In June 1999, it was reported that the prevalence and severity of asthma had increased over the past twenty years, the biggest sufferers being children and young adults located in inner-cities of the US (5). This trend has intensified in recent years, and further studies show that children of low-income families are disproportionately affected by asthma. There are many factors involved in one’s susceptibility to the disease and it is important to understand the causes and triggers of asthma to more clearly see why children in cities are at such high risk. As the problem has gained more attention, the government has taken on initiatives in order to improve the problem, including programs to help educate parents and healthcare providers about dealing with asthma in children. Asthma is a classic example of the interaction between genes and environment and is an important disease to understand in terms of both its scientific and social implications in this country (5).
Asthma is strongly hereditary and children diagnosed with asthma often have some sort of family history of the disease. The disease is something one is born with, and it is often passed down through generations, however, certain environmental conditions that cause asthma symptoms to appear, and those vary from person to person (3). Approximately 20 million Americans are diagnosed with asthma, 4 million of whom are children under the age of 18 (4). Asthma sufferers are divided into two categories: those who have allergic (extrinsic) asthma, and those who have non-allergic (intrinsic) asthma. Those with allergic asthma respond to specific allergens, such as pollen or pet dander, while those with non-allergic asthma may react to almost anything irritating. Allergic asthmatics find it much easier to treat their symptoms since it easier to determine their triggers (3).
In both types, asthma symptoms, such as an attack, are most often triggered by an inflammation of air way passages. When an asthma stimulus is present, the cells lining one’s airways release mediators, these are chemical substances that cause the airways to swell. The cells then produce extra mucus and the airways opening narrows to constrict breathing (2). Those born with asthma are often more sensitive to certain triggers that do not bother others, however, when left untreated, one’s sensitivity to these triggers significantly increases. Some major asthma-inducing factors include: smoke from cigarettes, household sprays, dust mites, pollens, molds, exercise- especially in cold weather, changes in weather, strong emotions such as anger, excitement, or fear which change one’s breathing patterns, and respiratory infections such as colds, flu, or sore throats, which is the number one trigger in children. Some people react when they inhale certain substances, and some need to actually ingest certain substances, such as shell fish. Every individual must track their triggers to better understand their condition (3).
When considering the conditions of a low-income child living in a big city, it is clear to see why he or she is more susceptible to the effects of asthma. Cities expose children to high levels of air pollutants, allergens, and tobacco smoke. Combined with poverty, increased stress levels, and lack of education, inner city children have a hard time attempting to control their asthma. These factors also lead to a disproportionate number of minorities affected by asthma. The National Health and Nutrition Survey studied children between the ages of sixth months and eleven years- old and found that 3% of white children, and 7.2% of blacks were diagnosed with asthma. Respiratory mortality, which is directly linked to asthma, is found to be three times higher in minorities (5).
Another important factor involved in treating children with asthma, which impacts the socioeconomic divide in those affected, is access to health care. In the 1980s, surveys showed that 50% of school-age children received care for their asthma through the ER, and found it difficult to obtain follow-up treatment after acute attacks (5). Controlling asthma is dependent on proper treatment from a physician, and taking medication incorrectly can prove extremely detrimental to a child’s health. This goes hand in hand with inconsistent knowledge concerning asthma, and families often find out at the wrong moment that they are incapable of handling asthma emergencies. It is for these reasons that, when the Asthma and Allergy Foundation of American (AAFA) annually determines the top 100 “Asthma Capitals,” they include the following factors which put residents at risk: annual pollen level, annual air quality, public smoking laws, poverty rate, uninsured rate, and school inhaler access laws (1).
It is this type of publicity that the nation needs in order to confront the problem of asthma, especially in cities. As Peter Eggleston, et al, argues in their paper on environmental conditions and asthma in US inner cities, “If it can be shown that disease can be improved by changing environmental exposures, this would support programs to improve housing condition in the inner city” (5). While they are focusing on one aspect that can be improved on, it brings up the important point that understanding causes can lead to providing better solutions. This is already happening in cities nationwide as non-profits and government agencies combine to design strategic plans to relieve those suffering from asthma. A prime example is the American Lung Association of Minnesota who is collaborating with the Healthy Learners Board and receiving funding from Center for Disease Control and Prevention. The community based project aims to improve health and quality of care for children with asthma, and strives to achieve sustainability for its programs and consistent reevaluation (5). Their focus is on education, health policy changes, clinic system changes, school-based initiatives, and environmental assessment and modification. The success of the mission is evident in their annual ranking on the Asthma Capitals list. Just last year, in 2005, Minneapolis was ranked the 51st worst state for asthma sufferers, and this year they dropped to number 99 on the list (6). Focusing the government’s attention on improving conditions for asthma sufferers inherently leads to fixing conditions those for the poor living in inner-cities. It is these types of programs, that combine efforts across the board, while still maintaining control at a local level, that need to be supported in the coming years to confront the issue of asthma.
"2006 Asthma Capitals." Asthma and Allergy Foundation of American. 2006. 16 Dec. 2006 <http://www.asthmacapitals.com/asthma_capitals2006.pdf>. 2)
“Asthma in Children.” Health Encyclopedia- Diseases and Conditions. 16 Dec. 2006 <http://www.healthscout.com/ency/407/383/main.html>.3)
"Asthma Overview: What Causes Asthma." Asthma and Allergy Foundation of America. 2005. 16 Dec. 2006 <http://aafa.org/display.cfm?id=8&cont=6>.4)
“Controlling Asthma in American Cities Project.” American Lung Association of Minnesota. Feb. 2006. 16 Dec. 2006. <http://www.americancitiesmsp. org/American Cities/2006update.asp>.5)
Eggleston, Peyton, Timothy Buckley, Patrick Breysse, Marsha Wills-Karp, Steven Kleeberger, and Jouni J. K. Jaakkola. “The Environment and Asthma in U. S. Inner Cities.” Environmental Health Perspectives 107 (1999): 439-450. 16 Dec. 2006 <http://www.pubmedcentral.nih.gov/
Warner, Jennifer. “America’s Worst Asthma Cities.” Medicinenet.com 15 Feb. 2005. 16. Dec. 2006 <http://www.medicinenet.com/script/main/ art.asp?articlekey=43547>.