Asthma Center Provides Comprehensive Care
By Chris Tedeschi
Asthma management can be daunting for patients and physicians alike. Treatment requires focused education, prevention, management, and, sometimes, emergency care. Last spring, asthma treatment at Columbia-Presbyterian became easier and more comprehensive with the establishment of the John Edsall-John Wood Asthma Center.
Named for two longtime Columbia asthma specialists, the center is one-of-a-kind in the region, combining research and education with one-stop asthma care. Dr. Paul Rothman, the Richard J. Stock Associate Professor of Medicine and chief of the division of pulmonary, allergy, and critical care medicine, is the center's first director. The Edsall-Wood Center also has locations at Columbia-Presbyterian/Eastside and in the Century Building in Riverdale.
Nationwide, asthma has been on the rise for years. Between 1980 and 1994, the U.S. asthma rate doubled, with approximately 14 million people now affected by the disease. In some of the neighborhoods around the medical center, asthma rates are more than double the national average.
Many patients fail to manage their asthma, which leads to frequent and unnecessary visits to the emergency room. A recent Columbia study found that patients in Harlem with severe asthma visited the emergency room an average of 12 times per year and that 23 percent had been intubated. Yet only 8 percent of those patients regularly used a peak flow meter, a simple device that allows patients to assess their lung function and detect a brewing attack while it can still be avoided.
"Our clinic was bursting at its seams," explains Dr. Rachel Miller, a Herbert Irving Assistant Professor of Clinical Medicine and one of the center's physicians.
The challenge is to head asthma off at the pass. Patients who learn to manage their asthma need to seek urgent care less often. Education plays a "huge" role in accomplishing that goal, says Dr. Miller. Full-time nurse educator and study coordinator Kim Geromanos teaches patients at the center how to use their medications and devices like spacers and peak flow meters to keep their asthma under control, even when symptoms worsen. Spacers attached to inhalers ensure that medication reaches the lungs efficiently.
Dr. Emily DiMango, assistant professor of clinical medicine and clinical director of the center, says that concentrated treatment and education programs have already made a difference. "We've seen some patients who have really learned to take care of their asthma," she explains.
Yet even as patients take their care into their own hands, staff from the Edsall-Wood Center remain only a phone call away. With a 24-hour beeper service, patients can always talk to a doctor when they are not sure what to do. Physicians can change their patients' medications over the phone and offer guidance on the spot. Such unfettered access to specialists constitutes a unique and vital characteristic of the center.
The Edsall-Wood Center also offers pulmonary function tests, allergist consultations, and an evaluation of dangerous environmental exposures. Simple interventions, such as eliminating pet dander in the bedroom, stopping mold from growing around leaky pipes and faucets, and dealing with cockroaches, help reduce allergens that can bring on an attack.
In addition to comprehensive care, patients have access to clinical trials of a variety of new therapies. Researchers have begun a study of a new inhaled steroid, and more trials are on the horizon.
"Clinical trials are a major aspect of the new center," Dr. Miller says. Some of the new drugs being tested at the center help to block the immune pathways that lead to asthma symptoms in the first place. By stopping the process early, such drugs could provide better maintenance for people with serious asthma. Other clinical studies examine the development of allergies in early life and in utero and look at the effects of aggressive pest management in keeping asthma at bay.
Dr. Wood, retired clinical professor of medicine, and Dr. Edsall, clinical professor of medicine and an active member of the new center, joined staff and patients for a dedication ceremony in March. They were joined by Robert Berkley, a patient of both men who provided major funding to establish the center. Additional funding for the center was provided by Arlene Taub, Dr. Byron Thomashow, and Mary Alice Graef.
PET Scans/Transplant Evaluation Process
Steven R. Bergmann, Director
Morton A. Kreitchman Positron Emission Tomography Center
Enhanced External Counterpulsation
John Edsall-John Wood Asthma Center