Highest Asthma Rates in the US are in New England

Opus

March 28, 2006

Interesting article in the Boston Globe yesterday. Our family found it pretty pertinent as our 3 year old DD suffers from asthma.

Asthma hits N.E. hard, study finds
Diagnosis rates are higher than in rest of US
By Stephen Smith, Globe Staff | March 27, 2006

The asthma epidemic has tightened its chokehold on New England, with one in seven adults and children diagnosed with the respiratory disease and its telltale wheezes and coughs, according to a report being released today.

The government-funded study shows the disease takes a higher toll in New England than in the rest of the country.

And although the precise cause remains a mystery, here, as elsewhere, the burden of the condition weighs most heavily on the poor.

The study, based on telephone surveys, estimates that the number of adults and children in the six New England states who report ever having been diagnosed with the condition rose by 400,000 from 2001 to 2004.

''It's totally mind-boggling," said Laurie Stillman, executive director of the Asthma Regional Council, the healthcare coalition that prepared the report and a similar one three years ago. ''I was really disheartened by the extent to which people are suffering from the disease -- adults, children, but especially the poor."

The costs are staggering, both economically and socially: Nationwide, expenses associated with the disease reach as high as $16 billion annually, fueled by medications and visits to the doctor and the emergency room. The disease translates into days of missed work or school and to nights spent awake with hacking coughs and heaving chests.

''Sometimes, my son cannot do the same thing as normal kids," said Doris Frantzis, who lives with her 10-year-old son, Renzo, in Jamaica Plain. ''He starts coughing, he cannot breathe."

That story is repeated across generations of the Goodrich clan. Five of Ada Goodrich's eight children have asthma. So do 17 of her 25 grandchildren. And so does she: Goodrich was hospitalized earlier this month with pneumonia -- a complication, she believes, of asthma.

''It's gone right down the whole line of the family, you know what I mean?" said Goodrich, who lives in Canton.

The sources of the national asthma epidemic remain murky -- as do the reasons behind New England's higher levels of the disease.

Blame has been fixed on everything from pest infestation to society's obsession with cleanliness, which has altered our immune systems and made people more susceptible to allergies.

Some specialists argue that one culprit is modern-day construction practices that have turned houses into sealed vaults, with measures taken to prevent inside air from leaking out and outside air from seeping in. The result is that well-known asthma triggers such as cockroach droppings, dust mites, and pet dander get trapped inside.

And so do children, because of cold weather, parental concern about safety, or time spent in front of the TV or computer.

''It is a little frustrating," said Betsy Rosenfeld, deputy regional health administrator for the US Department of Health and Human Services in New England. ''We keep producing the data, but we're not able to say anything definitive about the cause. That's the puzzle of asthma."

Researchers across the region are working to solve that riddle -- and to provide relief to patients.

At the Massachusetts Department of Public Health, disease trackers have teamed with school nurses to closely monitor the march of asthma among students, hoping that might yield clues about its causes. That agency also has strengthened regulations governing the air in skating rinks, fouled by fumes from ice-making machines.

At Boston Medical Center, patients had complained for years to their doctors about pests and mold infesting their homes and triggering labored breathing. So a few weeks ago, the hospital and city inaugurated a system that links doctors with the city's Inspectional Services Department, which can compel landlords to fix rundown rental units.

And at Hasbro Children's Hospital in Providence, researchers are trying to figure out why Puerto Ricans have higher rates of asthma and seem to get sicker from it.

''There is no silver bullet to what causes asthma and no silver bullet to fix it," said Dr. Megan Sandel, an asthma specialist at Boston Medical Center. ''What this new report shows us is that despite our best efforts to address the things that make asthma worse, we're clearly not doing enough."

The study's conclusions are based on two phone surveys -- one focused on children's health issues and the other on adults -- conducted by state and federal health authorities in 2003 and 2004. More than 45,000 New England households were polled. The asthma council, which plans to release its findings today, analyzed the statistics, with funding from the federal government and a private charitable trust.

In New England, 13.9 percent of children have been diagnosed with asthma, compared with 12.4 percent of children nationwide, according to the report. For adults, 15 percent of New Englanders have ever been diagnosed, compared with 13 percent elsewhere.

The epidemic is worst among those who can least afford its costs, according to the study, with children from the poorest families developing asthma at a rate more than double that of wealthier families.

''It tugs at your heartstrings and makes you feel that you have to do something for these populations," said Dr. Robert Klein, director of the Asthma and Allergy Center at Hasbro.

Stillman theorized that higher rates of asthma among the poor may be linked to the neighborhoods where they live -- neighborhoods with higher levels of environmental pollutants.

The report on asthma emerges less than a week after a Massachusetts Department of Public Health study tracked the expanding grasp of another chronic illness, obesity. Between 1990 and 2004, the number of obese adults rose 80 percent in the state.

The asthma study found that the obese are substantially likelier to have the respiratory illness, a finding that suggests an often symbiotic -- and dangerous -- relationship between the diseases.

Obese adults, for example, have asthma at a rate 51 percent higher than adults who aren't overweight.

''Could the increasing prevalence of asthma be related to the increasing prevalence of obesity?" Dr. George O'Connor, director of the adult asthma program at Boston Medical Center, wondered.

The metabolic changes triggered by obesity may play a role in asthma, too, O'Connor said. Researchers also know that obese people are prone to taking shallower breaths, which leaves them more vulnerable to asthma.

The study concludes with recommendations that more money be spent and more attention paid to the possible causes, triggers, and treatments for asthma.

''It is incumbent upon us to understand why this chronic respiratory disease has become so prevalent in our society, and in particular, why New Englanders are so profoundly affected," the report said.

Stephen Smith can be reached at stsmith@globe.com.