Issues > March 1, 1996 (#21) > Breathing Space: What You Can Do to Stop the Rise of Asthma

Breathing Space: What You Can Do to Stop the Rise of Asthma

by Mindy Pennybacker

"When my son Will was two months old, my husband and I woke up and heard him having a hard time breathing in his sleep, really struggling. We rushed him to the children's hospital--I had never seen a baby with asthma before," says Pat Jones, of Los Angeles. "We used to live in a duplex, next to a freeway. When we lived over there, we stayed at the emergency room," she says.

The relationship between ozone, or smog, and the exacerbation of asthma symptoms was recently documented in an Atlanta study involving 543 children during the summer of 1990. "Among African-American children living in the inner city of Atlanta, emergency-room visits were almost 40 percent higher on the days ozone was elevated," says Ruth A. Etzel, M.D., Ph.D., Chief of the Air Pollution and Respiratory Health Branch at the Centers for Disease Control (CDC). "These asthmatic children fared more poorly because of raised ozone levels," Dr. Etzel says.

The Recent, Alarming Rise in Asthma

In the past fifteen years, asthma has increased worldwide. In 1990, the Journal of the American Medical Association reported that death rates from asthma were on the rise in Canada, England, France, Denmark, Germany, and the United States. Australia and New Zealand have also reported increased asthma mortality. According to the CDC, more children suffer from asthma than any other chronic disease. "Asthma has become the leading cause of admission to hospital for children beyond the newborn period," says Philip Landrigan, M.D., a New York City pediatrician and co-author of Raising Children Toxic Free (Avon Books, 1995). Asthma is the number one reason for school absenteeism in America, according to the CDC. In 1991, an estimated 5.8 percent of U.S. children--or 3.7 million children--had asthma.

The disease is on the rise in adults, too. From 1982 through 1992, the prevalence rate of asthma increased 52 percent in Americans aged five to 34 years, and the overall annual age-adjusted death rate rose 40 percent.

Why this increase? Doctors and researchers have no single answer; asthma, they point out, is a multifaceted disease triggered by a combination of factors, but polluted indoor and outdoor air are definitely implicated in both its onset and its worsening.

Symptoms

How do you know if your child has asthma? "It's not just wheezing. Many kids have cough-variant asthma," says Harvey Karp, M.D., a pediatrician in Los Angeles. Symptoms include wheezing and persistent cough, or repeat episodes of bronchitis or pneumonia, Dr. Karp says. Asthmatics have hyperreactive airways; in reaction to allergens or irritants, breathing tubes in the lungs begin to close off.

Disproportionate Impact Upon Americans of Color

According to CDC findings in 1992, blacks are two to three times more likely than whites to be hospitalized for or die of asthma. In the last ten years alone, the asthma mortality rate doubled for African-American men and women. Nationally, asthma's prevalence among black children from low-income families is 26 percent higher than for white children.

"We lived in the St. Nicholas Housing Project in Harlem," says Nicole Bullard, a 17-year-old with asthma. "My brother had asthma really bad, and his doctor told us we had to move to a new neighborhood." The family moved downtown, but it wasn't enough to reverse the condition of her 28-year-old brother, who died of asthma and a heart attack four months later.

Over three-quarters of U.S. asthma deaths between 1980 and 1989 happened in urban areas. Central Harlem, one of the poorest communities in the nation, has a rate of hospitalization for asthma three times that of the rest of New York City for the zero to 34 year age group.

The Good News: Asthma is Arrestable

"The best way to keep a child out of the hospital is a well-educated parent," Dr. Landrigan says. Learn your family history, he advises. "Allergies run in families. A cold and/or allergens and irritants in the environment can trigger an attack."

Asthma Triggers

  • Cigarette smoke. Technically an airways irritant rather than an allergen, cigarette smoke's effect on asthmatics is severe.
  • Dust mites. Dust mites are microscopic, and their excrement is a potent allergen. They infest bedding, upholstery, drapery and rugs, and thrive on moisture and human skin cells.
  • Cockroaches are a primary allergen.
  • Pet danders. Cat, dog and horse danders, and even the molting feathers of pet birds, can cause severe reactions.
  • Mildews and molds.
  • Unvented gas appliances, heaters and stoves. The American Lung Association warns that nitrogen oxides can pollute indoor air without adequate venting of gas appliances--such as water heaters, stoves and clothes dryers--and also through wood-burning fireplaces and stoves. In addition, Dr. Bates warns against portable kerosene stoves and space heaters.
  • Ozone. "Ozone [smog] causes inflammation in the lungs at very low concentrations," says Dr. David Bates, professor emeritus at the University of British Columbia.
  • Particulate matter. Very fine pieces of soot, dust or smoke get deep into the lungs.

