Barriers to asthma management

A key determinant of the success of a clinical trial is the recruitment and retention of a study population of an adequate sample size.

Barriers to asthma management

Is it too late to reverse the trend? Rene Macura Martha Cota awakened one morning to find her infant son, Jose Miguel, gasping for air, his lips and the skin under his fingernails blue from lack of oxygen.

Terrified, she rushed him to her local hospital in Long Beach, Calif. The cycle went on for more than five years — Jose turning blue and barely able to breathe, Cota frantically strapping him into his car seat and racing through traffic, spending countless days and nights sitting in hospital emergency rooms.

She was a social worker in her native Mexico and now works as a community educator for the Long Beach Barriers to asthma management for Children with Asthma. Even at noon on this otherwise sunny day, the sky was blanketed in hazy toxic smog from the ports of Los Angeles and Long Beach, the entry points for more than half of the goods shipped into the United States and the largest source of air pollution in California.

Every day, idling cargo ships carrying 30, containers from Asia and the Pacific basin are unloaded by construction cranes towering more than feet high on the docks.

Then the containers are dispatched from the rail yards alongside the harbor onto 1, diesel-powered freight trains that ferry goods up and down the coast, and 35, semi tractor-trailers that speed along heavily congested highways to the rest of the country.

The Los Angeles metropolitan area, with nearly two cars per household, has the dubious distinction of having the highest vehicles-per-capita ratio in the world; more than 12 million cars travel on the extensive freeway system every day.

Two-thirds of them were enrolled as fourth-graders, and all were followed until they graduated from high school.

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Cota immediately signed up for the study and learned how to use a particle counter, which measures particulates and toxins in the air, to take samples of ambient air quality surrounding her home.

What the USC researchers ultimately uncovered after a decade of meticulous monitoring was eye-opening. The lung development of children who lived near highly trafficked corridors was stunted — about 20 percent smaller than average — which greatly impaired their functioning.

These youngsters also suffered from asthma at significantly higher rates — those living within a quarter of a mile from a freeway had an 89 percent higher risk of asthma than kids more than a mile away.

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Their asthma symptoms also were worse, and even among those with health insurance, their odds of ending up in the hospital emergency room choking from the bad air was triple that of youngsters in more affluent areas. Worse yet, pregnant women living in these high-traffic areas were more likely to give birth to premature or low-birth-weight infants, setting up the next generation for a lifetime of disabilities and developmental deficits.

Barriers to asthma management

Cota hardly needed a study to tell her this. She and two of her other children later developed severe allergies and now use inhalers and an arsenal of medications just to get through the day.

Bakersfield, the birthplace of the renegade rockabilly honky-tonk of Merle Haggard and Buck Owens, consistently tops the list.

A long, crescent-shaped lick of fertile flatlands that stretches more than miles and covers 22, square miles slightly smaller than West Virginiathe Central Valley is nestled between the coastal mountains on the west and the Sierra Nevada to the east.

But this high desert region is also home to 6. The spreading urban sprawl, coupled with industrial growth, has yielded increasingly tainted air. The surrounding mountains trap these pollutants, and the stagnant air envelops the region in a perpetual cloud of haze.

On average, nearly four Central Valley residents die prematurely every day because of the pollution, and experts predict that within the next few years, as temperatures continue to rise and population growth raises smog levels, one of every four children will have asthma.

They get sicker faster, and die younger. The disastrous health effects they experience from pollution are a preview of what will happen everywhere as climate change becomes a routine fact of life, and as the planet gets hotter, carbon levels continue to climb and air quality progressively worsens. Research on air quality in New York, Phoenix and Baltimore shows that ambient CO2 parts per million ppm levels can spike into the s, s and s, which climate modelers predict will become the norm in 20 to 30 years.

Right now, the global average is ppm. As temperatures rise and more pollutants are dumped into the atmosphere, the plume of that toxic cloud will broaden like ink on a blotter, covering more land under a suffocating carbon canopy.

And it will just go from bad to worse in the coming decades, as the Earth gets warmer.

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Two of the chief culprits behind asthma and allergies — air pollution and smog — will only intensify as the temperatures rise. The result is ozone smog, a toxic brew created as sunlight cooks the mix of pollutants and particles in the atmosphere.

As the air heats up, more ozone is produced. Increasing levels of ozone, in turn, trap more heat, exacerbating the urban heat island effect: Cities are normally about five to 10 degrees hotter than surrounding suburbs because asphalt and cement absorb sunlight, generating a vicious cycle of escalating pollution and heat.

Higher levels of ozone smog, toxic to the lining of the lungs, will also boost the incidence of respiratory diseases. A study done by European scientists looked at hospital admission data from 12 major cities including Dublin, London, Barcelona, Athens and Rome from at least a three-year period. They found that for every 1-degree Celsius about 2 degrees Fahrenheit temperature increase, hospitalizations from respiratory- and asthma-related illnesses rose by 4.

Chronic exposure to elevated levels of ozone has a serious cumulative effect. But ground-level ozone — the chemical combustion product of factory and vehicle emissions heated by sunlight — can have a devastating effect. Sunbelt cities like Los Angeles, Riverside, Calif.Whilst the inhaled route is the first line administration method in the management of asthma, it is well documented that patients can have problems adopting the correct inhaler technique and thus receiving adequate medication.

Browse the WebMD Questions and Answers A-Z library for insights and advice for better health. About this journal.

Health Informatics Journal is an international peer-reviewed journal. All papers submitted to Health Informatics Journal are subject to peer review by members of a carefully appointed editorial board.

The journal operates a conventional single-blind reviewing policy in which the reviewer’s name is always concealed from . You can control your asthma and avoid an attack by taking your medicine exactly as your doctor or other medical professional tells you to do and by avoiding things that can cause an attack.

Not everyone with asthma takes the same medicine.

Some medicines can be inhaled, or breathed in, and some can. Effective self-management is very different from telling patients what to do. Patients have a central role in determining their care, one that fosters a .

Prepare yourself for the AE-C test offered by the NAECB Earn CRCE credits Refresh your personal knowledge about asthma care The AARC Asthma Educator Certification Preparation Course has been assisting RTs and RNs since the NAECB debuted the AE-C examination in Over 4, professionals have.

California's Air Pollution Causes Asthma, Allergies and Premature Births |