Environmental racism and climate change - Missed diagnoses

The mother clutches her daughter as the nebulized albuterol permeates the young girl’s airways. My eyes dart between the monitor and the child’s small, dark-skinned chest as it heaves up and down at an alarming rate. I smile reassuringly, but the mother’s eyes begin to well with tears as she recounts her daughter’s numerous emergency department (ED) visits and home treatments.

“I have done everything the doctors have asked, and she just keeps getting worse. What am I missing?”

Later, while charting, I review in greater depth the patient’s extensive records — far too many for someone so young. Her care teams have all been following the evidence-based guidelines. What are we missing?