Part of the problem, according to experts, is industrialization. Dr. DavidRosenstreich, M.D., director of the division of allergy and immunology at theAlbert Einstein College of Medicine in New York City, reports that incidencesof the disease are not only increasing in the United States, but also in mostdeveloped nations. Twenty-one million Americans are currently living with thepotentially fatal disorder, and that number is likely to increase.

Dr. Rosenstreich, who also served as a senior investigator on the InnerCityasthma Study, which aims to identify factors related to the development ofasthma in children, says that genes, allergies, environment, and socioeconomicfactors related to quality and access to care are major contributing factors.Inner-city children in urban areas, like Dallasallergy immunology, Austin, and Houston, are far more vulnerable toelements that can cause or aggravate symptoms of the disease, and they are farless likely to have quality health insurance and access to outpatient healthcare. This would seem to validate one of the studies released this year by thenon-profit organization, the Commonwealth Fund, which states that lack ofhealth insurance is directly related to less access to care.

What many doctors seem to miss, however, is the extent to which the lack ofquality health insurance may impede this management process. It’s difficult, ifnot impossible, for a poor family with no health insurance to afford thenecessary medications, to see the doctor several times a year, and toconstantly monitor their children’s activities. TEDAS, and other initiatives,are of vital importance, but so, too, are initiatives to make sure thatfamilies are insured. Similar results may be seen if more aggressive action wastaken to enroll such children in low-income, and more affordable, healthinsurance plans.

Massachusetts may be on to something with its requirement that allindividuals get some kind of health coverage, but that such plans — evenprivate plans — could be subsidized by the state if one is below a certainincome level. In the end, it’s a collaborative effort; we, as a country, gotourselves into an industrial, pollution-based mess that is now causing oraggravating many diseases. Now it’s our job to take care of each other and getourselves out of it.

“In a way, each [emergency department] visit represents a failure,” saidDallas allergy immunology Marianna Sockrider, M.D., of Texas Children’sHospital. “Managing asthma often comes down to good care and well visits.Ideally, if families take control of their children’s asthma — following actionplans, using medication and controllers, communicating with their primary careproviders — most of those [emergency department] visits aren’t needed.”

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