Doctors at an asthma clinic in New York were puzzled as to why their patients were not getting better even after continued medical care. Even though the patients were compliant with their medications, they needed oral steroids and presented with more severe asthma attacks at the emergency department. Looking into the living conditions of the patient group that continued having problems provided some insight: they lived in housing units that were dilapidated. In a program in which St. Luke’s-Roosevelt Hospital and other clinics participated, with the help of legal services of an attorney law firm the hospital was getting help for patients, who lived in substandard housing. When a patient lived in a building with dust, mold, roaches or rodents, any amount of treatment for asthma was almost futile. Even though there were letters and phone calls from social workers to landlords, unacceptable conditions in these housing units were not corrected. One letter from the New York Legal Assistance Group finally did the job. In plain English the notice to the negligent landlord said: Clean the place up or see me in court.
Dr. Luis Chug at St. Luke followed up on the patients one year later. Patients who needed 18 courses of oral steroids could reduce the treatment to just 2 the year after the cleanup. Patients who had made 14 trips to the emergency department because of asthma attacks the year before made only 2 after the conditions were corrected. The overall asthma of the patients also improved. Ten patients were afraid to go to a lawyer to seek help. A year later their living conditions predictably had remained the same. Their asthma had not improved either. The legal action was cost effective, reported Dr. Chug. Each emergency visit cost the hospital about $470 in services, and each course of prednisone cost about $345. The patients do not pay legal fees. Instead the service is funded by grants from participating hospitals. The study shows very clearly how practical public health measures can be used to correct health problems. The legal processes available in New York City are not unique in North America, as many local and regional governments have statutes requiring proper building maintenance.
Substandard housing bad for asthma
The results are also relevant to asthma patients who are not struggling with substandard housing. Patients with asthma simply cannot get better, when they live among irritants and allergy causing substances. Dust, cigarette smoke, perfumes, home fragrances, vapors from household cleansers, animal dander from house pets or feathers from a seemingly cozy down comforter can be the culprits for patients with asthma that does not improve despite treatment.
More information about:
1. asthma: http://nethealthbook.com/lung-disease/asthma-introduction/
2. mold allergies: https://www.askdrray.com/mold-allergies-often-overlooked/
Reference: The Medical Post, November 14, 2006, page 23 and 25
Last edited November 2, 2014
About Ray Schilling
