Exploring the cause of asthma in kids

Poverty and race drive rates more than city living

BY MEREDITH COHN
THE BALTIMORE SUN (TNS)

BALTIMORE — It was the day after Mother’s Day in 2012 when Faith Walker ran into her East Baltimore house unable to breathe.

Faith Walker, 7, who has asthma, readies to take a breathing test as Monique Franklin, research assistant, coaches her on Jan. 23 at Johns Hopkins Children’s Center in Baltimore, Md. Johns Hopkins research shows that poverty, more than race, drives asthma rates. (KIM HAIRSTON/BALTIMORE SUN/TNS)
Faith Walker, 7, who has asthma, readies to take a breathing test as Monique Franklin, research assistant, coaches her on Jan. 23 at Johns Hopkins Children’s Center in Baltimore, Md. Johns Hopkins research shows that poverty, more than race, drives asthma rates.
(KIM HAIRSTON/BALTIMORE SUN/TNS)

Her mother, Tyishia Walker, who suffers from asthma and has an older daughter with the disease, knew exactly what was wrong: Faith also had the chronic lung condition.

“I’m sure it’s from living in the city,” said Tyishia Walker.” We have more rats, more mice. The house is old and moldy. I believe it makes a big difference.”

For the past 50 years, scientists also believed urban living led to higher rates of asthma in children.

But new research from Johns Hopkins Children’s Center disputes the notion that geography alone is a major risk factor for the disease and its telltale coughing, wheezing and breathlessness.

Common links
Up to 20 percent of children in Baltimore City have asthma, compared with the national average of 9.4 percent, according to government data.

There are, however, pockets around the country in suburban and rural areas where the prevalence of asthma is just as high, according to the study, recently published in the Journal of Allergy and Clinical Immunology.

The common links among 23,000 patient records reviewed from around the country appeared to be race, ethnicity and income, said Dr. Corinne Keet, a pediatric allergy and asthma specialist at Hopkins and the study’s lead investigator.

Key risk factors
Public health advocates say the information could impact how health departments allocate resources in suburban and rural areas, ensuring that at-risk kids outside of cities are screened and treated.

Key risk factors for asthma include roach and other pest allergens, indoor smoke, air pollution and premature births, but such issues are not exclusive to cities. Poor people don’t necessarily escape poverty by moving out of inner cities, and those who are African-American or Puerto Rican, specifically, don’t escape the genes that may be at play.

Nationally, about 17 percent of Black children and 20 percent of Puerto Rican children have asthma, compared with 10 percent of White children and 8 percent of Asian children, government data show.

“When we did the study we were expecting the prevalence to be higher in inner cities,” Keet said. “When we looked more closely at poor areas in cities and poor areas not in cities, we found there wasn’t a big difference.”

Dealing with triggers
Keet said more study is needed, but already some policy experts and doctors say the research may help public health officials in directing resources outside of urban areas.

“The implications are clear,” said Dr. Cary Sennett, president and CEO of the advocacy group Allergy and Asthma Foundation of America.

“Asthma is not a disease of the inner city, but affects children everywhere and, disproportionately, those who are living in poverty. In the wealthiest country in the world, we have much to do to address the problem of asthma in those who are most vulnerable — wherever they live.”

Poor families not only deal with more cases of asthma, he said, but more severe episodes because they are less able to afford interventions such as home assessments and remediation of “triggers,” such as mold, insect and rodent feces, and others.

Under control
Faith Walker, now 7, wasn’t a participant in the urban asthma study, but she is participating in the mouse research. She is allergic to mold, pollen, cut grass and varmint feces, and her mother said it’s been tough to control all of that, though she tries. Research assistants say Faith has the cleanest house among the study participants.

Doctors tested Faith for allergies after she was brought to the emergency room that day almost two years ago when she had her first serious attack.

Tyishia Walker had long suspected Faith had asthma because she was always coughing. When Faith ran in the house struggling to breathe, Walker gave her a puff of her own medicine, but when that didn’t work, she called for help and the girl spent two days in the hospital.

Faith’s asthma is now under control with daily treatments, but Walker still watches over her, keeping her home from school some days and reining in aggressive play.

Walker, 37, and living on a limited income from disability payments, hopes to find a way to move to Pennsylvania or somewhere that has more modern houses, fewer mouse droppings and lower pollution.

“When she was struggling so hard to breath, that scared me,” she said. “I’m limited in the money I can spend on rent. But I don’t want to live in Baltimore anymore.”

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