Childhood Asthma and Environment (YIKES!)

There is no doubt that the incidence of childhood asthma has climbed dramatically in the last 20 years. We see it in our schools, our neighborhoods and our own homes like never before.

Witnessing an asthma attack in a small child can be terrifying, and if you’ve seen one you know exactly what we’re talking about. The best description around is that it’s like trying to gulp air through a straw.

Explanations for the increase abound. Some experts suggest that children are being exposed to more and more allergens such as dust, insect droppings, and second-hand smoke. These are all triggers of asthma.

Others suspect that children are not exposed to enough childhood illnesses to build up their immune systems. It appears that children who fail to make enough protective antibodies may be at higher risk of developing asthma. Still others suggest that decreasing rates of breastfeeding have prevented important immune mediators from being passed on to babies.

But there’s an enormous elephant in the room that needs an elephant gun, and no one knows what to do about it. It’s the issue of man-made changes to our environment and their contribution to childhood asthma.

What follows is an excerpt from an excellent article written by Floyd J. Malveaux, MD, PhD. Dr. Malveaux is the executive director of the Merck Childhood Asthma Network, Inc. (MCAN), the nation’s only nonprofit dedicated to implementing science-based programs to address childhood asthma. He is a nationally recognized expert on asthma and allergic diseases, and Professor of Microbiology and Medicine at Howard University.

There is no doubt that the environments in which we all live, learn, work and play are changing and affecting our health. It is time for our nation to broaden its view on the environment and begin taking a long, hard look at how to reshape health care and chronic disease management to minimize adverse health consequences of environmental change both today and in the long-term.

One of the starkest examples of the consequences of the environment on health can be seen in childhood asthma, the single most common chronic condition among children. Asthma’s growing incidence in the United States, which some experts speculate is indirectly related to climate change, has left one-in-seven American children and their families struggling with ongoing management of the disease.

Nearly 60 percent of children diagnosed with asthma have had an attack within the previous 12 months, sending hundreds of thousands of parents racing their children to the hospital for emergent care each year. And what’s worse is that more than 1 million of these children remain uninsured and at risk for relatively poor health care.

As scary as these numbers are, they are only bound to grow if we do not address the impact of environmental changes and poor quality care on this condition – putting children at increased risk of developing or losing control of asthma.

The very nature of this chronic disease calls for strict control of environmental triggers, which can bring on life-threatening attacks. These exacerbating triggers, including indoor and outdoor air pollutants and allergens to which we are all exposed each day, are worsening with climate change and are in turn adversely impacting the severity of asthma for children.

For example, air with high ozone concentrations that 3.9 million children in the U.S. are exposed to each day, can both trigger wheezing and attacks and make children’s still developing airways more vulnerable to allergens in the future.

On top of the daily assault to their health via airborne pollutants, seasonal triggers are estimated to increase in abundance and severity. For example, a new report from the National Wildlife Federation shows that 16 states are at risk for moderate to large increases in highly allergenic tree spring pollen (3), a trigger for some asthmatic children.

These environmental factors lie beyond the control of any one family and fall outside of traditional “health care” interventions, but I see the impact they have on everyday life and childhood for the millions of children with asthma and their families. I also see the need to change our reactive approach to managing this disease to a proactive and preventive venue that embraces sound public health principles.

What changes can we as a nation make to improve outcomes for children with asthma and others with underlying diseases affected by the environment? On the local level, interventions in community-based locations used by children — playgrounds, schools and school-yards, and public housing units — and the implementation of policies such as those designed to reduce idling by buses around schools, have increasingly been shown to play a role in reducing asthma triggers.

Melba Miles is a great example. She is proud grandmother to two-year-old Jamal who suffers from asthma, and spent many months standing by as her grandson suffered asthma attacks, including one that left him in intensive care for five days. After the attack, Melba became involved in the Addressing Asthma in Englewood program, a local Chicago initiative that helped her learn to manage Jamal’s asthma. However, Melba noticed that every time the city sprayed vacant lots in her neighborhood with pesticides, Jamal and other residents with asthma experienced breathing troubles. The city’s policy was to spray vacant lots in Chicago, including many in Englewood, without any warning to people living nearby.

During a neighborhood advisory board of community leaders and caregivers created by the Addressing Asthma in Englewood program, Melba expressed her concerns about the effects pesticide spraying was having on residents’ asthma. Leaders of the asthma program took action. Working with city officials, they created new spraying policies that would limit exposure to the pesticides. Now, residents in Englewood and across Chicago can be put on a “do not spray” list or must be notified before their neighborhood is sprayed so they can close the doors and windows or stay indoors after the spraying occurs.

The ever changing climate, one of the most visible concerns in the 21st century, has raised our nation’s consciousness about our environment. As a result, many of us have focused on buying hybrid cars, recycling newspapers, greening our homes and workplaces and even saving endangered species. But we have not yet focused on what we can do to save our own health. For ourselves — and for our children and grandchildren — this has to change.

Thank you Dr. Malveaux, we couldn’t have said it better. Now where’s that elephant gun?

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Ellen and Rachel are two old friends and “expert” mamas—one a pediatrician and one a family therapist—with fifty years of parenting experience between them.

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