05/20/2010 08:44 am ET Updated Nov 17, 2011

Childhood Asthma and Environmental Health

There is a raging debate unfolding online and over the airwaves about who is to blame for the latest eco-disaster, the off-shore oil tanker that is spilling hundreds of thousands of barrels of oil in the Gulf of Mexico each day. We're also seeing more and more headlines looking to rewrite the story of Hurricane Katrina, shifting our collective memory from viewing it as a natural disaster to one that was human-made.

Natural disaster or human error. Your fault or mine. The truth is, placing blame just doesn't matter for one of the most significant results of both of these events. And what's worse, we don't seem to get it. Analysis and news reports have only begun to scratch the surface of the most detrimental effects of ecological disasters, the devastating impact on our health.

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 (1), 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.

Childhood asthma's high health costs are already staggering. Poorly managed asthma is an enormous drain on families, businesses and our health care system. Asthma steals $20 billion annually from employers, families and the health care system -- money we cannot afford to lose.

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. (2) 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 as the executive director of the Merck Childhood Asthma Network, Inc. (MCAN), 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.

So, 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.

Take, for example, Melba Miles, proud grandmother to two-year-old Jamal who suffers from asthma. She 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 funded by MCAN 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.

A recent report by The George Washington University, supported by my organization and the RCHN Community Health Foundation (RCHN CHF), provides guidance on what we can do on the national level. The authors recommend that to reduce triggers, public health agencies, housing authorities and environmental agencies must work in concert and collectively to promote evidence-based interventions and services that are essential to reducing the many environmental asthma triggers.

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.

D'Amato, G. et al, Clincal and Experimental Allergy, 2008. 38(*): p 1264-1274.
State of the Air, 2010. Accessed at" on April 30, 2010.

Extreme Allergies and Global Warming, Accessed at: April 30, 2010.