ASTHMA

Asthma

Asthma

This study is based on the personal interviews of five individuals who are currently working in health care organisations. According to their perceptions, asthma is a chronic inflammatory lung disease characterized by repeated instances of breathlessness, wheezing, and coughing. This disease has been discussed quite extensively in the medical and public health literatures but has largely been ignored in the economics literature. (Department of Health and Human Services, 1997) But as policymakers consider policy alternatives to reduce asthma rates such as raising cigarette taxes economists will be increasingly called upon for cost-benefit analyses. As a primer for such future research, a 1998 DHHS study estimated the annual cost of asthma, including medical costs and productivity losses, to be over $11 billion per year. Death rates due to asthma are on the rise, with an over 300% increase from 1977 to 1995. Race differences also persist. In 1995, the death rate among African Americans (11.5 per million) was over four times higher than that among whites (Mannino, Homa, and Pertowski 1998).

The medical community has reached a consensus that asthma is a disease of airway inflammation "resulting from a complex interplay between environmental exposures and genetic and other factors" (American Academy of Pediatrics, 2000). Second-hand tobacco smoke from cigarettes, cigars, and pipes is composed of over 3800 unique chemical compounds (National Research Council 1986). Concentrations of suspended particulate matter are two to three times higher in homes with smokers than homes without smoking, and this particulate matter is believed to be negatively associated with respiratory health (Dockery et al. 1982; American Academy of Pediatrics 2000).

According to experts' point of view, while there is minimal understanding of the environmental causes of asthma, the environmental triggers of child asthma have become more well known. Among the principal allergens that trigger asthma attacks among young children are house dust mites, cockroaches, mould, and animal hair (for examples, see Warner et al. 1996). Several studies have examined the relationship between exposure to second-hand tobacco smoke and the development of asthma in young children. However, almost all are cross-sectional studies that do not account for unobservable characteristics that may be correlated with both maternal smoking and the child's development of asthma, thus raising doubts as to the appropriateness of a causal interpretation of estimates.

A key component that is missing in many school-based asthma programs is effectively ensuring appropriate and ongoing medical care. Self-management education has been shown to improve self-management skills and self-efficacy. But it cannot substantially reduce morbidity without appropriate medical care and pharmacotherapy. Although evaluations include a wide range of study designs, the collective experience indicates that programs that either provide asthma care directly or ensure adequate links between the school and the student's asthma care clinician have successfully reduced asthma morbidity. School-based asthma management that is coordinated with the students' medical care includes obtaining asthma action plans and school medication forms and ensuring access to quick-relief bronchodilator medication throughout the school day.

However, ensuring appropriate medical care has been difficult for many ...