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Running head: ASTHMA BALTIMORE CITY VERSUS ATLANTA

Asthma: Baltimore City versus Atlanta


Bosede Adedire, Angela Long, Chritiana Ikome & Evangeline Okechukwu
Coppin State University
Helene Fuld School of Nursing Family Nurse Practitioner
Epidemiology
Nurs 520
Dr. Emmanuel Obiako
February 28, 2013

ASTHMA BALTIMORE CITY VERSUS ATLANTA

Asthma is an illness that is considered to be one of the main health care problems seen in
the western world that is increasing in prevalence (Ruggeri, Bragato, Colombo, Valla, & Matteo,
2012, p. 1). According to Patrawalla et al., 2012, asthma affects more than 17 million American
adults (p. 1). Asthma is estimated to be a disease that affects 4 to 7 % of the worlds population
and that may be an underestimate due to difficulty in differentiating between asthma and other
medical conditions such as chronic obstructive pulmonary disease (COPD) or bronchitis
(Ruggeri et al., 2012, p. 376). Asthma being underdiagnosed, it is being under treated and
causing a major healthcare crisis that results in loss days of work for adults, lost days of school
for children, lost time playing sporting activities, increased emergency room visits, and increased
inpatient days. Asthma costs the healthcare system more than $20 billion dollars a year despite
guideline treatment strategies (Patrawalla et al., 2012, p. 1).
There have been different definitions used to describe asthma as a health problem. One
definition describes asthma as a very common chronic disorder that affects the airways
(Moorman, Akinbami, & Bailey, 2012, p. 8). Another definition describes asthma as an
obstruction of the airways which can be caused by inflammation or narrowing of the airways in
the lungs or airway hyperactivity caused by an exposure (Moorman et al., 2012, p. 8). Asthma
has also been defined as a complex interaction of airway obstruction, bronchial hyper
responsiveness and underlying inflammation (McCance, Huether, Brashers, & Rote, 2010, p.
1283). McCance et al., (2010) added that mast cells, eosinophil and neutrophils contribute to the
inflammatory response along with T lymphytes, macrophages and damaged epithial cells
(p. 1283). Asthma affects all ages and about half of all cases are identified in early childhood
and another 30% being identified before 40 years old (McCance et al., 2010, p. 1283).

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Furthermore, asthma has been described as a familial disease which more than 100
genes have been identified that may play a role in the susceptibility and pathogenesis of asthma
(McCance et al., 2010, p. 1283). Moreover, not all people experience all of the signs and
symptoms of asthma, however, signs and symptoms of an asthma attack could include expiratory
wheezing, nonproductive coughing, shortness of breath, pain, chest tightness, prolonged
expiration, tachycardia, dyspnea and tachypnea (Moorman et al., 2012, p. 8). Some airborne
allergens such as pollen, mold, animal dander, dust mite and cockroach allergens can be a
trigger to cause an asthma attack or exacerbation (Moorman et al., 2012, p. 8).
Similarly, some occupational exposures that are sensitizing chemicals or dusts,
airborne irritants such as smoking tobacco or cigarettes are also exposures (Moorman et al.,
2012, p. 8). Risk factors also include urban residence, additional family history, recurrent
respiratory viral infections and obesity (McCance et al., 2010, p. 1283). When an attack begins,
the signs and symptoms that results from airway resistance may be different for different people.
This airway obstruction increases resistance to airflow and decreases flow rates, especially
expiratory airflow which cause air trapping, hyperinflation distal to the obstruction, and increase
work of breathing (McCance et al., 2010, p. 1284). As the obstruction becomes more serious
the alveoli become inadequately ventilated which can lead to respiratory failure (McCance et al.,
2010, p. 1284). Asthma has no cure neither is it preventable, (as cited by Moorman et al., 2012,
p. 8); an asthma attack can range from a nuisance to a life threatening event which can cause
death.
According to the U.S Census bureau, asthma affects more than 22 million people in the
United States and has become a major global health problem affecting more than 300 million
people worldwide (http://www.health.ny.gov/statistics/ny_asthma/read.htm). Reports from the

