Asthma educator Digna Remache interviews a patient at the Columbia Presbyterian Asthma Clinic. PHOTO: Rachel Elbaum

sthma educator Digna Remache remembers a patient who thought she was having a heart attack. She stuck her head in the refrigerator to get air but that only made breathing more difficult. The patient was having an asthma attack but was not aware that she even had asthma.

Incidents like this are the No. 1 reason that asthma education is so important – and so necessary in New York, which public-health researchers say is among the top four cities in the nation for asthma cases.

Asthma is a chronic respiratory condition, often triggered by allergies, that constricts the airways and makes breathing difficult. Incidents of asthma nationwide are on the rise. According to a report released last year by the Pew Environmental Health Commission at the Johns Hopkins School of Public Health in Baltimore, Md., cases of asthma in the United States will more than double by 2020.

Fast Facts

More than 17.7 million Americans have asthma. By 2020, cases of asthma in the United States will more than double. Asthma is the highest cause of hospitalization for children in New York City. The asthma hospitalization rate for children in East Harlem is the highest in New York City. Asthma cost New Yorkers more than $61 million in 1994. Sources: NYC DOH; Asthma and Allergy Foundation of America; American Lung Association

octors and researchers say that there is not one single cause that can be linked to all cases of asthma. The Pew report states that "while we do not know what causes the development of asthma, the environment plays a role." Certain triggers exist that may set off attacks and some of these triggers are more prevalent in poor, minority neighborhoods where apartment buildings are older and residents are less likely to have access to preventative medical care. A number of community groups are now on the defensive, educating communities about asthma triggers and how to best control a case of asthma.

In a May 2000 report, the Department of Health and Human Services characterized the problem of asthma in the United States as an epidemic. According to data from the New York City Department of Health for 1995, the latest figures available, the asthma hospitalization rate for children under 14 years old in New York City was 2.8 times higher than the rate for the United States and 4.2 times higher than the rate for the rest of New York State. In 1997, more than 33,000 New Yorkers were hospitalized for asthma and it was the leading cause of hospitalization for children. While asthma hospitalization rates provide an idea of the people most severely affected, it is difficult to know precisely how many people have asthma. Asthma can have varying degrees of severity and those who have the condition but are able to manage it will likely not require hospitalization, says Mike Zdeb of the New York State Department of Health.

Not all New York children are affected equally; children living in certain parts of the city are much more at risk. Researchers at New York's Mount Sinai Medical Center confirmed the discrepancies in asthma’s effects on different communities in New York in 1999. Using hospital discharge data for New York City, the researchers searched the records for people who had been hospitalized overnight due to asthma. The number of hospital visits was then mapped according to ZIP code. Using census data (projected from the 1990 census) the ZIP codes were also characterized for race, ethnicity, median household income and age distribution of their residents. The resulting map showed that people in poor, predominantly minority neighborhoods were more likely to be hospitalized with asthma and that a majority of those visits were made by children under the age of 18.

East Harlem, where Mount Sinai is located, had the highest asthma hospitalization rate in New York City: nearly six times the city average.

The researchers identified three major reasons that residents of poor communities may be at greater risk for asthma: inaccessibility to proper medical care, rundown housing conditions and a higher concentration of air-polluting facilities in poor and/or minority neighborhoods. The use of hospitalization as a measurement of asthma’s effects in a particular community leaves out those people who may suffer from the disease but have it under control.

"The emergency room is a short-term solution," says Leon Tulton, a research assistant in Mount Sinai’s Community Health Department who worked on the project. Instead of just receiving short-term treatment, the group at Mount Sinai would like to see improvements in patient education, one way to prevent asthma attacks.