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Commentary: Yes, people do die of asthma

“People don’t die of asthma, do they?” my sister asked upon hearing of the death of 27 year-old Erica Garner, the activist and daughter of Eric Garner.

“Sure they do,” I corrected her. “Particularly if they are poor and African-American.”

I immediately recalled the ambulance ride-alongs I did in medical school. Many times a shift, the paramedics would be summoned to a predominantly African-American neighborhood for an asthmatic having an attack. In some cases, the patient would have to have a breathing tube inserted into his or her trachea and was subsequently admitted to the intensive care unit of the hospital. Without that treatment, the patient would have died. And many do. There are thousands of preventable deaths from asthma each year, with African-Americans estimated by the U.S. Department of Health and Human Services to be nearly three times more likely to die from their asthma as white Americans.

When I started practicing medicine, I used to tell my patients that they could avoid being hospitalized for an asthma attack. We would figure out their asthma triggers and remove them from their homes. We would craft their “asthma action plans” — a proven method of home monitoring for picking up decreasing lung function early and treating it aggressively with inhalers or, in severe cases, oral steroids. At the earliest signs of trouble, I wanted to see them in the office that day. And it worked. My patients were able to stay out of the hospital, they were able to keep their asthma in control.

The old saying goes, “It is better to be lucky than to be good,” and I imagine that my patients had benefitted from the luck of being able to afford their inhalers much more than they had from anything else I did. For an asthmatic, inhalers are life, and that life is expensive. The cheapest long-acting inhalers start at $200 and go up from there, sometimes costing upwards of $500 a month for basic treatment. Insurance may help, but the steroid inhalers patients need to keep their asthma in check are often listed as Tier 4 or higher with out-of-reach co-pays often forcing patients to decrease or forego their medication altogether. The U.S. Centers for Disease Control and Prevention reports that 2 in 5 uninsured patients could not afford their asthma medications, but also that 1 in 9 insured patients could not. With an estimated 1 in 12 adults and 1 in 10 children suffering from asthma, that works out to millions of Americans struggling to control their asthma because they just can’t get the necessary preventive treatments.

Volunteering twice a week in an under-served clinic, I now care for patients who often don’t have insurance, making long-acting inhalers a theoretical treatment for many of them. While drug companies have patient-assistance programs, they are complicated to figure out, slow to take effect, and unpredictable at best. Out of desperation, I recently posted a request on a local physician-mothers’ Facebook group to beg for inhalers for my indigent patients. A generous allergist donated a boxful of inhalers. I carefully carried the box from her office as if it were a precious treasure — the contents were easily worth $5,000. But more than monetary worth, that box contained life for a dozen or more patients.

I don’t tell my patients that they won’t be hospitalized for their asthma anymore. I can’t. From month to month, I don’t know who will be able to afford their medication and who won’t. I don’t know how long the dwindling supplies in the cabinet of the small church clinic will last. Without these medications, without the ability to control their environment, it doesn’t matter what I say or do, my patients are at risk of dying from their asthma.

This year, we have myriad treatments for asthma and our understanding of the disease is more nuanced than ever. There are pages in several languages doctors can print off the internet to have patients keep track of and learn to manage their asthma. It is a disease we are quickly getting a handle on from an intellectual perspective, but treatments still remain out of reach for far too many.

I don’t know what triggered Erica Garner’s death from asthma, but like her father’s untimely death, it should not be in vain. Erica Garner’s death should get us talking about asthma.

I don’t tell my patients that they won’t be hospitalized for their asthma anymore. I can’t.

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