Analysis: An asthma patient's best friend?


Allergyby Ed Susman, UPI

SALT LAKE CITY, Oct. 24 (UPI) -- Inner-city asthma patients whose medicine doesn't help because they live in rundown housing may be better offer getting referred to a lawyer rather than a specialist.

In New York City, when doctors asked a lawyer to confront recalcitrant landlords, the patients got their homes repaired -- and used less medicine, required fewer trips to the emergency room or treatment, and in general, improved their overall condition.

"There's no way that a person who lives in a dusty, moldy, rodent-infested, roach-infested apartment is going to get any benefit from asthma medicine," Mary O'Sullivan, chief of the asthma clinic at St. Luke's-Roosevelt Hospital in New York, told United Press International.

In a program worked out between St. Luke's-Roosevelt and the New York Legal Assistance Group, the hospital paid $225 -- representing three hours legal time -- for attorney Julie Brandfield to write a letter to the landlord that basically said: Clean the place up or see me in court.

"I wrote letters, social workers wrote letters until we were blue in the face to the landlords, but nothing ever happened" O'Sullivan said Tuesday at the annual meeting of the American College of Chest Physicians in Salt Lake City, Utah. "But one letter from Julie and the owners cleaned up these awful places."

In the report to the meeting, Luis Chug, a pulmonary fellow at St. Luke's said that among the 11 patients who went to the lawyer:

--Patients who were taking emergency courses of oral steroids because of uncontrolled asthma were able to reduce those courses from 18 the year before their apartments were cleaned up to just two, the year after the clean-up.

--Reduced by 94 percent the need for visits to the hospital emergency department for asthma -- 14 trips prior to legal intervention versus two visits after the homes were fixed.

--Significantly improved their asthma condition, with most patients improving by at least one level on the scale of seriousness of the lung disease.

"We were able to show that when living conditions are severely degraded, improving those conditions will improve asthma control," Chug told UPI.

Chug reviewed the cases of 21 patients who had asthma that had shown little improvement despite compliant use of inhaled steroid medication. All the patients lived in sub-standard housing. Eleven of the patients who allowed lawyers to write letters on their behalf improved dramatically one-year after the legal intervention occurred and their homes were repaired.

O'Sullivan said that once the letters arrived, the landlords knew they had to take action of go to court and they preferred fixing up the places. She said 10 other patients opted not to go to the lawyers to get help. "Most of these people were afraid to take legal action," she said. Those patients showed no improvement in their asthma conditions.

For the patients who got help, the legal fees were clearly cost effective, said Chug. Each emergency room visit costs the hospital about $450 in services; each course of prednisone cost about $345, he said. "The savings are substantial," he said.

"While the numbers of patients involved in this study were small and the fact that this is a retrospective study, the results show that patients with asthma cannot get better when they live among irritants and allergens," Paula Anderson, professor of pulmonary and critical care at the University of Arkansas for Medical Sciences, Little Rock, told UPI. "This study shows how brilliantly practical public health measures can be to correct health problems."