We see asthma in television shows and in movies and we don’t think twice about it. On some level we have even made it comical. What is up with that trope anyhow? You know the one, they are always clutching their inhaler, they give off an anxious persona, and they are always the nerd.
It’s unfortunate because asthma is a chronic disease just like diabetes, or Chron’s, or cystic fibrosis. Yet people seem to forget how difficult asthma can be. In the past four weeks I have spoken to over 80 physicians, individuals with asthma, and parents of children with asthma. I’ve heard some of the same stories over and over again.
I had to adjust my entire life.
I have to be careful of my environment.
Every time I want to have a meal on a patio I think twice because I am scared someone might just pull out a cigarette that sends me into an attack.
It’s embarrassing to not be able to breathe.
It’s hard to use my inhaler.
It gives me anxiety and it makes me feel inferior.
I want to take my medication on time, but I always forget.
And the worst part, is the mental battle - this is a disease that I will have for life. One that might be under control one day and the next the battle starts all over again.
From my conversations with these people, there have been three recurrent problems – medication adherence, inhaler technique, and environmental triggers.
Well, I’m here to tell you that you aren’t alone, and it can be better.
There are policies that we can urge New Mexico to adopt today.
Medication adherence, compliance – it’s known by a lot of different names. No matter what name you want to call it – it’s hard! For a chronic disease it’s especially hard – taking a medication every single day, making monthly trips to the pharmacy. It’s costly and time consuming. And despite a plethora of research that shows easier access to medications makes adherence easier, New Mexico has quantity limit restrictions on all asthma medications. These restrictions are the reason you have to make a monthly trip to the pharmacy to pick up your maintenance inhaler.
Abolishing these restrictions and moving to a 3-month opt out supply program will reduce the mileage on your car and the time spent waiting in lines. It’s also been shown to improve adherence by as much as 20%. And improved adherence opens the door to plenty more – reduced ER visits, hospital admissions, missed school and work.
Here is how this program would work. Individuals with asthma who are insured by Medicaid or Medicare would be automatically enrolled so that they receive a 3-month supply of their medication every time they go to the pharmacy. (And btw, if the program is a success there is hope that private insurance will follow suit.)
Sounds like a pretty sweet gig to me!
And this isn’t the only policy New Mexico can adopt.
This next policy option focuses on school aged children.
Did you know that asthma is a leading cause of school absenteeism?! It accounts for about 14 million absences each school year – one-third of all school days missed in the US.
Right now, New Mexico does not have any governing body to ensure indoor air quality policies in schools. The result – aging school infrastructure and mold and allergen inducing asthma attacks.
It’s awful – schools are place where kids are supposed to feel safe! But New Mexico can do something to help.
We can urge New Mexico to develop an Air Quality on Schools Subcommittee. The committee would act as an oversight body to develop Indoor Air Quality management policies on three areas: Indoor Air Quality maintenance; planning and construction to assure indoor air quality; and a public information plan for students, parents, and staff.
The subcommittee would sit within the Capital Outlay committee of the Public Education Department and would work in collaboration with the Department of Health and Environmental Department – Air Quality Bureau.
And of course, with any new committee you have to have funds to make it happen. But as Elizabeth Warren would say – I have a plan for that! The state can look to Minnesota and Maryland both of whom are notable for providing grants to school districts for health and safety capital improvements, including an explicit category for Indoor Air Quality-related repairs.
These programs have been huge successes in both Minnesota and Maryland! If we do this right, it could result in in over 9,000 fewer missed school and workdays and over 800 mitigated hospital interactions.
And this isn’t just great for getting our kids back in the classroom, this could also save New Mexico over 14 million dollars’ worth of reduced asthma related costs.
While both of these options I have just outlined are quite compelling there is still another option – and this one has a proven track record!
The U.S. Department of Housing and Urban Development have outlined an evidence-based guide to effective asthma home intervention programs. These programs address asthma and allergy triggers, and home safety for families who are enrolled in Medicaid and have children with uncontrolled asthma.
Children in the program are assigned a case manager that help families create an Asthma Action Plan and conduct an environmental assessment. Depending on the results of the assessment patients will receive products to ensure home safety and reduce allergy and asthma triggers. Some examples of products that can make a huge impact are allergen mattresses and pillow covers. If the case manager decides these quick fixes weren’t enough to get the child’s asthma under control, second and third level interventions can be used. Some examples of this include air filters, pest control, structural repairs and carpet and mold removal.
Sounds like this might cost a fortune, right? Well, when you think about how much New Mexico spends on asthma related healthcare costs already - $320.8 million annually - the program starts to become more appealing. Similar programs have actually shown to be incredibly cost-effective.
In fact, the US government believes in the intervention so much that there is actually a grant program for states to prove the cost effectiveness. The New Mexico Department of Health can apply to the Healthy Homes Demonstration Grant Program to receive funding to pilot it.
The reality is that asthma is hard and frustrating. But it doesn’t have to control your life.
To the 200,000 New Mexicans who have asthma, let’s start the conversation. Talk with your friends, families, coworkers, educate them on the importance of tobacco free public spaces. Educate them about the quantity restrictions on asthma medication in New Mexico. If you feel like you need to know more before you start the conversation – reach out to the NM Council on Asthma – they are happy to help! If we continue this conversation, then there is hope that New Mexico will one day have home intervention programs and 90-day supplies of medication. Together, we can build a community that understands asthma and what it means to have it.