What’s Up With Kids and Asthma?

By Laurine Brown, PhD

A friend called in a panic. Her daughter was in the hospital, unable to catch her breath. Asthma attack. She’s among the growing number of kids with asthma. Disturbingly we’ve seen a doubling over the past decade. The Centers for Disease Control estimates 6 million children are afflicted. Asthma is now the leading cause of school absenteeism. In some inner city schools, one quarter of the kids carry inhalers. The cost of treating all these kids? More than $2 billion a year.

Wheezing, shortness of breath, coughing spells. This serious breathing problem constricts and inflames airways, restricting airflow to the small sacs deep in the lungs (alveoli) where oxygen is transferred to the blood stream and carbon dioxide removed. What up with kids and asthma? And what can we do about it?

Dirty Air and Global Warming – Clearly polluted air contributes, and may even cause asthma. Children are especially vulnerable to air pollution because their lungs are still developing and they breathe more rapidly than adults, taking in 50% more air per pound of bodyweight. The Environmental Protection Agency (EPA) estimates that kids are 40% more likely to have an asthma attack on high outdoor pollution days. A report from the American Public Health Association and scientists at Harvard largely blames global warming, smog, and the atmosphere’s growing burden of carbon dioxide--linked to car exhaust and industrial pollution (like coal-burning). How does global warming exacerbate asthma? Extra heat in the atmosphere stimulates rapid plant growth (like ragweed), resulting in more fungus, pollen, and spores; this causes allergies that often lead to asthma. Also, extreme weather causes more floods and damp houses, leading to more indoor pollution from molds.
What can be done? Avoid intensive outdoor exercise during high ozone days (often late afternoon). Avoid high traffic areas and pesticide sprayings. Locate local pollution sources in your community on www.scorecard.org or www.epa.gov. Work with neighbors and government officials to cut industrial and vehicle emissions, and clean up your air.

Diesel Bus Fumes – In a recent study of childhood exposure to air pollution, children wore air monitoring equipment while they moved through their school days. Body pollutants were highest during the bus ride to, and from school, and especially when buses were idling. Diesel exhaust (with over 40 hazardous air pollutants, including 21 likely carcinogens) has been proven to worsen (and may even cause) asthma symptoms. The average diameter of diesel particulates is tiny (0.2 micrometers), which means they can penetrate deeper into a child’s lungs, where they are likely to be retained. What can be done? Implement a “No Idling Policy” for buses on school property. Such “win-win” programs have been shown to reduce fuel costs without hindering bus performance.

Stuffy Indoor Air – Levels of indoor pollutants can be 2 to 5 (and up to 100) times higher than outdoors, the EPA has found. In addition to common indoor asthma triggers like dust mites, molds, pet dander and pest droppings, pay attention to these: Tobacco Smoke – Tobacco smoke contains several hundred recognized toxic substances, including lung carcinogens. Children living in households with smokers have higher risks of bronchitis and asthma, and 50% higher hospitalization rates. Formaldehyde – Higher rates of asthma and bronchitis have been found in children from homes with higher formaldehyde levels. In a study of mobile homes and those with particle board, formaldehyde was associated with more dry and sore throats, bloody nose, sinus problems, cough, headache, and more. Fragrances – The complex volatile organic compounds in strong-smelling perfumes, paints, magic markers and other art supplies, cosmetic spays, pesticides, scented cleaning solutions and more can increase asthma. In one study, 90% of 60 asthmatics reported worsening symptoms when exposed to odors, and 40% had visited emergency rooms after these incidents.
What can be done? Don’t smoke, especially around children. Avoid pressed wood and particle board. Avoid synthetically scented products. Open windows to ventilate. See www.epa.gov/iaq.org for ways to clear asthma triggers from homes and schools. Also www.checnet.org (search “asthma”).

Food Triggers - Some food additives can trigger asthmatic attacks in sensitive kids, according to the American Lung Association, including some synthetic red, blue, and yellow food dyes (thought to be bronchoconstrictors), monosodium glutamate, benzoate preservatives, and sulfating agents. Interestingly the rise in consumption of processed foods with these additives has paralleled the rise in asthma.
What can be done? See www.feingold.org for lists of foods to avoid. Add protective nutrients from fruits & veggies. One study found that eating five or more apples or three tomatoes a week increased lung function, and reduced wheezing -- antioxidants in produce may protect airways against insults of pollutants.

Antibiotics - Some scientists suspect antibiotic therapy (especially in the very young) may promote an allergic-airway response. Antibiotics wipe out helpful bacteria (alongside the harmful), such as those in our gut which play a key role in strengthening immunity and regulating the immune response to pollen. Researchers gave lab animals antibiotics and then exposed them to mold spores. The result? Greater sensitivity to inhaling the spores, and breathing problems similar to hay fever.
What can be done? Unless absolutely necessary, do not administer antibiotics to children under 6 months of age. With older children and adults, use antibiotics only when really necessary.

Nighttime Distress – Asthma can be a nocturnal disease, at its worst between 10p and 4am when cortisol (hormone that regulates many bodily functions) levels are lowest.
What can be done? Practice stress relief, and help your children calm, especially at night.

Asthma in Numbers • 26 million: Americans with asthma • 20 million: Annual lost work days • 14 million: Annual lost school days •6 million: US children with asthma • 2 million: Annual emergency room visits • 500,000: Annual hospitalizations • 5,500: Annual deaths from asthma

•“Asthma in Numbers, air pollution: Environmental Protection Agency, www.epa.gov, viewed 10/25/04; American Lung Association, “Key Facts About Asthma” Public Policy Brief, 2001; Wargo, J and LE Wargo, “Asthma and Air Quality” in The State of Children’s Health and the Environment 2002, Children’s Health Environmental Coalition @ www.checnet.org, p15-29; The following articles cited in Lowe, C. “Catch Your Breath” Energy Times, October 2004: American Public Health Association, “Inside the Greenhouse: The Impacts of CO2 and Climate Change on Public Health in the Inner City”; National Health Interview Survey, 1982-94
• Diesel Bus Fumes: (Wargo & Wargo 2002); Grassroots Environmental Education, “School Bus Idling” and “School Buses and Diesel Exhaust” Fact Sheets in Our Children at Risk, Action Package, www.grassroots.org, 2004.
• Food Triggers: The Feingold Association of the US, “Why do so many people have asthma?” www.feingold.org, Fact Sheet. 2000; Lowe, C. “Catch Your Breath” Energy Times, October 2004 and American Journal Clinical Nutrition 2003; 78:414 (cited in Lowe 2004).
• Antibiotics: Noverr, Mairi PhD “104th General Meeting American Society of Microbiology; and European Respiratory Soc conference, Vienna, 9/03; (cited in Lowe 2004).
• Nighttime Distress: Fink, Robert MD, “Pediatric Asthma: Diagnosis and Treatment Goals” Medscape; (cited in Lowe 2004).