Featured in MDNEWS Lower Hudson & Bronx Edition, October 2012 According to the Centers for Disease Control and Prevention, an estimated 25.7 million persons in the United States (one in twelve adults and one in eleven children) had asthma in 2010. Women, children, black people, Latinos, people of mixed race, and those living in poverty are at particular risk.
In the Bronx, nearly six percent of the population suffers from asthma—2.3% over the rate among New York City residents overall.
The Montefiore Asthma Center opened in June 2011 to deliver comprehensive, consistent, targeted patient care for patients with the most complex cases of severe and refractory asthma. The Asthma Center's mission—to improve asthma control, patient symptoms, and prevent Emergency Department visits and hospital admissions through proactive outpatient management—is accomplished by bringing together pediatric and adult pulmonologists and allergists, as well as a physician assistant who serves as an asthma patient educator, into a single office location.
Patients may be referred to the Asthma Center by a specialist or primary care physician, or may be selected based on their medical utilization history.
The Asthma Center Experience
Upon arrival at the Asthma Center, each patient meets with a specially trained nurse, who conducts an in-depth evaluation of how the patient's disease developed, previous diagnostic tests and interventions, and successful therapies and/or exacerbating factors (including home, school, and work environments).
Over the course of the first two visits, each patient is seen by an allergist, pulmonologist, and asthma-specialist patient educator.
- The allergist conducts a diagnostic assessment including allergy skin testing and makes recommendations based on environmental and immunological aspects of the disease. The patient educator then provides one-on-one social and lifestyle counseling, reviewing and explaining the physicians' recommendations, and creating a strategy to allergen-proof the patient's home.
- The pulmonologist conducts additional diagnostic tests to identify or rule out the possibility of another breathing condition, and formulates a comprehensive care plan, recommending patients for innovative immunotherapy and biologic immunomodulators when appropriate. The patient educator then meets with the patient to demonstrate appropriate methods for taking prescribed medications, particularly devices such as inhalers.
The Asthma Center team compiles extensive documentation of the patient's environmental history, skin testing results, pulmonary function test results, and summary of the diagnosis, actions, and recommendations of both the allergist and pulmonologist. This documentation is shared electronically with referring physicians for follow-up.
Data from the first three years of the Asthma Center's existence shows that over 500 patients with refractory (severe) asthma have been treated with favorable results, patients are being helped to manage their asthma, and asthma-related office visits and overall costs for both the adult and pediatric divisions have reduced, particularly for patients cared for in the Montefiore Health System.
The Asthma Center's research efforts include the following areas:
- Pediatric asthma and obesity, including both epidemiology and mechanisms
- Exhaled biomarkers of asthma
- Aspirin-sensitive asthma biomarkers and mechanisms
- Patient education strategies and related software devices
These research studies are supported by grants from NIH, Genentech, Stony Wold Foundation, and the Einstein-Montefiore Institute for Clinical and Translational Research.