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17


Apr
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A Breath of Fresh Air: Addressing the Childhood Asthma Epidemic

Access to clean air is an often-overlooked public health issue.

For those in good respiratory health who have never had to worry much about air quality, it might seem easy to take clean air for granted, although access to clean air is every bit as vital for humans as access to food, water, and shelter. In some cases, access to clean air is tenuous and varies widely based on economic and environmental factors.

The San Francisco Bay Area in particular is teeming with sources of air pollution, including industrial factories, power plants, motor vehicles, and even wood-burning. While particulate matter is a respiratory hazard due to its particle size, many common air pollutant are also toxic, such as ozone, nitrogen oxides, carbon monoxide, sulfur dioxide, hydrogen sulfide, and hydrocarbons such as benzene.

For a large industrial city, San Francisco has relatively good air quality on average. Asthma risk correlates strongly with geography, and the childhood asthma epidemic is an ongoing health crisis for the Bay Area, which contains many pockets of unhealthy air relative to the city of San Francisco itself. Housing tends to be cheaper in these areas, which are often near freeways, factories, and other sources of air pollution; for low-income families, these may be the only places in the Bay where they can afford to live. Older, cheaper homes may contain contaminants such as lead and asbestos, which were not banned for use in home construction until the 1970s.

Childhood asthma is a serious issue in the Bay Area, especially for those in poverty.

Childhood asthma rates are still unacceptably high, but significant progress is being made, including environmental measures to reduce pollution, free local asthma education and treatment programs, efforts to address the housing crisis, and novel technological solutions such as real-time remote monitoring devices for patients using asthma inhalers. Still, industrial waste, fuel emissions, and other human activities are far from the only sources of local air pollution. In November 2018, the Bay Area experienced record-breaking poor air quality because of the hazardous levels of particulate matter generated by out-of-control wildfires. Perhaps more important in the immediate term than the causes of poor air quality are the impacts of poor air quality on sensitive groups, such as children with asthma.

Rates of childhood asthma vary by income: within American families earning over 200% of the Federal Poverty Level (FPL), 8.2% of children contract asthma at some point; this rate rises to 9.9% in households between 100% and 200%, and 12.2% for those below 100% of the FPL. The California Department of Public Health estimates that in San Francisco County, as many as 9.7% of children ages 0–4 and 17.1% of children ages 5–17 are diagnosed with asthma at some point; 6.3% and 11.6% of these same groups, respectively, have active asthma. Racial disparities in access to care may also be a factor: minority children are two to four times more likely to be hospitalized for asthma than non-Hispanic white children. A national study on over 2,500 deaths caused by pediatric asthma found that non-Hispanic black children are six times more likely to die from asthma than Hispanic or white children. 50% of these deaths occurred at emergency departments or clinics rather than at home or in a hospital, suggesting that earlier and better treatment could have prevented many of these deaths. Children who visit the doctor less frequently are more likely to be hospitalized, so making doctors’ visits more affordable is imperative.

Risk factors which can cause or exacerbate childhood asthma include inadequate preventative treatment, insufficient levels of antioxidants in the diet, poor medication adherence, existing allergies, chronic stress, and prolonged exposure to high concentrations of pollutants. Children from low-income families are less likely to be prescribed and consistently take controller medications, and more likely to suffer from high levels of chronic stress as well as exposure to pollutants at home, school, and elsewhere. Children with existing food allergies are already at a high risk for contracting asthma when exposed to allergens in the air, such as dust, pollen, ozone, and even inhaled food particles. Adverse consequences of childhood asthma include: missed school days, which can hamper academic success; increased hospitalization, which can lead to high medical bills; reduced physical activity and participation in sports; increased risk of weight gain, anxiety, and depression; and interference with sleep patterns.'

Small steps can make a big difference towards prevention and treatment of childhood asthma.

A diet high in antioxidant foods can reduce sensitivity to ozone. Prolonged exposure to unhealthy levels of ozone can impair lung function, cause asthma, and aggravate existing respiratory diseases such as asthma, emphysema, and chronic bronchitis. Lower-income families are less likely than others to eat healthy proportions of antioxidant-rich foods, such as artichokes, blueberries, cranberries, spinach, and dark chocolate. Although it is possible to obtain some healthy foods inexpensively, many of these “provide relatively more nutrients than calories” and may not be as appetizing as familiar, higher-calorie foods. Consider seeking a physician’s guidance on eliminating any allergens from your family’s diet and increasing the proportions of healthy antioxidant foods.

If your child has asthma, you should take them to see a doctor regularly, particularly an allergist if possible. Make sure that you and your child understand the different types of asthma inhalers and their purposes. You should also minimize your child’s exposure to second-hand smoke, household dust, and other asthma “triggers” including food allergens as much as possible. Clean your living spaces frequently, and get a reliable household air purifier if you can afford it. Check air quality reports regularly and take any recommended precautions, such as reducing your child’s outdoor activity on days when the air quality is “unhealthy” or “unhealthy for sensitive groups.” Even if your child does not have asthma, these precautionary measures can go a long way towards prevention, reducing the risk of future respiratory illness.

What local programs are available to help children with asthma in the Bay Area or nationwide?

If you are a San Francisco Bay Area resident and you cannot afford to take your child to an asthma doctor, try to get an appointment with the Breathmobile, a mobile asthma clinic based in Oakland which offers free examinations to any child between the ages of 3 months and 18 years. There are also free programs such as Asthma Start, a project of the Alameda County Public Health Department, which offers in-home asthma case management services including education and referrals.

Other large metro areas across the country may or may not have similar programs, and we suggest checking with your state or county health department to see what resources are available; you can use the CDC's health department directory to find them.

Can telehealth help with the treatment of asthma in children?

The short answer is yes! Although some cases of asthma may require in-person treatment, SAMI-Aid's telehealth doctors can and do treat asthmatic patients, including children. If you create a SAMI-Aid account for your child and then book an online doctor appointment on your child's behalf, you will automatically be matched with a pediatrician. Generally, your child can see a pediatrician virtually through SAMI-Aid within 15 minutes for just $59.99 per visit! SAMI-Aid's basic membership is free and all doctor visits including pediatrics, therapy, and psychiatry cost only $59.99; there are no hidden or recurring fees. SAMI-Aid has also recently launched a SAMI-Aid Premium membership, which allows you two doctor visits for just $79.99 per month. SAMI-Aid Premium also includes free bonus features such as our Provider & Price Search tool, which allows you to find and compare prices on office visits with family doctors near you who accept uninsured patients. 

The SAMI-Aid team is passionate about helping you find high-quality, affordable respiratory care solutions so that you can breathe easy regarding both your health and your finances.

 


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