How To Prevent Attacks

  • Take early action. "In order to get asthma in the first place, we think the important thing is exposures to various allergens very early in life, meaning less than two years of age," says Douglas Dockery, Ph.D., professor at Harvard School of Public Health. This is one more reason a pregnant woman should not smoke. To prevent the onset of asthma, or if the child already has asthma, parents should eliminate common allergens and irritants from the home, says Dr. Landrigan. Rather than schedule expensive allergy testing, he says, parents should first take a step-by-step approach, as follows:
  • Ventilation is crucial. "The building of tightly-sealed houses over the last two decades has made it much easier for moisture and dust to collect in homes," Dr. Dockery notes. Many vapors trapped indoors, from perfumes and air fresheners to formaldehyde from particle board, irritate asthmatics. Make sure that stoves are well-vented; when it's fresh or even cold outside, keep windows open a crack to circulate air. On hot days, close windows and use air conditioners to ventilate and filter out smog.
  • Buy mattress and pillow encasings that are impermeable to dust mites. Vinyl or plastic mattress covers cost $20 to $50. The important thing is to get a tight seal. You can leave plastic or vinyl covers out in the sun to offgas them, first. Tightly-woven (at least 380-count) cotton mattress covers are expensive (about $119 for twin-size) and need to be washed with other bedding to remove mites. Foam rubber mattresses must also be encased, Dr. Karp warns. "Foam rubber is a haven for mites."
  • Avoid feather comforters and feather or foam rubber pillows. Encase all pillows.
  • Launder in hot water (130˚F). Bedding, including blankets, should be washed at least every two weeks. Warm water will not kill mites.
  • Take up carpets, take down curtains. Bare floors and windows are best. Carpets and heavy draperies are dust mite heaven. If you can't take up carpets, Dr. Karp suggests applying nontoxic tannic acid solution, available at Allergy Control Products (see Resources), to kill mites.
  • Dust with a damp cloth and vacuum frequently. Small particles irritate asthmatic airways the most. When buying a vacuum cleaner, ask if it will fit HEPA (High Energy Particulate Air) Filters, a $100 option, which trap much finer particles. Wipe walls and ceilings with a damp mop. Vacuum central air and heating vents.
  • Beware of vacuum cleaner backdraft. The January 1995 issue of Consumer Reports found that the dustiest exhaust came from canister-style machines; upright vacuum cleaners are recommended.
  • Keep clutter to a minimum. Piles of dirty clothes make a growth environment for mildews and mites; piles of paper attract cockroaches. Pat Jones keeps stuffed animals, a frequently-overlooked mite paradise, off her asthmatic daughter Cathy's bed.
  • Dehumidify. "Dehumidifying is enormously important, as many asthmatics are highly allergic to mildews and molds," says Harriet Burge, Ph.D., associate professor at Harvard School of Public Health, herself an asthmatic with three humidifiers in her home. "Keep the basement dry, and never put carpeting on low-grade concrete floors." Use linoleum or tile.
  • No pet, no danders. "Cat dander is everywhere, even if you wash the cat," Dr. Etzel says. "The only real solution is not to have the cat." Or, wash the animal every two to three weeks, Dr. Karp advises.
  • No cigarette smoking in the home or car, or anywhere in asthmatics' presence.
  • Furnace and heating duct filters should be replaced periodically as they collect dust and molds. Some businesses, like Absolute Environmentals Allergy Store (see Resources), provide duct-cleaning services.
  • Keep asthmatics away from gas stoves. "Open the oven door and you get a blast of nitrogen dioxide," says Dr. Bates. "The asthmatic child should not sit in the kitchen doing homework if the oven is being used."
  • Ask your pediatrician about allergenic foods. If there is a family tendency to allergy, Dr. Etzel says, parents might limit foods associated with allergies, such as cow's milk, from the child's diet in the first two years. She and other pediatricians recommend that mothers try to breastfeed their infants for at least the first year. Note: sulfites, present in some dried fruit and wine, have caused fatal reactions in some asthmatics.
  • Restrict outdoor activities when pollution is high. Check your local air quality index daily. Asthmatic children should not exert themselves outside in hot, smoggy weather, or when a dusty wind blows; smog counts tend to be highest between 3pm and 6pm. "But remember, a parent's goal is to minimize symptoms so that your child can go about life fully, without restrictions," says Dr. Karp.
  • Eradicate cockroaches.
  • As a last step, try air cleaning and purifying machines. Consumer Reports says a good air cleaner can help those allergic to dust and mold spores, citing the fan/filter models as most effective in removing airborne dust. The machine will help most in the asthmatic's bedroom; but keep it at least six feet from the bed (it creates draft), and don't place on carpet (it can kick up dust). A HEPA air cleaner for one room costs about $100. But, "They can only help if you've gotten rid of the risk factors first, like dust mites, mold and danders," Dr. Burge warns. Warning: many asthmatics experience irritation from the ozone type of air purifier.
  • Drive less, fight pollution at the source, and support sustainable transportation. Paradoxically, asthma has soared while overall air quality has improved, at least in the U.S., thanks to pollution control standards. But statistics show that urban populations, who dwell with higher levels of ozone and particulates, remain especially at risk. For an asthmatic, when it comes to dirty air, less is more. Dr. Etzel's Atlanta study showed increased emergency room visits when ozone reached .11 parts per million, lower than EPA's standard of .12 parts per million.

    Therefore, we must continue to fight pollution at its industrial and automotive sources, and demand public transportation, electric cars, and stricter clean-air standards. Nicole Bullard, for instance, is a member of the Youth Earth Crew for West Harlem Environmental Action, which keeps pressure on the city to monitor air quality at a sewage treatment plant and is holding a conference on diesel bus fumes this month.

Resources

For free pamphlets on asthma:

Mail order vendors:

Filed under: Respiratory illness, Asthma and allergies

Green Guide 21 | March 1, 1996 | For Your Health