Addressing urban asthma
Englewood project reaches out to children at greater risk
Friday, October 19, 2007
Short stuff: Health roundup
Asthma is the primary chronic disease in U.S. children, affecting more than 6.5 million. It’s also the third leading cause of childhood hospitalizations and the number one cause of school absences.
If managed well, the risks of asthma can be virtually eliminated, but the disease has doubled in prevalence in this country since 1980.
"We’re doing a better job of diagnosing, but there are other things going on," says Dr. Floyd Malveaux, executive director of the Merck Childhood Asthma Network, a non-profit organization based in Washington, D.C., established two years ago to address childhood asthma. He says exposure to indoor and outdoor "triggers" has significantly increased over the last 25 years.
"I think we’ve pretty much peaked at a historically high level, but the prevalence is not equally spread among children," he says, referring to higher numbers in the nation’s urban areas and discrepancies among racial groups. Puerto Ricans have the highest numbers of asthma diagnoses and African-Americans are a close second.
"Statistics show urban areas and medically underserved areas, like parts of Chicago, are more seriously affected," Malveaux adds.
The national average has 8 percent of American children affected, but Chicago’s Englewood and West Englewood neighborhoods are at least at 12 percent to 15 percent, Malveaux says. This "uneven distribution," as he calls it, is common in cities across the country.
In areas like Englewood, asthma is much more severe. Hospitalization rates double, ER visits double and death rates, though rare, are triple what they are in non-urban areas. The Addressing Asthma in Englewood Project is one of six projects targeting the disease the asthma network is funding.
"This is a very serious public health problem," Malveaux says.
"In impoverished areas there’s a lack of appreciation [for asthma], for what it is, for how to manage it and for having the means to manage it."
He says medically underserved areas don’t have access to the care and specialists in their own neighborhoods.
Two things cause asthma: genetics and environment. Seventy-five percent of those who will have asthma get it before age 10.
Environmental influences, including tobacco smoke, air pollution and infestations, are triggers. "Data also shows that the closer you live to freeways affects the development of asthma," Malveaux says.
When the potential for developing asthma is present and access to triggers is greater, the risk of death goes up, the risk of hospitalization goes up and quality of life goes down.
"Kids love to play, but won’t play as much," Malveaux says. "They won’t learn as well. It affects their attention span."
He says in Chicago, there’s a significant need to address childhood asthma.
"A child whose asthma is well-managed can do anything any kid can do," he says.
The Englewood program, funded through 2009, identifies the kids at risk and their families and arranges home visits to identify triggers in the home.
So what can you do? Malveaux says you can push local politicians to take this public health matter seriously and to create asthma-safe environments by eliminating smoking indoors.
"We’ve got to make our communities more asthma-friendly," he says. "This includes implementing no-idling policies and integrated pest management [for cockroaches, rats, etc., that carry allergens]. And we need to stop development near freeways."
• It is the most common chronic disease among children in the United States with more than 6.5 million children affected.
• It is the third leading cause of hospitalizations among children under the age of 15.
• Childhood asthma results in both direct medical costs and indirect costs (about $16.1 billion annually), including missed workdays for caregivers and nearly 14 million missed school days for children annually.
• Asthma deaths in Illinois are the highest among African-Americans in the U.S.
• Asthma-related hospitalizations in Englewood and West Englewood are among the highest in Chicago—60.2 and 71.1 respectively per 10,000 people in 2002. This is more than double Chicago’s average of 31.6.
• Many children in the Englewood community have symptoms, but have not yet been screened. In fact, the schools have documented that only 3 percent of children have asthma while community screenings have shown that those rates are actually closer to 15 percent.
• Children with asthma in the community lose more than 200,000 days of school annually.
Source: The Addressing Asthma in Englewood Project
What’s new with the flu?
Influenza—the flu—is a health concern each year.
This summer, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices issued updates to its recommendations regarding influenza vaccinations, many of them dealing with children.
Dr. Laura Schwab, a pediatrician in Chicago, offers the following tips, based on the CDC’s new recommendations:
• All children between 6 months and 5 years old should be immunized against flu. "Also, all kids with any chronic medical condition, regardless of age—as long as they are over 6 months old—should be immunized."
She says immunizing school-aged kids will help control outbreaks.
• Those in contact with children under 6 months (who are too young to be immunized) should be vaccinated to protect these babies who are at the highest risk.
• One of the main changes in the CDC’s recommendations is that kids between 6 months and 8 years old who haven’t been previously immunized need to receive two doses of age-appropriate vaccine within the same season, followed by one dose in following years.
"Two doses are thought to increase the immune response and hence increase protection against influenza," Schwab says. Another recommendation is that children who only received one dose in their first year of being vaccinated against the flu should receive two doses the following year.
Vaccinations generally start in October or November, but Schwab says the earlier the immunization, the better.