Asthma
An Unexplained
Epidemic
What
is the asthma problem in Hartford?
Unlike lead poisoning,
asthma is not a disease that must be reported to city or state health departments,
so statistics are not as readily available, and researchers have reported
different findings.
A 2000 survey by
the Hartford Health Department found that 15% of adults reported that they
had asthma. Among households surveyed, 33% reported that at least one household
member had asthma. Reported asthma rates varied by race/ethnicity and income
in this survey.
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Hartford
Health Survey 2000
|
|
Reported
Asthma Rates
|
| By race/ethnicity |
|
| Hispanic households |
50%
|
| Black (African American, Caribbean/Virgin Islander) households |
30%
|
| Non-Hispanic white households |
20%
|
| By economic status |
|
| Households in poverty |
44%
|
| Other low-income households |
32%
|
| Higher income households |
25%
|
In a recent statewide
survey, Environment and Human Health, Inc., a nonprofit organization, collected
information from school nurses about the prevalence of asthma in school-age
children. Overall, they found an 8.7% asthma rate:
-
7.8% for elementary
school students
-
10.2% for middle
school students
-
9.4% for high
school students
For Hartford County, the asthma
prevalence was 9.0% for elementary school children. While this survey found
similar rates among urban, suburban, and rural districts, there were marked
differences in districts according to socioeconomic status. Poorer districts
had higher asthma prevalence rates (9.0%) than richer districts (5.5%). For
additional information about this survey, see http://www.ehhi.org.
Other researchers believe the asthma
prevalence in Hartford is much higher. The Connecticut Children's Medical Center
and the University of Connecticut Health Center are conducting a survey of children
between 6 months and 18 years who have visited primary care clinics in the city.
Of approximately 8000 children who have been screened, 33% have asthma; this
number is based on self-reports that have been confirmed by doctors. Of the
children who have completed the survey, 48% of Hispanic/Puerto Rican children
and 35% of African American children have asthma. Some 40% of the children with
asthma in this program are under five years old.
According to the Easy Breathing
Program, these rates probably overestimate the prevalence of asthma in Hartford,
however, because these are children who have already sought medical treatment.
In summer 2000, the
Hartford City Council declared an "asthma emergency" in the city. Although
researchers differ on the precise numbers, all agree that asthma is a significant
problem in Hartford and must be addressed.
What is Hartford
doing about asthma?
Hartford's Asthma Call to Action Task Force 2003 Annual Report
Asthma management
|
Easy
Breathing
The Easy Breathing
Project is an asthma management program that is open to all children
who live in or receive their medical care in Hartford. It provides quality
asthma care and education to Hartford's children with asthma. Its immediate
goals are
- To improve asthma diagnosis
by primary care providers
- To improve how accurately
providers determine the severity of asthma and to ensure the appropriate
use of anti-inflammatory medicines
- To provide better after-hours
telephone access to asthma information
|
In the past year,
Easy Breathing has helped to reduce the number of hospitalizations and emergency
room visits among children enrolled in the program. Children are using inhaled
medicines more often and using oral medicines less often. Asthma-related costs
have gone down.
The Easy Breathing Program is
a cooperative project of the University of Connecticut Health Center, the
Connecticut Children's Medical Center, Saint Francis Hospital, HMOs, pharmaceutical
companies, the Hartford Health Department, and community organizations. The
long-term goals of the program are to improve the health of Hartford's children
with asthma and to reduce medical costs.
Contact:
Michele Cloutier, M.D.
Connecticut Children's Medical Center
282 Washington Street
Hartford, CT 06106
mclouti@ccmckids.org
860-545-9000
Education and outreach
-
Asthma Information
Center: referrals, information, speakers bureau
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A Is for Asthma:
a preschool program for childcare providers
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Open Airways
for Schools: a school-based asthma management program for children aged
8 to 11 years
This program,
which runs in more than 25 Hartford schools, teaches children to recognize
their own asthma triggers and the early warning signs of an asthma attack.
-
Camp Treasure
Chest: a medically supervised summer camp for children 9-13 with asthma
-
Breath Games:
Olympics games for children with asthma
-
Professional
conferences for healthcare workers
Hartford Environmental
Justice Network
|
The Hartford Environmental
Justice Network, composed of Hartford residents and grassroots community
organizations concerned with environmental issues, has received EPA funding
to educate city residents about possible connections between diesel emissions
and asthma.
Contact:
Mark Mitchell, M.D., MPH
860-548-1133
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Photo courtesy of Hartford Environmental Justice Network
Asthma kick off campaign, April 2000, Hartford City Hall
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Saint Francis Hospital
and Medical Center, Hartford Regional Lead Treatment Center
The Hartford Regional Lead Treatment
Center has expanded its lead-poisoning efforts into a "healthy home" initiative,
which serves children with severe asthma as well as children who have been lead
poisoned. This program provides home visits and housing modifications or relocation
for asthmatic children. With EPA support, it is enhancing its lead and asthma
education and outreach efforts.
Contact:
Lisa Menillo, M.D.
860-714-5316
Improving School Environments
Tools
for Schools
The EPA's
Tools for Schools program provides
an action kit for schools to use to identify and address indoor air quality
problems, including those that may be asthma triggers. For information on the
kit, contact atesta@alact.org, connecticosh@snet.net,
or kenny.foscue@po.state.ct.us.
