Can health systems keep patients out of the ER in communities hit hardest by asthma?

Asthma is far more prevalent in places with low-income residents of color, a pattern that’s true around the globe as well as here in the United States.

To address asthma’s health burden, people have done everything from investing in advanced technology to passing legislation to lessen our carbon footprint. However one aspect often seems to be missing from such interventions: the human element.

There are now electronic monitoring devices that accompany asthma inhalers, to keep a running tab on an individual’s breathing patterns. There are devices that detect wheezing levels and work in collaboration with smartphone apps. And then there’s bronchial thermoplasty, which uses heated waves sent from a small tube that is inserted into your lungs in order to erode excess “airway smooth muscle.”

While such technology can provide new ways of treating asthma, health care providers say the ultimate goal is to give patients the tools and information to better manage their condition, so they don’t end up in the emergency room with each flare up.

Medical researchers have reported strong links between asthma and environmental factors, such as pollution and smoke inhalation. And then there’s genetics. Geneticist Marquitta White told NPR in 2016, “On average, 60 percent of what's going to determine whether or not you have asthma is going to be due to genetic factors.”

The far eastern end of Oakland, California, a community commonly referred to as Deep East Oakland, is home to large groups of working-class black and Latino residents. People of color account for 93 percent of the total population. With the exception of West Oakland — also home to large numbers of people of color — Deep East Oakland suffers from much higher rates of chronic illnesses, including asthma, than the rest of the city.

In these communities, health care providers and nonprofits are seeking new ways to reach, inform and treat those living with asthma.

There are efforts such as BreatheMobile, a mobile asthma clinic that largely works with youth in West Oakland. And in East Oakland, LifeLong Medical Clinic has teamed up with Sutter Health to inform people about preventative measures and assist them with controlling their asthma, and to further understand why the illness is impacting people of color in low-income communities.

“We’re looking to get involved in the community to understand why so many people are coming into our emergency rooms, when many of them drive past the clinics,” said Dr. Stephen Lockhart, Sutter Health’s chief medical officer, before speaking to a room full of asthma patients at LifeLong’s clinic in Deep East Oakland.

Since the partnership between Sutter Health and LifeLong Medical began last year, 78 people suffering from asthma attacks have been cared for by primary care physicians, and only two have since returned to the emergency room, according to Sutter Health researcher Maria Moreno.

With the introduction of a new app called “My Health Online,” Sutter Health and LifeLong Medical hope to further curb the number of people making trips to the ER. The app allows patients to access medical help via their smartphone. That means people like Tanesia Trammell, a patient of Lifelong Medical, won’t necessarily have to go to the emergency room to deal with her asthma.

Trammell and her 16-year-old daughter recently attended one of LifeLong’s asthma meetings in Deep East Oakland. Just days prior, Trammell said she had an asthma attack that took her to the emergency room. She’s now looking to get more help to head off such severe attacks. In turn, she’s willing to give LifeLong Medical and Sutter Health more details on what triggers her asthma.

Trammell and her daughter are two of 2.6 million African Americans living with asthma. According to a recent CDC study, about 16 percent of all African American youth have asthma. That’s compared to only seven percent of white children in the U.S.

And in Alameda County, where Trammell and her daughter live, a study by the Alameda County Public Health Department notes that, “among children, the rates of those diagnosed with asthma are highest among Hispanics and African Americans (30 percent each).”

Dr. Lockhart says part of the solution lies in building better relationships between medical providers and patients, which helps people manage the condition rather than end up in the ER.

“A lot of people go to the emergency room just to get their medication refilled. But it’s not a trivial matter,” said Lockhart. “If you have asthma, that’s not trivial to you! At that moment, it’s a real problem. But it’s a problem that can be better solved in a primary care room.”

It’s an experience Lockhart, who is an African American resident of East Oakland and an asthmatic himself, has had all of his life. “The key to asthma is that if it’s well-managed, it doesn’t have to be something that controls and destroys your life,” said Lockhart.

(Photo: David McNew/Getty Images)