370,000 people in Connecticut have asthma. There are ways to reduce risk.
There are many causes but no cure. There is no vaccine to prevent it.
The disease is asthma, and 25 million people nationwide, children and adults, suffer from it
In Connecticut, 71,900 children and 298,000 adults, more than one in 10 overall, have it, according to the state Department of Public Health, although the rate has been dropping from its most recent peak in 2015-17.
Asthma is more common among males, Black and Hispanic people and those who live in cities, largely because of the old houses, schools and factories with poor ventilation.
Asthma is the most common chronic disease of childhood, said Dr. Alex Hogan, a pediatric hospitalist at Connecticut Children’s medical center.
“If you have asthma and you’re over the age of 5, you really, truly have asthma,” he said. “There’s a lot of kids who have an asthma-like syndrome that may or may not stay if they’re younger than that.”
Hogan said for 60% to 70% of children with asthma, the cause is some type of allergic reaction, though it is the same disease as adult asthma.
“So you have a nice open airway,” he said. “Normally people with asthma have chronic inflammation of those airways, and so that chronic inflammation makes the airways narrower, if untreated.” Then, a trigger, can set off an asthmatic reaction. Hogan said that might include “cigarette smoke, pollen and, most commonly for hospitalized kids, it’s like a cold virus.”
The allergens affect the smooth muscle in our lungs, which constricts the airways, “and you now have a really hard time breathing, you’re having air pass through a small hole because the muscles are so constricted,” Hogan said.
‘Astronomical’
To make things worse, those with asthma are at greater risk of getting seriously ill from COVID-19, the health department says.
In the hospital, albuterol is the first line of treatment, to relax the muscles. Later, inhaled steroids may be given in acute cases, Hogan said.
Connecticut Children’s normally has 40 to 50 admissions during the winter months, when cold weather and being around other children make asthma more common, and 20 or fewer the rest of the year. But when COVID-19 hit in March 2020, “our admissions per week dropped like a stone,” he said.
Lately, admissions have been more normal, “but in the last two months, cases have been astronomical,” Hogan said. “Because there’s an outbreak epidemic of likely enterovirus, which is like a seasonal virus that just comes around every now and then. But it’s causing a lot of kids to be admitted to the hospital for virus-induced wheezing, which is likely related to asthma.”
September brought in 100, he said.
Dr. Carrie Redlich, director of the Yale Occupational and Environmental Medicine Program, said asthma, “no matter what causes it, tends to look the same. It’s a disease that can start in childhood. It can continue into adulthood. It can go away and come back as an adult or it can just start new as an adult.”
She said about 15% of new asthma in adults is related to work. For example, she’s seen bakers exposed to airborne flour who tend to be from small bakeries. But it can also be a preexisting case that the work environment makes worse. However, she said it’s widely unrecognized as a work-related disease by physicians, who focus more on treatment and medications than on causes.
“It’s really important to recognize, to try and prevent the disease or prevent the disease from getting worse by reducing the exposures that are causing the problem, rather than by giving more medication,” Redlich said.
Patients may be reluctant to say their asthma is related to work because they’re afraid of losing their job, she said. And it’s not always clear what the trigger for the disease is.
“For any of the illnesses like asthma that are related to work, there isn’t one test that will identify it specifically as being related to work,” she said.
Old or poorly maintained homes also can be a source of mold and other irritants that can cause or exacerbate asthma.
“The Church Street South housing project near the train station in New Haven that was condemned because of the conditions … a big driver of that was so many people living there had asthma,” Redlich said. It affected as many as 40% of residents.
‘Biological soup’
Paula Schenck is an environmental specialist and assistant director of UConn Health’s Center for Indoor Environments and Health. She advises physicians about the effects of indoor conditions, and years ago worked with the Hartford Public Schools on how to keep students, teachers and staff safe from threats such as mold and dust.
“By addressing indoor environments, we certainly saw a significant decrease in kids coming to the nurse’s office,” Schenck said. “Kids come to the nurse’s office to get their asthma meds in elementary school all the time. So that’s a matter of control, which is very important.
“But what we saw was a real reduction when the indoor environment was addressed with respect to moisture … and other kinds of things that lead to asthma exacerbations and to developing asthma.”
She calls indoor air, with its mold-promoting moisture, dust mites, paint flecks and other particulates a “biological soup.”