In Connecticut, 68% of schools reported indoor environmental problems, according
to a recent study by the U.S. General Services Administration.
-
ConnectiCOSH
(Connecticut Council on Occupational Safety and Health) has been awarded
an EPA grant to recruit 25 new schools across the state for the Tools for
Schools program.
-
The University
of Connecticut, with EPA support is also developing an asthma intervention
project in several Hartford public schools and examining the effectiveness
of Tools for Schools in reducing health problems due to asthma triggers.
-
The American
Lung Association of Connecticut is continuing and expanding its work on
the Tools for Schools program.
- The Connecticut School Indoor
Environment Resource Team is a group of federal, state, and nonprofit agencies
that can help Connecticut schools with Tools for Schools training, implementation,
and technical issues.
For additional information, contact
Donielle Wilson
ConnectiCOSH
(860)549-1877
Click here for Implementation
Guidelines
or
Kenny Foscue
Connecticut Department of Public Health
860-509-7742
Initiatives
Asthma Call to
Action
This organization
consists of representatives of the Hartford's Health Department, public schools,
area hospitals, community organizations, and other agencies who are concerned
about asthma in Hartford. Its goals are to
- Increase awareness
about asthma among all residents of Hartford
- Promote standards
of asthma care
- Provide a forum
for information exchange among health care professionals
- Establish a network
of organizations and individuals providing asthma education and resources
- Define feasible
improvement strategies
Activities have
included education for children, parents, nurses, and doctors.
Three physicians champions have been appointed to the task force: Dr. Scott
Wolf, Hartford Hospital; Dr. Richard ZuWallack, St. Francis Hospital and Medical
Center; and Dr. Michelle M. Cloutier, Connecticut Children's Medical Center.
Contact:
Rita Kornblum
or Katherine McCormack
Hartford Health Department
860-547-1426
Pediatric Asthma
Coalition
Contact:
Michele Cloutier, M.D.
Connecticut Children's Medical Center
282 Washington Street
Hartford, CT 06106
860-545-9000
What
remains to be done?
Given that knowledge of asthma is
growing and that better medications are available, the rise in asthma is particularly
troubling. It suggests a need for better understanding of the causes of asthma,
better environmental controls, changes in the health care system, more education,
and adjustments in public policy are all needed to combat the problem.
Understanding why asthma is increasing
- Understanding both environmental
and genetic factors
- Understanding role of social
and economic factors
Identifying and eliminating income,
racial, and ethnic disparities
- Improving environmental conditions,
both indoors and outdoors
- Ensuring access to quality medical
care
In 1997, the National Asthma
Education and Prevention Program published new guidelines for diagnosing
and controlling asthma, but a recent study found that many doctors were
underestimating the severity of a patient's asthma or not diagnosing it
correctly.
Reducing exposure to environmental
triggers (allergens and irritants)
- Eliminating exposure to tobacco
smoke
- Reducing exposure to cockroaches,
molds, and dust mites
- Reducing exposure to ozone, particulate
matter, and other air pollutants
Improving medical management of
asthma
- Getting appropriate prescriptions
- Understanding how to use them
correctly and the importance of using them correctly
Enlisting support from public schools
- Promoting healthy school environment
- Promoting asthma education for
students with and without asthma
Educating the public for
improved prevention
- Educating asthma patients
and their families
- Educating the general public
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Photo courtesy of Hartford Environmental Justice Network
Asthma kick off campaign, April 2000, Hartford City Hall
|
Establishing a coordinated nationwide
system for tracking asthma
Public policy
The U.S. government has issued several
major documents about asthma:
In May 2000, the Pew
Environmental Health Commission released
a major nationwide study of asthma and called for a "war on asthma." The report
criticized the federal program as inadequate, especially in its allocation of
resources for prevention research, addressing environmental concerns, tracking,
and implementation. It also recommended that the federal government, under the
leadership of the Surgeon General:
- Establish a national system to
track asthma rates and environmental risks
- Address environmental causes
of asthma development and asthma exacerbation
- Investigate all asthma-related
deaths
- Begin research on environmental
risk factors
- Develop prevention strategies
- Conduct long-term studies
- Investigate why low-income
and minority communities have higher asthma rates and develop intervention
strategies
- Conduct a public education campaign
- Provide better enforcement of
public health and environmental rules
- Train enough health professionals
to combat the disease
- Exert political leadership to
emphasize prevention of the disease as well as treatment.
According to the commission, since
asthma prevalence is closely related to poverty, "a large proportion of asthma
prevalence could be prevented" by identifying and reducing risk factors associated
with poverty.
In August 2000 the Hartford City
Council declared an asthma emergency and requested a comprehensive, citywide
policy to deal with asthma, including
- A multimedia, multilingual asthma
education and outreach campaign, directed especially at those most at risk
and their families
- An investigation by the Connecticut
Department of Public Health and the U.S. Centers for Disease Control into
why Hartford's asthma rate is so high and into ways to prevent asthma
- Monitoring of asthma rates in
Hartford
- More screening to identify asthma
in its early stages
- Encouraging accurate diagnosis,
treatment, and self-management of asthma
- Full enforcement of environmental
laws and regulations designed to protect lung health
- More public education about how
recycling reduces trash burning and air pollution