ASTHMA BALTIMORE CITY VERSUS ATLANTA

National Center for Health Statistics (NCHS) re-emphasize other findings that indicate that
asthma is on the rise in the United States as a whole, and it is the major cause of decrease
economic productivity from missed days of work by adults and time loss from academic
preparedness for students (http://www.cdc.gov/nchs/asthma/nhsr.htm). Additional findings
report that approximately 10.2 million (13.9%) U.S. children less than 18 years of age were
diagnosed with asthma at some point in their lifetime, and an estimated 7.1 million (9.7%)
children currently have asthma (http://www.cdc.gov/nchs/asthma/nhsr.htm). Also, an estimated
29.7 million (13.2%) U.S. adults had been diagnosed with asthma during their lifetime, and an
estimated 17.5 million (7.7%) adults currently have asthma which results into four hundred and
fifty six thousand hospitalizations nationwide (http://www.cdc.gov/asthma).
The burden of asthma on the economy is not far-fetched, from monetary loss due to
rising hospitalization to increase number of asthma prevalence which invariably put the
economy at a point where more is being spent taking care of the sick which kicks the economy
out of balance for a while, if not for a long time. Despite the rising cost of health care from
asthma management, treatment and research has not been able to find a cure or means to prevent
asthma. Asthma costs in the US grew from about $53 billion in 2002 to about $56 billion in
2007, about a 6% increase (http://www.cdc.gov/asthma), which could probably go towards
other productive needs in the economy. It continues to be an urgent need to find a resolution to
the incidence of asthma or perhaps a more defining treatment that could prevent rising spending
on the health problem, and ultimately prevent morbidity and mortality from the disease.
Presently, there are different modes of treatment to prevent acute respiratory distress and
provide effective management of asthma, different modalities has been put in place, the means
for controlling and preventing symptoms are well established. The National Asthma Education

ASTHMA BALTIMORE CITY VERSUS ATLANTA

and Prevention Program (NAEPP) has developed classification systems intended for use in
directing asthma treatment. Based on NAEPP classification, Porth & Matfin (2009) identified
two categories for management and treatment of asthma: control of factors contributing to
asthma severity and pharmacological treatment (p.711). Measures to control factors contributing
to asthma severity are aimed at prevention of exposure to irritants, and factors that increase
asthma symptoms and precipitate asthma exacerbation, which include education of the patient
and family regarding methods used in avoiding exposure to irritants and allergens that are known
to induce or trigger an attack. Patient education is important in asthma management because the
ability to know and prevent asthma triggers leads to a more effective management and symptom
control in the long run. Effective use of prescription medications and the cognizance of when,
and how to administer such medications play a major role in asthma management and outcomes.
Furthermore, asthma pharmacological treatment includes the use of medication for longterm management and short-term relief; daily use of preventive medication to avert attacks;
monitoring of early symptoms; avoiding factors that trigger attacks; and removing risks (e.g.,
tobacco smoke or mold) from the home, school, and work environments
(http://www.cdc.gov/asthma/). The short-term relief medication include: albuterol, bitolterol,
pirbuterol, terbuterline, which relax smooth muscle and provide symptom relief usually within
thirty minutes, they are administered by inhalation. Long-term treatments of asthma are the use
of anti- inflammatory medications taken daily to achieve and maintain control of persistent
asthma symptoms; these are long acting bronchodilators and leukotriene modifiers (Porth &
Matfin, 2009, p.714). Preventive control medications have been found to effectively reduce the
inflammation that results from asthma symptoms (McCance et al., 2010, p. 1285).

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Additionally, long-term management with anti-inflammatories has been recognized to


control and prevent asthma symptoms by reducing swelling and mucus production in the airways
and consequently causing a reduction in sensitivity and reaction to asthma triggers
(http://www.cdc.gov/asthma/). Porth & Matfin (2009) added that bronchodilators used for acute
and chronic asthma management opens swollen airways that are restricting breathing (p.713).
From the foregoing, it is paramount to be aware that effective treatment and management of
asthma with available resources decrease or prevent untoward outcome from the health problem,
which could reduce spending towards the disease management. Though asthma has a huge
impact on the economy as a whole, however, the prevalence and impact of asthma varies from
one geographical area to the other. The difference in prevalence of asthma from one geographical
area to the other depends on different factors based on the environmental factors of the area
under study. For the purpose of this paper, extraction of CDC and US Census data is used to
show differences in the prevalence of asthma between Baltimore City and Atlanta.
Appendix A (table 1), presents data that shows the prevalence of asthma between
Baltimore city and Atlanta between 2000 through 2010. The data indicate the trend and the
prevalence of asthma which is slightly higher in Baltimore city compared to Atlanta. The data
represents how many people have asthma at the time of survey but not the time period that the
disease started in these populations. The figures describe the prevalence of asthma in the
population between these two geographical locations, the trend shown on the illustration
represents the prevalence of asthma in Baltimore and Atlanta population at the time of
examination, which shows how many people have had the disease at the specified time frame
used. Therefore, the data is influenced by the duration of time those individuals captured had
asthma. Though, from statistics obtained, the population in Baltimore is higher compared to

