City TV, Channel 21 Hartford to present a live call-in Healthy Hartford Program about asthma, May 24, 2006; 6:00pm  Flier     

Asthma

An Unexplained Epidemic

For information about Hartford's asthma problem, click here.

What is asthma?

Asthma is a chronic lung disease in which a person's bronchial tubes (airways) become swollen, and extra mucus (a thick, slippery, sticky fluid) blocks air from getting to the person's lungs. During an asthma episode or attack, the person may cough, wheeze, gasp for breath, and experience chest pain or tightness. Asthma attacks are most common in the early morning and at night. Asthma ranges from mild to life-threatening.

While asthma cannot be cured or prevented at this time, asthma can be managed, and many asthma attacks, hospitalizations, and deaths may be preventable. Proper medical management and the reduction or elimination of environmental asthma triggers, such as tobacco smoke, dust, and mold, can help to reduce the impact of asthma.

Why is asthma a major health problem?

Asthma is widely considered an epidemic in the United States today. Asthma rates are rising for all age groups, within and outside urban areas, regardless of race, income, and region of the country. Asthma currently affects an estimated 17 million Americans, and according to the Pew Environmental Health Commission  that number could reach 29 million by the year 2020. It is the number one chronic disease of children. In addition, the number of asthma cases is increasing alarmingly. Between 1980 and 1994: Overall, among all race, age, and sex categories throughout the United States, the number of people with asthma increased 75% In children under five, the number increased 160% In children five to fourteen, the number increased 74%

Photo courtesy of Hartford Environmental Justice Network Dirty Dozen Award, Connecticut Resources Recovery Authority facility, South Meadows, Hartford

The number of doctor's office visits, emergency room visits, and hospitalizations have also increased. In Connecticut, the number of hospitalizations for asthma increased by more than 3,000 between 1991 and 1996.

The asthma death rate is also increasing rapidly. In the past twenty years, the number of deaths has nearly tripled. The current rate of 5000 deaths per year may double again by 2020. Moreover, many asthma deaths are preventable.

Doctors are not sure why asthma is increasing so dramatically. This rise is seen despite better understanding of the disease and better medications for treating it.

Economics

The financial costs of asthma are very high. The disease costs the nation more than $11 billion per year for health care and lost productivity, of which more than $1 billion comes from Medicaid and Medicare. By 2020, the total costs could reach $18 billion, with $2 billion coming from Medicaid and Medicare. In Connecticut, asthma hospitalizations cost some $171 million in 1996.

Family and social costs In addition to the medical costs, asthma has enormous social and emotional costs. It affects the quality of life, keeping children out of school and adults out of work. It may limit occupational choices and physical activity. When asthma is not well managed, patients and their families often feel that asthma controls them, rather than the reverse. The feelings of anxiety and fear associated with asthma attacks, though they may not be quantifiable, may be deep and deeply disturbing.

Who is affected by asthma?

Although asthma often begins in childhood, anyone can develop asthma at any age. However, the burden of asthma falls disproportionately on children, poor people, and people of color.

 

Children

• In the United States today, more than 5 million children under the age of 18 have asthma.
• The incidence (number of new cases) of asthma among children is increasing more rapidly than the incidence of asthma in the population as a whole. · Hospitalizations among this group have increased 36% in the past decade.
• Among children between 5 and 14, the asthma death rate nearly doubled from 1980 to 1993.
• Most children are unlikely to outgrow the condition. According to the American Lung Association, for nearly three-quarters of the children with asthma, "the condition is a lifelong ordeal."

Low-Income Populations

Asthma is more common, and more severe, in large, inner cities. According to the Pew Commission, poverty—rather than location—largely accounts for the higher prevalence of asthma in these areas. Poverty-related factors may include:

• Poor indoor air quality
• Greater air pollution
• More and earlier infections
• Poor nutrition and less breast-feeding of babies

People of Color

Asthma is more severe among people of color and in urban communities. Poor children and children of color are more likely than white, non-Hispanic children to visit an emergency room, to be hospitalized, or to die from asthma.

• In the United States, while the number of emergency room visits and hospitalizations for asthma have increased for all racial and ethnic groups, urban African Americans are more likely to visit emergency rooms and more likely to be hospitalized because of asthma than white people.
  • African American children are four times more likely to seek care in an emergency room than white children. African American children are hospitalized three times more often for asthma than white children.
• In Connecticut, nonwhites and Hispanics have a larger percentage of hospitalizations for asthma than do whites and non-Hispanics.
  • Nonwhites make up 13% of Connecticut's population but account for 48% of all asthma hospitalizations.
  • Hispanics represent 6% of Connecticut's population but account for 23% of all asthma hospitalizations.
• In the United States, while the death rates from asthma have increased for all groups, the death rates for African Americans are higher than for whites and other groups.
  • Although African Americans represent about 13% of the U.S. population, they account for 22% of deaths from asthma
  • In 1995, the death rate from asthma for African American children was four times that of white children.

Gender

• Asthma is increasing more rapidly for women than for men.
• Although asthma is more common in young boys than girls, the disease more often persists for life in women.
• Asthma can also get worse during pregnancy.
• Women are more likely than men to go to the emergency room because of asthma.
• In Connecticut girls age 18 and under make up 43% of asthma hospitalizations, but women over 18 account for 72% of asthma hospitalizations.

• Allergens, which set off allergic reactions in individuals who are sensitive to those substances.

Allergens include indoor substances (such as dust mites, molds, and pet dander) and outdoor ones (pollens and mold spores)

• Irritants, which provoke or worsen asthma attacks in all people with asthma.

  Irritants include indoor substances (tobacco smoke, aerosol sprays, and perfumes) and outdoor ones (automobile exhaust and gasoline).

In children under 5 years old, viral respiratory infections are the number one asthma trigger.

Adults may be exposed to industrial fumes, chemicals, dust, and gases that can lead to occupational asthma.