. She now intercedes before a trip to the emergency room is necessary.
"I know it so well now, I start treatment," she said. "I don't wait for (an asthmatic attack)."
Sidney, who loves to ride his bike, has not been to an emergency room in four years.
"I think if you really know what to look for and how to take care of it, you can nip it in the bud and keep it from getting really bad," Smith said.
While most patients have mild asthma that is easily controlled with outpatient care, some asthmatics repeatedly land in emergency rooms. Some blacks are in this group.
The U.S. Centers for Disease Control and Prevention reported in 1995 that black asthmatics were treated at emergency rooms nearly five times more often than whites.
Parkview Hospital's emergency room statistics reflect a similar trend. While blacks make up about 11 percent of Allen County's population, they comprised 24.5 percent of the asthmatics rushed to Parkview during the 12 months ending in February.
Kathy Williams, a 48-year-old Fort Wayne woman, uses emergency rooms regularly. She has called 911 more than 10 times in desperate attempts to regain her breath.
Her attacks can be caused by a variety of triggers — allergies, mold, food, even prolonged laughter. Her struggles with the illness have taken a toll.
"I can hardly walk or move without breathing real hard," she said. "I don't try to exercise or go up stairs, because I really can't."
Asthma runs in her family: Four siblings, two children and four grandchildren have the disease. An uncle died from it in the 1970s.
When asthmatics become ill, doctors understand patients' actions may contribute to the problem. Filling the prescription, taking the medicine and appearing for follow-up appointments are all necessary for proper disease management.
Yet some patients do not comply with doctors' orders. They don't go for follow-up visits or take the correct medicines, and they end up in emergency rooms.
"We'll never have a day without someone coming in with an asthma attack," said Dr. Jeffrey Nickel, medical director of Parkview's emergency department.
"Follow-up is absolutely necessary with a chronic illness like asthma," he said. ". . . If they don't have a primary-care physician, they're going to be a lot worse when they get here."
Often, patients' misconceptions about the effects of some drugs and their costs lead patients to use the wrong medications. Instead of taking daily doses of maintenance medication such as Flovent or Pulmicort, asthma patients too often rely on quick-relief, rescue inhalers such as Proventil, Ventolin and Maxair, physicians say.
That's not surprising to Dr. Doug Neeld, a Fort Wayne asthma and allergy specialist. Neeld said one inhaler of Proventil — about 200 huffs — should last a year. He has had patients use it all in one week.
"Rescue inhalers are designed to give you quick relief but not lasting relief," said Neeld. "It's like fool's gold. You get relief for four to six hours."
While airways may clear due to the rescue inhaler, an asthmatic's underlying lung inflammation is not affected. Daily medication used to control asthma — often inhaled steroids — is designed to return the lining of the lungs to a normal state.
Neeld said inhaled steroids are "the single best class of medicine we have, so you don't need to use a nebulizer (breathing machine) several times or go to the emergency room. The benefits greatly outweigh any potential minimal side effects," he said.
Williams stopped seeing an asthma specialist and is now being treated only by her family physician.
"If I'm not feeling better, I go to the hospital, because I know I need to," she said.
Seeing a doctor who understands asthma and can communicate well with patients is crucial.
"For people who are having problems, they should seek out the help of someone who specializes in the treatment of asthma," Neeld said.
"Treatment's changed pretty dramatically in the last 10 years," said Neeld. "The big challenge is getting (treatment guidelines) out to all the doctors."
Dr. Cesar Ochoa treats asthmatic children each day he practices at the Neighborhood Health Clinic, 3024 Fairfield Ave. Many of the pediatrician's patients use Medicaid to pay their bills. Too often, he said, their scheduled visits are missed.
"A lot of moms bring their kids only when they're sick, and there's no reason for that," said Ochoa.
Though asthma medication may run as much as $200-$300 a month, Neeld often works with drug distributors to hand out free drugs.
Even if the proper drugs are prescribed and taken, the home environment affects an asthma patient's outcome greatly.
Secondhand cigarette smoke, the time demands of a single parent and a variety of dysfunctional family conditions all hinder the proper management of a disease such as asthma, regardless of the sufferer's race.
"This is a very complex problem," said Ochoa. "There's economic, social and psychological factors."
