New procedure may reduce chronic asthma

Howard Manly

A new clinical trial is now underway at Beth Israel Hospital that attempts to alleviate the breathing problems associated with asthma, a debilitating condition that disproportionably affects the respiratory system of minorities.

If proven successful, the procedure could dramatically reduce the impact of what is considered to be the nation’s sixth-ranked chronic condition. Based on most recent statistics, 12 million people reported having an asthma attack that required urgent care, resulting in 10.4 million doctors’ office visits, 1.8 million emergency room visits, 465,000 hospital admissions and more than 3,000 deaths.

The numbers are more depressing for minorities. Though only 12.7 percent of the population, African Americans account for 26 percent of all asthma deaths. The death rate from asthma for African Americans was three times higher than whites. The hospitalization rate was three times higher for blacks than whites, and the emergency room visits were four times as high for blacks.

The reasons for the disparate numbers remain unclear. Triggered by a wide range of substances, including dust, animal dander, cockroaches, perfume, tobacco smoke, weather, molds and other air pollutions, asthma attacks occur when bronchial tubes are inflamed and clogged with mucous. Typical symptoms of asthma are shortness of breath, tightness in the chest, wheezing and fatigue.

The new procedure would, in essence, clear the airways in the bronchial tube by removing some of the soft muscle lining those airways. Called Bronchial Thermoplasty, the procedure calls for inserting a flexible bronchoscope, a routine procedure, and applying thermal energy or heat to the soft muscle in the small to medium sized airways. The goal is to reduce the ability of the airways to contract.

Trials are underway in four different countries, including the Interventional Pulmonology Division of Beth Israel Deaconess Hospital.

The procedure is only the latest attempt to solve what has appeared to be an unsolvable problem. Despite numerous efforts and media attention, the gap between blacks and whites with asthma has actually grown since the 1990s. In a study published last month, more than four times as many black children as white children are hospitalized for asthma, and more than five times as many black children die from the disease.

The study was published in the Journal of Allergy and Clinical Immunology and examined asthma hospitalization and mortality data from the national Hospital Discharge Survey and the Centers for Disease Control from 1980 through 2002.

According to the study, asthma hospitalizations for white children decreased during that time from 11.5 to about 8 per 10,000 individuals, but hospitalizations for black children increased from about 34 to nearly 37 per 10,000.

More troublesome, the asthma death rate for blacks increased from 9.9 to 13.2 deaths per million people from 1984 to 2001. During the same time, asthma deaths for whites increased from 2.1 to 2.6 per million people.

“It is unlikely that there is a single explanation for what underlies these trends,” the study’s authors said in a prepared statement. “Common factors thought to be associated with disparities include differences in prevalence of disease, access to care, quality of care and treatment, patient education, and personal health beliefs and behaviors.”

Dr. Ruchi S. Gupta, lead author of the study, told the New Jersey Star Ledger that the largest factor associated with quality in asthma management, beyond access to health insurance, is the medication used to treat the disease. Black children on Medicaid had worse cases of asthma and less use of preventative medication than white children.

“We need to really look into what’s causing this — whether it’s the quality of care received, the treatments offered to certain populations and not others,” Gupta said.