Breathing Easier (Part 1): Asthma and Indoor Air Quality

We rely on the air we breathe, whether it’s inside the house or out taking a walk. But if you have asthma, poor air quality can mean that those everyday things can be difficult, if not impossible.

Asthma is a chronic condition that affects thousands of children and adults alike. About 1 in 11 children and 1 in 12 adults in America have asthma. It’s also among the most expensive chronic conditions, having a significant financial impact in the United States. Asthma’s economic burden is estimated at $62 billion from medical costs and loss in work productivity and school absences. There are nearly 2 million asthma-related outpatient visits to the ER each year, and about 10 people die of asthma each day.

Asthma is a complex, chronic disease that affects the lungs. Inflamed airways make it difficult to move air in and out of lungs. It causes wheezing, breathlessness, chest tightness and nighttime or early morning coughing. For some people asthma is a nuisance while for others it can be life-threatening due to sudden-onset asthma attacks. While it isn’t certain what causes asthma, it is commonly accepted that it’s due to a combination of environmental and genetic factors.

Currently, there isn’t a cure for asthma. However, it is treatable with a combination of medication and avoiding or eliminating asthma triggers. And yet, in the United States it is estimated that 50% of adults with asthma and 40% of children with asthma do not have control of their condition.

Indoor air quality and asthma triggers

Low-income, more vulnerable communities are often the hardest hit by poor air quality, which makes it harder to control asthma. For many, the poor air quality is found inside their homes. In fact, nearly 40% of all asthma attacks are triggered by something in the home environment. Some of the most common triggers include tobacco smoke, dust mites, cockroach allergens, rodents and mold. Poorly maintained housing and pollution-heavy locations put residents at a higher risk of developing asthma.

An abundance of research and outcome-based findings show that healthy housing practices improve the control of asthma for children and adults. According to the CDC, “Many studies…have shown that home visits can improve asthma control and medication adherence while reducing ED visits, hospitalizations, and missed work or school days.” In many cases, finding the root cause of asthma triggers in the home are as effective as medication. Solutions can be as simple as eliminating mites by removing carpeting, washing bedding, rugs and window treatments to more involved solutions like mold remediation and installation of proper ventilation and air treatment filters.

However, these solutions can be left undone due to financial restraints, or a negligent landlord.

As Doctor Tyra Bryant-Stephens of the Children’s Hospital of Philadelphia has said: “The reality is that pediatric physicians can provide all of the anti-inflammatory medications on the planet to their patients, but if they are sending them to houses that are not only teeming with asthma triggers but falling apart at the seams, children will continue to suffer, spending more time in the emergency department or in the hospital.”

Asthma in Philadelphia: Coming home

Philadelphia is the fourth-most challenging city in America to live with asthma according to the Asthma and Allergy Foundation of America. In West Philadelphia alone there are 12,500 children with asthma. The Community Asthma Prevention Program (CAPP) of the Children’s Hospital of Philadelphia has been taking action for the last 20 years in a community that experiences high levels of asthma morbidity and mortality. Since July 2017, UHC pediatric members with asthma diagnoses have begun to be engaged in the CAPP program.

How does the program work? First CAPP identifies asthma patients under the age of 18 in Philadelphia from visits at practices in the city. These patients were either admitted to the hospital once or visited the Emergency Room twice in the past year for asthma. The program utilizes community health workers (CHWs), who are members of the community in which they serve and trained in environmental asthma management. CHWs visit the families’ homes to provide education on asthma, triggers, medication and environmental remediation.

Part of the CAPP program is to provide free supplies to families including dusters, mattress covers, pillow covers, bins, sponges, white vinegar, mice/roach bait, spacers, masks, and vacuums.  These items are provided in conjunction with education on how and why to utilize them in the home. Removing irritants such as dust and mold, particularly in the child’s bedroom, can go a long way in reducing the level of asthma attacks.

And as a crucial piece of the puzzle, CAPP also refers program participants to local community resources that help with issues around housing, guardianship, utility assistance, pest management and tenants’ rights.

CAPP has shown in studies that it can reduce ER visits and inpatient hospitalizations. It’s a clear demonstration of how supportive and responsive health care system, coupled with an approach based on healthy homes, can help bring about optimal asthma control.

To read more:

Children’s Hospitals of Philadelphia: Community Asthma Prevention Program (CAPP)