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Atlanta which might be a contributory factor to the difference in statistical findings of asthma
prevalence between the two cities, environmental issue is another factor. However, prevalence
has been identified as being useful for measurement of disease burden in a community, but not as
a measure of disease risk (Gordis, 2009, p. 46). Therefore, the prevalence result of asthma
between the two cities represents the total cases of the disease and not an indication for risk
measurement. Likewise, the population in Baltimore towers that of Atlanta which makes the
prevalence of asthma in Baltimore not comparable to that of Atlanta due to the difference in
population between the two cities. Further analysis of gathered data illustrates a steady rise in
asthma rate in Baltimore city from year 2000 and 2001 with a sharp increase in asthma
prevalence in 2002. The ups and downs in asthma prevalence in Baltimore city is shown
throughout the periods under review (Appendix A, table 1) which could be attributable to
different factors. Similarly, asthma prevalence in Atlanta had been through the rigors of upward
slope but more steady rise compared to Baltimore city which shows significant increase in
asthma prevalence in years reviewed.
The illustration on (Appendix B, figure 1 & 2) compares graphical representations on
asthma prevalence between the two cities to emphasize and show further clarification on facts
obtained and the burden of asthma on the two cities. Information obtained for asthma prevalence
for the two cities can be used to obtain valuable information necessary for planning health
services, which provides important leads to how best to manage the health problem of asthma.
The outcome of the statistical findings between the two cities can be used by public health
departments to make decisions in reference to how best to further improve and manage the
treatment of asthma in these populations. Mitigating the risks in diverse environments is a major
component plan in asthma management, and a good platform to strengthen overall asthma care.

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In conclusion, continued surveillance is necessary in the geographical areas under review


to evaluate the effectiveness of different therapies and approaches committed to improving
health care quality and asthma treatment in this population. Efficient and effective management
of asthma from varied standpoint can foster treatment management and improve quality of life
for those affected. Porth & Matfin, (2009) emphasize that active management of asthma
reduces absolute disability from disease, and decreases funds dedicated to unnecessary acute
episodes that may result from disease (p. 719), and eventually lessen the burden that the disease
may have on the economy as a whole.

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References
CDCs national asthma control program. (2013). Retrieved from http://www.cdc.gov/asthma
Gordis. L. (2009). Epidemiology. 4 th edition. Philadelphia. Saunders Elsevier
McCance, K., Huether, S., Brashers, V., & Rote, N. (2010). Pathophysiology: The Biologic Basis
for Disease in Adults and Children (6th ed.). Missouri: Mosby Inc.
Moorman, J., Akinbami, L., & Bailey, C. (2012). National surveillance of asthma: United States,
2001-2010. National Center for Health Statistics Centers for Disease Control and
Prevention, 3(35), 1-67. Retrieved from www.cdc.gov
National Asthma Education and Prevention Program. (2009). Asthma comprehensive treatment
Management. Retrieved from: http://www.naepp+ASTHMA+site:www.nhlbi.nih.gov
Patrawalla, P., Kazeros, A., Rogers, L., Shao, Y., Liu, M., Fernandez-Beros, M., Reibman, J.
(2012). Application of the asthma phenotype algorithm from the severe asthma research
program to an urban population. PLOS One, 7(9), 1-7.
doi.org/10.1371/journal.pone.0044540
Porth, C. & Matfin, G. (2009). Pathophysiology: Concepts of altered health states
(8th ed.). Philadelphia: J.B. Lippincott-Raven.
Ruggeri, I., Bragato, D., Colombo, G., Valla, E., & Matteo, S. (2012). Cost and appropriateness
of treating asthma with fixed-combination drugs in local health care units in Italy. Clinico
economics and Outcomes Research, 4(4), 375-382.
doi.org/10.2147/CEOR.S36499
United States Census Bureau. (2012). Asthma prevalence and incidence nationwide
Retrieved from http://www.census.gov/dem/figures/asthma

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Appendix A
Asthma in Baltimore vs. Georgia from 2000 to 2010
BALTIMORE CITY, MARYLAND

YEAR

ATLANTA, GEORGIA

POPULATIO

PREVALENCE

DISEASE

POPULATIO

N IN

IN

RATE PER

THOUSAND

THOUSAND

100.000

IN

PREVALENCE

DISEASE

IN

RATE PER

THOUSANDS

100.000

THOUSAND
S

2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010

648654
645253
642246
642324
641004
640064
640961
640150
638091
637418
620560

47351
45812
65509
46247
58331
76807
59609
69776
58066
88601
76949

7300
7100
10200
7200
9100
12000
9300
10900
9100
13900
12400

Appendix B
Figure 1

418823
431321
442947
457068
468839
483108
498208
519569
537385
540922
420003

27698
28538
29234
34280
35162
34783
38361
40006
46752
35159
37380

6613
6616
6600
7500
7500
7200
7700
7700
8700
6500
8900

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Figure 2

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