Nozart Breaks Down Asthma Education Barriers

Through teaching, advocacy, and community outreach, AARC member Linda Nozart, MPH, BSRT, RRT, AE-C, known as “Thee Asthma Lady,” is working to close these knowledge gaps and improve outcomes for underserved populations. In this Q&A, Nozart, who is also the CEO of Noz Health ED, LLC, highlights how her personal experiences with asthma turned into a lifelong mission to help others with respiratory issues.

Despite advances in treatment, asthma patients still face severe complications and even death, all of which is heightened among people who lack access to proper education and care.

Through teaching, advocacy, and community outreach, AARC member Linda Nozart, MPH, BSRT, RRT, AE-C, known as “Thee Asthma Lady,” is working to close these knowledge gaps and improve outcomes for underserved populations. In this Q&A, Nozart, who is also the CEO of Noz Health ED, LLC, highlights how her personal experiences with asthma turned into a lifelong mission to help others with respiratory issues.

AARC: How did the idea of “Thee Asthma Lady” come about? What does it represent in your work today?

Linda Nozart: My first asthma initiative was taking over the asthma program at our hospital in North Brooklyn, New York, working with local senior centers. We had an initiative from the state’s asthma program to enroll patients at certain senior centers in the community in our asthma clinic and program. When we would go to the senior centers, the staff and nurses would tell the seniors to go over to the table over there to see “thee asthma lady.” And they would point to my team, whose tablecloth was bright green.

A lot of people think I called myself “Thee Asthma Lady.” At first, I didn’t like the name because I’m a respiratory therapist; I’m not a one-trick pony with just asthma. But I learned to embrace it because it was a term of endearment, so people would smile and point at me, which would lead patients to me. Some of the patients would forget my name but would remember “Thee Asthma Lady.”

AARC: How has your personal experience with asthma shaped your desire to help people with this condition?

Nozart: I am the only one with asthma in my family, and I was the first one in my family to be born in America. So, I had to help my family navigate the healthcare system, speaking to doctors in English. It wasn’t easy.

I also know what it is like for parents who cannot afford inhalers. I went to Catholic school, and our option was literally between paying tuition or getting the inhaler. I don’t think Catholic schools can do this now, but when you could not pay your tuition, they would call your name over the loudspeaker—they’d call me, my brother, and my sister—and they would line up our desk in the front lobby, and everyone would know we did not pay the tuition. Can you imagine the trauma from that? So, I told my parents, I’d rather not have the inhaler if I could avoid that shame.

That alone made me want to help people avoid the same situation. It’s the reason why I became a respiratory therapist.

Also, at the beginning of my career in 2010, one of my patients was a 5-year-old African American boy who passed away, unfortunately, due to a severe asthma attack. He had a relative who did not know the signs and symptoms of asthma. This broke my heart, and I said, “I never want this to happen again.” And it really changed how I saw my career and why I do what I do today.

AARC: What’s one asthma misconception you wish people knew more about?

Nozart: The idea that there’s such a thing as “a little bit of asthma.” Asthma is a very complex disease—a chronic lung disease, and it’s something that you don’t want to play with. We don’t want folks walking around without medication. So, we’re trying to make sure when we hear statements like that, we start from a place of education and understanding why people say things like that.

That’s why I do a lot of community outreach—advocacy work and social media. It’s to make sure that folks don’t take asthma lightly. Because, even with everything that we know today, with all the medications that exist, folks are still suffering and dying from asthma, and they shouldn’t be.

AARC: Are there any other knowledge gaps that you see, especially in populations that might be underserved by healthcare systems?

Nozart: There are so many knowledge gaps, especially with basic things. Seventy-five percent of people with asthma don’t use their inhaler correctly.

And many people think their asthma is well-controlled. If you have something that you live with every day, you just assume that it’s under control. But they might still have a constant cough, or they’re wrestling with basic things. So there’s a huge knowledge gap, and even things like using a spacer—people may have had asthma their whole lives but have never seen one, which helps deliver the medication directly where it needs to be. After all these years, there’s still a lot of work to do.

AARC: Is there a specific technique or step that people consistently miss when using inhalers?

Nozart: It’s everything. I’ve seen people forget to take the cap off, not prime it, or spray it around them like its perfume. Folks are creative, let’s say.

That’s why, when we teach inhaler use, we start from the beginning. We don’t want anyone to feel like we’re talking down to them. But if people are forgetting to take the cap off, then we have to cover it. There is a series of steps; if you don’t do them properly, you won’t get the full benefit of the inhaler.

In general, using an inhaler is very coordination-dependent. If the timing isn’t right, you are missing the benefit. That’s why I also talk about using the spacer, which is the golden way to use an inhaler because it reduces the need for coordination.

AARC: To that end, how can respiratory therapists connect with communities to improve outcomes?

Nozart: Be outside, be in the community. Be where people are on social media. That’s where people get their information every day. It’s a very scary time—people are not always getting information from healthcare professionals. People on social media can say whatever they want.

That’s why it’s important for us, as respiratory therapists, to be in these spaces in the community—not just in the hospital. We are important in the hospital, yes, but we also need to be in the communities. We need to be on social media—across all these other spaces where we can positively influence patients and everyday people.

You don’t need a huge online presence. By just sharing other folks’ content that you trust, you can start building a community and go from there.

AARC: What is your approach when meeting with families or patients?

Nozart: What I tell patients and/or their families is that you want to be a part of the detective work, like you’re Scooby Doo and the gang. We need to figure out what the asthma triggers are when they walk us through their daily lives. So, when you are feeling ill, what are you seeing? What time is it? What are you near? Are you inside? Outside? That’s the detective work, and it’s very practical, just keeping track of those things. That’s how we can tailor the treatment plan—the asthma action plan. Asthma care is not one-size-fits-all.

AARC: What would you like to see, whether policy changes, funding, or something else, that would make the biggest difference in improving outcomes?

Nozart: If I had a genie, I’d start with the social determinants of health, which are areas like housing, having access to quality food, and clean air. That includes the price of inhalers, too. If you don’t know where your next meal is going to come from, you’re not picking up a prescription. It’s just not happening. If you can’t afford the food, you most likely will not go to your maintenance appointment.

When it comes to public housing, we have buildings, especially in New York City, that are more than 90 years old and are falling apart, causing poor indoor air quality. That’s a huge problem. You are what you breathe at home. So, I’d like to see policies that address those social determinants of health. I think it would move the needle greatly.

AARC: Any final parting thoughts?

Nozart: We must continue to speak with patients and not at them. Meeting patients where they are and really using shared decision-making, including the whole healthcare team, to build rapport in a way that helps them progress. You can give people a treatment plan, make suggestions, provide education, but at the end of the day, if there’s no connection, nothing improves.

Oprah Winfrey, who made a billion dollars from communication, said that to have good communication, there has to be a connection. And the way we connect is: we align accordingly, we believe boldly, we collaborate correctly, and then we deliver. Meaning, you have to understand what the patient is really like and speak from that perspective. What is their version of having the optimal quality of life?

Once you have that connection, you can communicate better and have a better chance of influencing them, especially patients who are considered “hard to reach.” I have a lot of experience with that “hard patient” in the asthma space, and what I’ve learned is really just about continuing to build that rapport and shared decision-making, giving options, understanding their beliefs, and aligning with them.