Beyond the inhaler 

As a lung doctor, I’m constantly trying to understand what’s keeping my patients breathless. Objective testing helps of course, but that alone doesn’t capture the full phenotype of a patient’s pulmonary status. It would be analogous to having a patient weigh themselves, calculate a body mass index, and share that they have excess weight without understanding what caused or is maintaining the patient’s status. Medicine can’t simply ignore the social factors that result in health concerns.

To paraphrase a quotation from Sir William Osler when he was discussing tuberculosis, asthma is an outcome with medical aspects to it. Many inhalers that my colleagues and clinicians prescribe are often offset by the environmental factors facing patients in their home and respective neighborhood environment. No inhaler will offset an air quality index over 100 in a neighborhood built next to a large highway, pushing out noxious air from automobiles thousands of gallons a day. Or an individual living in subsidized housing apartment buildings, where air vents push secondhand smoke from one home to the next.

To offset much of the disparities of asthma, the focus on air quality should be as stern as the one we have implemented for sewage and water quality and safety. For many in the United States, drinking water out of one’s faucet is a passive action without much thought into hoping one will not become ill from the liquid. And massive outbreaks of cholera or other infectious gastrointestinal microbes isn’t a common theme for Americans either. The right to quality water and sewage systems has been cemented into our social capital.

For asthma and air quality alike, as physician-citizens, we need to advocate for three things. First, an understanding of indoor home air quality since that’s where a patient and their family spend the most time. Are their HVAC systems up to date? Can they afford the cost of a quality HVAC system? Would they benefit from a HEPA filter system as well?

Next, assist in understanding the causes of outdoor air pollution that impacts socioeconomically disadvantaged neighborhoods more than affluent ones. Acting on this disparity should assure equitable air quality for all alike.

And finally, look to see what legislative actions are on the docket for state and national air quality advocacy. Here, many can support organizations such as the American Lung Association to assure air quality standards are maintained and improved upon.

Asthma disparities can become a thing of the past. However, it will need all of us, one breath at a time, to act and advocate for it.

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.