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Spring, 2011

GIP in Focus

Burn Analogy Sparks Patients' Use of Inhaled Corticosteroids

“Many individuals with asthma who live in the inner city believe that their asthma is an event, not a chronic disease where their airways swell up and muscles around them tighten,” said Michael B. Foggs, M.D., an allergy and immunology specialist with Chicago’s Advocate Health Centers. “That’s why we need to explain the concept of inflammation to them in terms that they can understand.”

What Dr. Foggs has found over the course of his work with high-risk, inner-city asthma patients in Illinois’ largest health care facility, is that using a highly visual analogy works best with patients.

“Since everyone knows what a burn is like, I tell them that when you have asthma without symptoms, it’s as if you have first-degree burns throughout your lungs,” said Dr. Foggs, who is also the immediate past-chair of the National Medical Association’s Allergy, Asthma & Immunology Section and contributor to the Expert Panel Report 3—Guidelines for the Diagnosis and Management of Asthma on the issue of adherence for patients from racial and ethnic minority communities.

Cross section of airways under normal conditions and affected by asthma
Figure A shows the location of the lungs and airways in the body. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway during asthma symptoms.

“To keep those burns under control, you need to take your medication so that your lung tissue can absorb it and heal. If you don’t take your medications, and [you] develop symptoms, that’s like a second-degree burn. An asthma attack is like a third-degree burn.”

Dr. Foggs admits that the burn analogy is a bit dramatic, but he reports that it resonates with patients and allows them, within the time constraints of a visit, to understand the importance of taking their prescribed medication. 

Using inhaled corticosteroids (ICS) is one of six key steps to improve asthma control. Research has proven that taking ICS every day, long term, is the best way to reduce chances that the lung’s airways will become inflamed or surrounding muscles constrict.  The challenge is that many patients fear steroids.

“It’s not necessarily a lack of education that’s keeping people from taking the ICS,” said Dr. Foggs. “It’s their belief system.”

Dr. Foggs uses the story of one patient as an example: A highly educated African-American woman with a Ph.D. had resisted taking the ICS prescribed by her primary care physician. It took hearing the burn analogy, and talking through some of her underlying beliefs about health care, to convince her to take her medication daily.

Dr. Foggs also reports that in addition to considering underlying health beliefs—plus frequency and intensity of symptoms and attacks—his practice profiles patients as high-risk by looking at other variables, such as the following:

  • Whether the patient falls into a racial or ethnic group that has a higher-than-average rate of death due to asthma (African-American females and Puerto Ricans top the list of death rates from asthma).
  • Whether the patient is skeptical about taking medication in general, including anti-inflammatories such as aspirin or Ibuprofen.
  • Whether the patient is obese and has sleep apnea.
  • Whether there are environmental triggers such as cigarette smoke in the home; dust mites and cockroaches; and/or something that leads to higher than normal stress (the latter is still being researched as an asthma trigger).

Be sure to check future editions of NACI In the Know for additional stories on how providers and researchers are working to improve the care and control of asthma for inner-city asthma patients.

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Last Updated April 2011




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