Science Matters: Closing the Asthma Gap

To observe October as Children’s Health Month, we will periodically post Science Matters feature articles about EPA’s children’s health research here on the blog. Learn more about EPA’s efforts to protect children’s health by going to www.epa.gov/ochp.

Nearly 26 million Americans, including seven million children, are affected by asthma. But when emergency room doors burst open for someone with an asthma attack, chances are the patient will be a poor, minority child.

According to the Centers for Disease Control and Prevention (CDC), minority children living in poor socioeconomic conditions are at greatest risk. For instance, 16% of African American children had asthma in 2010 compared to 8.2% of white children, and they are twice as likely to be hospitalized with an asthma attack and four times more likely to die than white children. The asthma rate among children living in poverty was 12.2% in 2010, compared to 8.2% among children living above the poverty line.

“Across America we see low-income and minority children and families at a disproportionately higher risk for asthma and respiratory illnesses. Air pollution and other challenges are having serious health effects, which compound economic challenges through medical bills and missed school and work days,” said EPA Administrator Lisa P. Jackson. “As the mother of a child with asthma, I know what it means for our children to have clean and healthy air to breathe.”

Administrator Jackson made those remarks during the unveiling of the Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities, a blueprint for how EPA and other federal agencies can team up to reduce asthma disparities.

A major part of that effort is the work conducted by EPA scientists and their partners exploring environmental causes and triggers of asthma, including how socioeconomic factors contribute to childhood asthma. The overall goal is to illuminate the underlying factors of asthma to support work on prevention and intervention strategies.

What increases the risk of developing asthma? While part of the answer certainly lies with genetics, as more than half of all children with asthma also have close relatives with the illness, the environment also plays a key role. Air pollutants, allergens, mold, and other environmental agents trigger asthma attacks.

EPA researchers and their partners are leading the effort to develop new scientific methods, models, and data for assessing how such triggers increase the risk for asthma and asthma attacks. The impact of this research has already contributed to current regulatory standards for two priority air pollutants regulated under the National Ambient Air Quality Standards (NAAQS): ozone and particulate matter. EPA’s asthma research has also been factored into health assessments for diesel emissions.

The next step is to learn ways to better protect those most at risk.

“Now we’re digging into the disparities side of the asthma problem,” said Martha Carraway, MD, a researcher at EPA. “Kids with poorly controlled asthma are more likely to be treated in the emergency room than kids with controlled asthma. So for public health reasons we need to understand how environmental factors, including air pollution, affect asthma control in vulnerable populations.”

To advance that work, EPA researchers and their partners took advantage of a 2008 lightning strike that occurred in Pocosin Lakes National Wildlife Refuge in North Carolina. The 40,000-acre (16,000-hectare), smoldering peat fire sparked by the lightning sent thick, billowing clouds of smoke wafting into the air.

In collaboration with scientists at the University of North Carolina Center for Environmental Medicine, Asthma, and Lung Biology, a team of EPA researchers led by David Diaz-Sanchez, PhD compared emergency room visits for asthma with air quality reports. Looking at the results geographically, they found that low income counties had significantly more visits than more affluent counties, even though air quality and exposure levels were the same.

“EPA studies suggest that children and others living in low-income counties could be less resilient to air pollution, possibly because of social factors such as inadequate nutrition. For example, if you’re poor and you’re not eating well, your asthma may be more severe,” said Nsedu Obot Witherspoon, MPH, Executive Director of the Children’s Environmental Health Network, a national multi-disciplinary organization whose mission is to protect developing children from environmental health hazards and promote a healthier environment. “Of course, other factors may also be involved, such as whether kids take medications correctly and whether they have access to good medical care.”

EPA’s research on asthma disparities can help guide newer and better interventions for reducing exposure to asthma triggers and limiting the impacts of the ailment, helping to close the gap for minority and poor children and improving the health of children everywhere.

Editor's Note: The opinions expressed in Greenversations are those of the author. They do not reflect EPA policy, endorsement, or action, and EPA does not verify the accuracy or science of the contents of the blog.