“Chronic leaks or humidity that isn’t controlled, and then having an environment where the ventilation is inadequate, it’s a perfect storm for an environment that creates all kinds of biological growth that then can become sensitizers for asthma and for other respiratory illness,” Schenck said.
She said water is often a problem when there are leaks, but also in many 1980s and 1990s office buildings that were built with indoor gutters to avoid them showing on the outside.
“And what’s happened is those interior gutters, whether they’ve ruptured or whether there’s been a roof leak that then has forced the water through the gutters, you’ve kept moisture inside,” she said.
In homes, she’ll look at how water is draining off the roof, and whether it’s going into the basement.
Improving the environment should be considered a treatment for asthma because it reduces the need for medications, Schenck said. “In the early 2000s, all the great controller meds came out, where people take their puffer every morning,” she said, as opposed to inhalers used when someone has an asthma attack.
“And then they did a study, an [epidemiological] study, looking at what happens with time, and they found that there was a difference in height. It did affect the children,” Schenck said. If there was a focus on the indoor environment “early on, they wouldn’t have needed as much medication. So it’s a part of treatment,” she said.
Some help is coming from the state, as Gov. Ned Lamont announced Sept. 14 that $150 million in grants would be given to schools to upgrade heating, ventilation and air-conditioning systems, in addition to $165 million schools have committed from money they received from a federal school emergency relief fund.
While the money is focused on preventing COVID-19, it will help with asthma, too.
Reducing risk
Another issue is chemicals, especially in a factory that uses isocyanates, used in manufacturing foams, fibers, paints and varnishes, as well as in the auto industry and building insulation, according to the National Institute for Occupational Safety and Health.
Schenck said isocyanates are “a causative agent for asthma.” Proper ventilation and maintenance are vital, she said.
Schenck works with doctors whose patients are showing asthmatic symptoms, talks about what may be causing them, “and then I work with the employer to say, what can we do to reduce the risk,” she said. “So hopefully that person will be able to stay at work before they get asthma chronically. We want to see our patients before it’s a chronic process.”
An example is blown insulation in a house. While the person working with the insulation may wear the proper suit to avoid breathing in the fumes, “there’s a carpenter 20 feet from that person who has no protection, working on that same construction site,” she said. This can put the carpenter at risk of asthma, Schenck said.
Schenck said there has been improvement in environments but said, increasingly, “there is a tension between energy management and environment for health.” An example might be that ventilation is turned off at night, causing humidity to rise too high. “And so, we do see continuing patients from office buildings and schools because energy conservation has won out,” she said.
Another factor that can increase asthma is higher temperatures as the result of climate change. A 2020 report from the Yale Center on Climate Change and Health reported that a later winter and earlier spring can increase the amount of ragweed pollen, which exacerbates asthma, as can more ground-level ozone and wildfire smoke.
Tim Morse, professor emeritus in occupational and environmental health at UConn Health, puts together an annual Labor Day report for the state Workers’ Compensation Commission. It includes worker’s compensation claims and physician reports of occupational illness to the state health department.
“Occupational illnesses has always been known to be greatly underreported, so what this report tries to do is pull together what we do know about it,” Morse said.
The 2022 report, including data from 2020, does not list asthma as a major claim in workers’ comp, partly because it’s focused on COVID-19, but claims did rise for asthma and bronchitis from 28 in 2019 to 31 in 2020. Physician reports, which include reactive airways dysfunction syndrome, dropped from 20 to 12.
While the numbers are not large — and underreported — Morse said the drop in reports could have to do with the pandemic.
“A lot of things were affected by COVID in 2020, and so there are a lot of people working remotely,” he said. “If you’re not going into the office, then you’re not getting exposed to that indoor air quality problem or mold or so on. … You could at least hypothesize that COVID had an impact on occupational asthma.”
Repeated exposure to chemicals and mold can lead to asthma, Morse said. “There’s a sensitization reaction, where if you are exposed to a relatively large amount of something, then you could get an asthma reaction. And then once you’ve had that reaction, then you get more sensitive to it, kind of like with poison ivy,” he said.
Both in the home and workplace, bleach or a substitute, known as quaternary ammonium compounds, can also bring on an asthmatic reaction, Morse said, which can be avoided by using microfiber mops, which don’t require disinfectants but pick up particles using just water.
Ed Stannard can be reached at estannard@courant.com or 860-993-8190.
