It’s no surprise that the Bronx has the highest incidence of asthma in America. Heavy traffic, construction, overcrowded living conditions, a high rate of smokers and poor compliance result in a hospitalization rate which is 21 percent higher than the national average. The death rate from asthma is 43 deaths per millions residents (compared to 13 deaths per million throughout New York State).
“Our emergency department sees about 400 patients with asthma every month,” says Dr. Mihai Smina, a pulmonary specialist with the Center for Comprehensive Care at SBH Health System (St. Barnabas Hospital). “Our physicians and physician assistants speak to repeat patients in the ER and make appointments with them, yet only about 10 percent follow up. We’re working hard to better educate patients and improve compliance.”
The Center for Comprehensive Care treats asthma patients who are 16 years of age and over (in addition to younger patients who are seen at the center’s pediatric allergy clinic). Initially, specialists evaluate and diagnose patients – an important need, says Dr. Smina, as 40 percent of these patients are actually found to have COPD, congestive heart failure, sleep apnea, or some other condition. They check patients’ medications and adjust them if necessary. A pharmacist dedicated to the center answers questions regarding the use of inhalers, nebulizers and bronchodilators. Patients undergo a pulmonary lung function test and those who smoke are encouraged to participate in the smoking cessation program. For those with more severe asthma, the use of advanced therapy, such as injectable medications, may be explored. A referral may be warranted to a.i.r. bronx (Asthma, Intervention and Relief), an organization that brings care into the patient’s home by checking for and remediating such risk factors as dust, mold, and vermin.
“Most importantly, we put together an action plan that examines the triggers that cause the patient’s asthma attacks and offers solutions,” says Dr. Smina. “With these patients, we’ve had very good results in getting them the help they need to avoid trips to the ER and hospitalization.”